Introduction: The contribution of individual and combined inflammatory markers for the prognosis of acute ischemic stroke (AIS) remains elusive. This study investigated the effect of systemic inflammatory response index (SIRI), and neutrophil to high-density lipoprotein ratio (NHR), which is mediated by fasting blood glucose (FBG), on 90-day prognosis of patients with AIS.
Methods: In this pre-specified substudy of an observational cohort study, 2,828 patients with AIS were enrolled from the Nanjing Stroke Registry between January 2017 and July 2021. Peripheral venous blood was collected from patients fasting for at least 8 h within 24 h of admission to gather information on the following parameters: neutrophil count, lymphocyte count, monocyte count, HDL level, and fasting blood glucose level. Then, the SIRI and NHR values were calculated. Following this, the correlation among SIRI, NHR, and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. Lastly, mediation analysis was performed to examine the relationship between systematic inflammatory response and study outcomes mediated by FBG.
Results: SIRI and NHR were both negatively correlated with clinical outcomes (p < 0.05). Logistic regression analysis revealed that SIRI and NHR were independently associated with poor outcomes after adjusting for potential confounders. Subgroup analyses further validated these correlations. Meanwhile, mediation analysis corroborated that FBG partially mediated the associations between SIRI and a poor prognosis at 90 days (indirect effect estimate = 0.0038, bootstrap 95% CI 0.001-0.008; direct effect estimate = 0.1719, bootstrap 95% CI 0.1258-0.2179). Besides, FBG also played a mediating role between NHR and poor outcomes (indirect effect estimate = 0.0066, bootstrap 95% CI 0.002-0.120; direct effect estimate = 0.1308, bootstrap 95% CI 0.0934-0.1681).
Conclusion: Our study demonstrated that SIRI and NHR are positively associated with poor clinical and mortality outcomes at 90 days in AIS patients, which was partially mediated by FBG.
背景和目的：单个和合并的炎症标志物对急性缺血性卒中（AIS）预后的影响仍不明确。本研究探讨了全身炎症反应指数（SIRI）和中性粒细胞与高密度脂蛋白比值（NHR）（由空腹血糖（FBG）介导）对 AIS 患者 90 天预后的影响：在这项观察性队列研究的预设子研究中，2017年1月至2021年7月期间，南京卒中登记中心共登记了2828例AIS患者。患者入院24小时内空腹至少8小时，采集外周静脉血，收集以下参数信息：中性粒细胞计数、淋巴细胞计数、单核细胞计数、高密度脂蛋白水平和空腹血糖水平。然后，计算 SIRI 和 NHR 值。然后，通过单变量和多变量逻辑分析，研究发病 90 天后 SIRI、NHR 和改良 Rankin 量表（mRS）评分之间的相关性。最后，还进行了中介分析，研究系统性炎症反应与研究结果之间由 FBG 中介的关系：结果：SIRI 和 NHR 均与临床结果呈负相关（p < 0.05）。逻辑回归分析显示，在调整了潜在的混杂因素后，SIRI 和 NHR 与不良预后独立相关。亚组分析进一步验证了这些相关性。同时，中介分析证实，FBG 部分中介了 SIRI 与 90d 时不良预后之间的关系（间接效应估计值 = 0.0038，bootstrap 95% CI 0.001 至 0.008；直接效应估计值 = 0.1719，bootstrap 95% CI 0.1258 至 0.2179）。此外，FBG在NHR和不良预后之间也起着中介作用（间接效应估计值=0.0066，bootstrap 95% CI 0.002至0.120；直接效应估计值=0.1308，bootstrap 95% CI 0.0934至0.1681）：我们的研究表明，SIRI和NHR与AIS患者90天后的不良临床结局和死亡率呈正相关，而FBG在一定程度上起到了中介作用。
{"title":"The Association of Systemic Inflammatory Response Index and Neutrophil-to-High-Density Lipoprotein Ratio Mediated by Fasting Blood Glucose with 90-Day Prognosis in Acute Ischemic Stroke Patients.","authors":"Aimei Zhang, Yuan Zhu, Junqi Liao, Dan Wu, Xiaohui Yan, Jingyi Chen, Qiuhua He, Fantao Song, Li Li, Yunze Li, Zhaoyao Chen, Wenlei Li, Qin Yang, Zhuyuan Fang, Minghua Wu","doi":"10.1159/000539132","DOIUrl":"10.1159/000539132","url":null,"abstract":"<p><strong>Introduction: </strong>The contribution of individual and combined inflammatory markers for the prognosis of acute ischemic stroke (AIS) remains elusive. This study investigated the effect of systemic inflammatory response index (SIRI), and neutrophil to high-density lipoprotein ratio (NHR), which is mediated by fasting blood glucose (FBG), on 90-day prognosis of patients with AIS.</p><p><strong>Methods: </strong>In this pre-specified substudy of an observational cohort study, 2,828 patients with AIS were enrolled from the Nanjing Stroke Registry between January 2017 and July 2021. Peripheral venous blood was collected from patients fasting for at least 8 h within 24 h of admission to gather information on the following parameters: neutrophil count, lymphocyte count, monocyte count, HDL level, and fasting blood glucose level. Then, the SIRI and NHR values were calculated. Following this, the correlation among SIRI, NHR, and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. Lastly, mediation analysis was performed to examine the relationship between systematic inflammatory response and study outcomes mediated by FBG.</p><p><strong>Results: </strong>SIRI and NHR were both negatively correlated with clinical outcomes (p < 0.05). Logistic regression analysis revealed that SIRI and NHR were independently associated with poor outcomes after adjusting for potential confounders. Subgroup analyses further validated these correlations. Meanwhile, mediation analysis corroborated that FBG partially mediated the associations between SIRI and a poor prognosis at 90 days (indirect effect estimate = 0.0038, bootstrap 95% CI 0.001-0.008; direct effect estimate = 0.1719, bootstrap 95% CI 0.1258-0.2179). Besides, FBG also played a mediating role between NHR and poor outcomes (indirect effect estimate = 0.0066, bootstrap 95% CI 0.002-0.120; direct effect estimate = 0.1308, bootstrap 95% CI 0.0934-0.1681).</p><p><strong>Conclusion: </strong>Our study demonstrated that SIRI and NHR are positively associated with poor clinical and mortality outcomes at 90 days in AIS patients, which was partially mediated by FBG.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shnece Duncan, Andrea Menclova, Maggie-Lee Huckabee, Dominique A Cadilhac, Anna Ranta
Introduction: Dysphagia (i.e., disordered swallowing) is a consequence of stroke. Existing literature on the marginal cost of dysphagia after stroke is limited and ignores long-term impacts. Our aim was to determine the marginal 12-month cost attributable to dysphagia, including health-related quality of life (HRQoL) impacts, among patients hospitalised with stroke in New Zealand.
Methods: Secondary analysis of observational data from the REGIONS Care study, a national study from New Zealand of consecutively hospitalised patients with acute stroke between May 1, 2018, and October 30, 2018, including an outcome survey at 12 months among those who provided consent. Patients were identified as dysphagic if they received a swallow screen in hospital resulting in a speech language therapist review. Patients that required a nasogastric feeding tube in hospital were classified as "severe." Optimal linear propensity score matching was utilised to provide a group of patients to compare with stroke and dysphagia. All costs were converted to 2021NZD.
Results: Overall, of the 2,379 patients in the REGIONS cohort (51% male, median age: 78), 40% (944/2,379) were dysphagic (52% male, median age: 78), and 5% (111/2,379) were classified as severely dysphagic. Within 12 months of hospital discharge, dysphagia reduced HRQoL overall by 0.06 index points (95% CI: 0.028-0.100), and severe dysphagia by 0.12 index points (95% CI: 0.03-0.20). The estimated marginal 12-month cost attributable to stroke-related dysphagia was NZD 24,200 on average per patient. This estimate includes the additional hospitalisation costs (NZD 16,100), community rehabilitation services (NZD 570), hospital level aged residential care (NZD 4,030), and reduced HRQoL (NZD 3,470) over a 12-month period post-hospital discharge. The overall total marginal cost for those with severe dysphagia was NZD 34,000 per patient.
Conclusion: We report cost estimates to 12 months from a national perspective on the additional costs and HRQoL outcomes of dysphagia for people hospitalised with stroke in New Zealand. Findings provide a novel contribution internationally since few prior studies have extended beyond the acute hospital phase of care. By quantifying the economic burden, we provide information to decision makers to improve dysphagia management strategies and ultimately enhance the overall HRQoL for people with stroke and dysphagia.
{"title":"How Much Does Dysphagia Cost? Understanding the Additional Costs of Dysphagia for New Zealand in Patients Hospitalised with Stroke.","authors":"Shnece Duncan, Andrea Menclova, Maggie-Lee Huckabee, Dominique A Cadilhac, Anna Ranta","doi":"10.1159/000539133","DOIUrl":"10.1159/000539133","url":null,"abstract":"<p><strong>Introduction: </strong>Dysphagia (i.e., disordered swallowing) is a consequence of stroke. Existing literature on the marginal cost of dysphagia after stroke is limited and ignores long-term impacts. Our aim was to determine the marginal 12-month cost attributable to dysphagia, including health-related quality of life (HRQoL) impacts, among patients hospitalised with stroke in New Zealand.</p><p><strong>Methods: </strong>Secondary analysis of observational data from the REGIONS Care study, a national study from New Zealand of consecutively hospitalised patients with acute stroke between May 1, 2018, and October 30, 2018, including an outcome survey at 12 months among those who provided consent. Patients were identified as dysphagic if they received a swallow screen in hospital resulting in a speech language therapist review. Patients that required a nasogastric feeding tube in hospital were classified as \"severe.\" Optimal linear propensity score matching was utilised to provide a group of patients to compare with stroke and dysphagia. All costs were converted to 2021NZD.</p><p><strong>Results: </strong>Overall, of the 2,379 patients in the REGIONS cohort (51% male, median age: 78), 40% (944/2,379) were dysphagic (52% male, median age: 78), and 5% (111/2,379) were classified as severely dysphagic. Within 12 months of hospital discharge, dysphagia reduced HRQoL overall by 0.06 index points (95% CI: 0.028-0.100), and severe dysphagia by 0.12 index points (95% CI: 0.03-0.20). The estimated marginal 12-month cost attributable to stroke-related dysphagia was NZD 24,200 on average per patient. This estimate includes the additional hospitalisation costs (NZD 16,100), community rehabilitation services (NZD 570), hospital level aged residential care (NZD 4,030), and reduced HRQoL (NZD 3,470) over a 12-month period post-hospital discharge. The overall total marginal cost for those with severe dysphagia was NZD 34,000 per patient.</p><p><strong>Conclusion: </strong>We report cost estimates to 12 months from a national perspective on the additional costs and HRQoL outcomes of dysphagia for people hospitalised with stroke in New Zealand. Findings provide a novel contribution internationally since few prior studies have extended beyond the acute hospital phase of care. By quantifying the economic burden, we provide information to decision makers to improve dysphagia management strategies and ultimately enhance the overall HRQoL for people with stroke and dysphagia.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Preclinical evidence demonstrated the therapeutic potential of thiazolidinediones (TZDs) for the treatment of intracerebral hemorrhage (ICH). The present study conducted an investigation of cerebrovascular and cardiovascular outcomes following ICH in patients with type 2 diabetes mellitus (T2DM) treated with or without TZDs.
Methods: This retrospective nested case-control study used data from the Taiwan National Health Insurance Research Database. A total of 62,515 T2DM patients who were hospitalized with a diagnosis of ICH were enrolled, including 7,603 TZD users. Data for TZD non-users were extracted using propensity score matching. Primary outcomes included death and major adverse cardiovascular events (MACEs), which were defined as a composite of ischemic stroke, hemorrhagic stroke (HS), acute myocardial infarction, and congestive heart failure. Patients aged <20 years with a history of traumatic brain injury or any prior history of MACEs were excluded.
Results: TZD users had significantly lower MACE risks compared with TZD non-users following ICH (adjusted hazard ratio [aHR]: 0.90, 95% confidence interval [CI]: 0.85-0.94, p < 0.001). The most significant MACE difference reported for TZD users was HS, which possessed lower incidence than in TZD non-users, especially for the events that happened within 3 months following ICH (aHR: 0.74, 95% CI: 0.62-0.89 within 1 month, p < 0.01; aHR: 0.68, 95% CI: 0.54-0.85 between 1 and 3 month).
Conclusion: The use of TZD in patients with T2DM was associated with a lower risk of subsequent HS and mortality following ICH.
简介：临床前证据表明，TZDs具有治疗脑出血（ICH）的潜力。本研究调查了接受或不接受 TZDs 治疗的 2 型糖尿病（T2DM）患者 ICH 后的脑血管和心血管预后：这项回顾性巢式病例对照研究使用了台湾国民健康保险研究数据库的数据。这项回顾性巢式病例对照研究使用了台湾国民健康保险研究数据库中的数据，共纳入了 62515 名因诊断为 ICH 而住院的 T2DM 患者，其中包括 7603 名 TZD 使用者。未使用 TZD 患者的数据采用倾向得分匹配法提取。主要结局包括死亡和主要心血管不良事件（MACE），MACE定义为缺血性中风、出血性中风（HS）、急性心肌梗死（AMI）和充血性心力衰竭（CHF）的综合。年龄小于20岁、有脑外伤病史或既往有MACEs病史的患者被排除在外：结果：与不使用 TZD 的患者相比，使用 TZD 的患者在发生 ICH 后的 MACE 风险明显较低（调整后危险比 [aHR]：0.90，95% 置信区间）：0.90，95%置信区间[CI]：0.85-0.94, p < 0.001).使用TZD的患者MACE差异最大的是HS，其发生率低于未使用TZD的患者，尤其是ICH后3个月内发生的事件（aHR：0.74，95% CI：1个月内0.62-0.89，p <0.01；aHR：0.68，95% CI：1-3个月0.54-0.85）：结论：T2DM患者使用TZD可降低ICH后发生HS和死亡的风险。
{"title":"Thiazolidinediones Decrease the Recurrence of Intracerebral Hemorrhage in Type 2 Diabetes Mellitus Patients: A Nested Case-Control Study.","authors":"Cheng-Di Chiu, You-Pen Chiu, Hei-Tung Yip, Hui-Ru Ji, Der-Yang Cho, Irene Han-Juo Cheng, Cho-Yi Chen","doi":"10.1159/000539001","DOIUrl":"10.1159/000539001","url":null,"abstract":"<p><strong>Introduction: </strong>Preclinical evidence demonstrated the therapeutic potential of thiazolidinediones (TZDs) for the treatment of intracerebral hemorrhage (ICH). The present study conducted an investigation of cerebrovascular and cardiovascular outcomes following ICH in patients with type 2 diabetes mellitus (T2DM) treated with or without TZDs.</p><p><strong>Methods: </strong>This retrospective nested case-control study used data from the Taiwan National Health Insurance Research Database. A total of 62,515 T2DM patients who were hospitalized with a diagnosis of ICH were enrolled, including 7,603 TZD users. Data for TZD non-users were extracted using propensity score matching. Primary outcomes included death and major adverse cardiovascular events (MACEs), which were defined as a composite of ischemic stroke, hemorrhagic stroke (HS), acute myocardial infarction, and congestive heart failure. Patients aged <20 years with a history of traumatic brain injury or any prior history of MACEs were excluded.</p><p><strong>Results: </strong>TZD users had significantly lower MACE risks compared with TZD non-users following ICH (adjusted hazard ratio [aHR]: 0.90, 95% confidence interval [CI]: 0.85-0.94, p < 0.001). The most significant MACE difference reported for TZD users was HS, which possessed lower incidence than in TZD non-users, especially for the events that happened within 3 months following ICH (aHR: 0.74, 95% CI: 0.62-0.89 within 1 month, p < 0.01; aHR: 0.68, 95% CI: 0.54-0.85 between 1 and 3 month).</p><p><strong>Conclusion: </strong>The use of TZD in patients with T2DM was associated with a lower risk of subsequent HS and mortality following ICH.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giuseppina Affinito, Vito Salerno, M. Di Gennaro, Luca Scafa, Alessandro Russo, M. G. Fumo, R. Giordana, F. Falco, Flavio Della Pia, Angelica Di Cecca, Miriana Migliaccio, C. R. Ilardi, Chiara Criscuolo, Myriam Spisto, M. Triassi, Vincenzo Brescia Morra, R. Palladino, Elena Salvatore, M. Moccia
OBJECTIVE To provide population-based estimates of prevalence and incidence of any dementia and Alzheimer's dementia in the Campania Region (South Italy), and to validate towards a clinical registry. METHODS Population-based study, using routinely collected healthcare data of individuals living in the Campania Region (South Italy) from 2015 to 2020. We included individuals aged ≥65 years alive at the prevalence day (1 January 2021) who had at least one administrative record for dementia and/or Alzheimer's dementia from 2015 to 2020. Age-and sex-standardised prevalence rates were calculated using direct standardisation method (European population in 2020 as reference population). To estimate incidence, we tested three possible algorithms, which differed for the duration of the time interval between study baseline (Jan 1, 2015) and index date (first record for dementia and/or Alzheimer's dementia in administrative databases). We employed a clinical database for the validation of our algorithms towards neuropsychological test results. RESULTS Among individuals aged over 65, 80,392 had dementia, of which 35,748 had Alzheimer's dementia. The age- and sex-standardized prevalence rates per 1,000 individuals for any dementia and Alzheimer's dementia were 77.64 (95%CI = 77.57; 77.68) and 34.05 (95%CI = 34.01; 34.09), respectively. There were 82.10 incident of any dementia cases per 100,000 per year (0.79 sensitivity and 0.62 specificity), and 59.89 incident cases of any dementia per 100,000 per year (0.80 sensitivity and 0.59 specificity). The capture-recapture method showed very low number of undetected cases (1.7% for any dementia and 3.0% for Alzheimer's dementia). Our algorithms showed acceptable performance with AUC ranging from 0.59 to 0.72, and double likelihood ratio of correctly identifying individuals above and below MMSE standard cut-offs (24 and 26). CONCLUSIONS Prevalence and incidence of any dementia and Alzheimer's dementia in the Campania Region (South Italy) from 2015 to 2020 are in line with previous estimates from other countries. Our algorithm, integrating administrative and clinical data, holds potential for assessing dementia's epidemiological burden, identifying risk factors, planning healthcare access, and developing prevention strategies.
{"title":"Incidence and prevalence of dementia: A 2015-2020 population-based study in the Campania Region of Italy.","authors":"Giuseppina Affinito, Vito Salerno, M. Di Gennaro, Luca Scafa, Alessandro Russo, M. G. Fumo, R. Giordana, F. Falco, Flavio Della Pia, Angelica Di Cecca, Miriana Migliaccio, C. R. Ilardi, Chiara Criscuolo, Myriam Spisto, M. Triassi, Vincenzo Brescia Morra, R. Palladino, Elena Salvatore, M. Moccia","doi":"10.1159/000539031","DOIUrl":"https://doi.org/10.1159/000539031","url":null,"abstract":"OBJECTIVE\u0000To provide population-based estimates of prevalence and incidence of any dementia and Alzheimer's dementia in the Campania Region (South Italy), and to validate towards a clinical registry.\u0000\u0000\u0000METHODS\u0000Population-based study, using routinely collected healthcare data of individuals living in the Campania Region (South Italy) from 2015 to 2020. We included individuals aged ≥65 years alive at the prevalence day (1 January 2021) who had at least one administrative record for dementia and/or Alzheimer's dementia from 2015 to 2020. Age-and sex-standardised prevalence rates were calculated using direct standardisation method (European population in 2020 as reference population). To estimate incidence, we tested three possible algorithms, which differed for the duration of the time interval between study baseline (Jan 1, 2015) and index date (first record for dementia and/or Alzheimer's dementia in administrative databases). We employed a clinical database for the validation of our algorithms towards neuropsychological test results.\u0000\u0000\u0000RESULTS\u0000Among individuals aged over 65, 80,392 had dementia, of which 35,748 had Alzheimer's dementia. The age- and sex-standardized prevalence rates per 1,000 individuals for any dementia and Alzheimer's dementia were 77.64 (95%CI = 77.57; 77.68) and 34.05 (95%CI = 34.01; 34.09), respectively. There were 82.10 incident of any dementia cases per 100,000 per year (0.79 sensitivity and 0.62 specificity), and 59.89 incident cases of any dementia per 100,000 per year (0.80 sensitivity and 0.59 specificity). The capture-recapture method showed very low number of undetected cases (1.7% for any dementia and 3.0% for Alzheimer's dementia). Our algorithms showed acceptable performance with AUC ranging from 0.59 to 0.72, and double likelihood ratio of correctly identifying individuals above and below MMSE standard cut-offs (24 and 26).\u0000\u0000\u0000CONCLUSIONS\u0000Prevalence and incidence of any dementia and Alzheimer's dementia in the Campania Region (South Italy) from 2015 to 2020 are in line with previous estimates from other countries. Our algorithm, integrating administrative and clinical data, holds potential for assessing dementia's epidemiological burden, identifying risk factors, planning healthcare access, and developing prevention strategies.","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140663941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Cerebral palsy (CP) is a nonprogressive movement disorder resulting from prenatal or perinatal brain injury that benefits from early diagnosis and intervention. The timing of early CP diagnosis remains controversial, necessitating analysis of clinical features in a substantial cohort. METHODS We retrospectively reviewed medical records from a university hospital, focusing on children aged >24 months or followed up for ≥24 months, and adhered to the International classification of diseases-10 for diagnosis and Subtyping. RESULTS Among the 2012 confirmed CP cases, 68.8% were male and 51.44% had spastic diplegia. Based on the Gross Motor Function Classification System (GMFCS), 62.38% were levels I and II, and 19.88% were levels IV and V. Hemiplegic and diplegic subtypes predominantly fell into levels I and II, while quadriplegic and mixed types were mainly levels IV and V. White matter injuries appeared in 46.58% of cranial MRI findings, while maldevelopment was rare (7.05%). Intellectual disability co-occurred in 43.44% of the CP cases, with hemiplegia having the lowest (20.28%, 58/286) and mixed types (73.85%, 48/65). Additionally, 51.67% (697/1349) of the children with CP aged ≥48 months had comorbidities. CONCLUSIONS This study underscores white matter injury as the primary CP pathology and identifies intellectual disability as a common comorbidity. Although CP can be identified in infants under one year old, precision in diagnosis improves with development. These insights inform early detection and tailored interventios, emphasizing their crucial role in CP management.
{"title":"Cerebral Palsy Heterogeneity: Clinical Characteristics and Diagnostic Significance from a Large Sample Analysis.","authors":"Junying Yuan, Mengli Cui, Qiongqiong Liang, Dengna Zhu, Jie Liu, Jiefeng Hu, Shijie Ma, Dong Li, Jing Wang, Xuejie Wang, Deyou Ma, Kate Himmelmann, Xiaoyang Wang, Yiran Xu, Changlian Zhu","doi":"10.1159/000539002","DOIUrl":"https://doi.org/10.1159/000539002","url":null,"abstract":"INTRODUCTION\u0000Cerebral palsy (CP) is a nonprogressive movement disorder resulting from prenatal or perinatal brain injury that benefits from early diagnosis and intervention. The timing of early CP diagnosis remains controversial, necessitating analysis of clinical features in a substantial cohort.\u0000\u0000\u0000METHODS\u0000We retrospectively reviewed medical records from a university hospital, focusing on children aged >24 months or followed up for ≥24 months, and adhered to the International classification of diseases-10 for diagnosis and Subtyping.\u0000\u0000\u0000RESULTS\u0000Among the 2012 confirmed CP cases, 68.8% were male and 51.44% had spastic diplegia. Based on the Gross Motor Function Classification System (GMFCS), 62.38% were levels I and II, and 19.88% were levels IV and V. Hemiplegic and diplegic subtypes predominantly fell into levels I and II, while quadriplegic and mixed types were mainly levels IV and V. White matter injuries appeared in 46.58% of cranial MRI findings, while maldevelopment was rare (7.05%). Intellectual disability co-occurred in 43.44% of the CP cases, with hemiplegia having the lowest (20.28%, 58/286) and mixed types (73.85%, 48/65). Additionally, 51.67% (697/1349) of the children with CP aged ≥48 months had comorbidities.\u0000\u0000\u0000CONCLUSIONS\u0000This study underscores white matter injury as the primary CP pathology and identifies intellectual disability as a common comorbidity. Although CP can be identified in infants under one year old, precision in diagnosis improves with development. These insights inform early detection and tailored interventios, emphasizing their crucial role in CP management.","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140685898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eva Joëlle Haasdijk, Yasmin Sadigh, Gizem Yildirim, R. Dammers, V. Volovici
BACKGROUND Limb-shaking transient ischemic attack (LSTIA) is a rare neurological condition which presents with involuntary jerky movements of the arm or leg, often because of carotid stenosis or occlusion. Due to the rarity of the condition, the epidemiology of LSTIA is poorly understood and the disease is frequently misdiagnosed. There is no standard treatment to date. The purpose of this study is to provide an overview of the epidemiology of LSTIA and its current treatment options. METHODS Embase, MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials for randomized controlled trials and Google Scholar were searched from database inception to 30th of December 2023 for articles containing information on the epidemiology and treatment of LSTIA. An individual patient data meta-analysis (IPD-MA) was performed using data extracted from the included articles. Inclusion criteria were description of both the epidemiology and treatment of LSTIA in patients over the age of eighteen with carotid stenosis/occlusion, confirmed by radiographic imaging. Exclusion criteria were studies focusing on pediatrics, no epidemiological data, internal carotid artery (ICA) stenosis/occlusion not radiologically confirmed, full-text unavailable, full-text not in English or Dutch, and non-original articles. RESULTS Of the 8855 articles screened, 55 articles containing 251 patients were included. 50 articles harboring 81 patients were included in the IPD-MA and 7 articles harboring 187 patients were included in the cohort analysis. The results of the IPD-MA showed that LSTIA was caused by unilateral ICA stenosis/occlusion in 29 patients (36%) and most often from bilateral ICA stenosis/occlusion in 52 patients (64%). Limb-shaking was unilateral in 66 patients (83%) and was accompanied by weakness in 27 patients (33%). The intervention with the highest success rate was endovascular intervention (carotid stenting or balloon angioplasty), as all 10 patients remained asymptomatic after treatment. The cohort analysis showed that LSTIA can be caused by both unilateral and bilateral carotid stenosis or occlusion. The prevalence within cohorts of TIA patients of LSTIA varied considerably from 3.5% to 29%. CONCLUSION A large international clinical registry is warranted to gain a better understanding of the epidemiology of LSTIA. There is insufficient evidence available to suggest a standard treatment.
{"title":"Limb-shaking transient ischemic attacks in patients with carotid occlusion or stenosis: a systematic review and individual patient data meta-analysis.","authors":"Eva Joëlle Haasdijk, Yasmin Sadigh, Gizem Yildirim, R. Dammers, V. Volovici","doi":"10.1159/000538977","DOIUrl":"https://doi.org/10.1159/000538977","url":null,"abstract":"BACKGROUND\u0000Limb-shaking transient ischemic attack (LSTIA) is a rare neurological condition which presents with involuntary jerky movements of the arm or leg, often because of carotid stenosis or occlusion. Due to the rarity of the condition, the epidemiology of LSTIA is poorly understood and the disease is frequently misdiagnosed. There is no standard treatment to date. The purpose of this study is to provide an overview of the epidemiology of LSTIA and its current treatment options.\u0000\u0000\u0000METHODS\u0000Embase, MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials for randomized controlled trials and Google Scholar were searched from database inception to 30th of December 2023 for articles containing information on the epidemiology and treatment of LSTIA. An individual patient data meta-analysis (IPD-MA) was performed using data extracted from the included articles. Inclusion criteria were description of both the epidemiology and treatment of LSTIA in patients over the age of eighteen with carotid stenosis/occlusion, confirmed by radiographic imaging. Exclusion criteria were studies focusing on pediatrics, no epidemiological data, internal carotid artery (ICA) stenosis/occlusion not radiologically confirmed, full-text unavailable, full-text not in English or Dutch, and non-original articles.\u0000\u0000\u0000RESULTS\u0000Of the 8855 articles screened, 55 articles containing 251 patients were included. 50 articles harboring 81 patients were included in the IPD-MA and 7 articles harboring 187 patients were included in the cohort analysis. The results of the IPD-MA showed that LSTIA was caused by unilateral ICA stenosis/occlusion in 29 patients (36%) and most often from bilateral ICA stenosis/occlusion in 52 patients (64%). Limb-shaking was unilateral in 66 patients (83%) and was accompanied by weakness in 27 patients (33%). The intervention with the highest success rate was endovascular intervention (carotid stenting or balloon angioplasty), as all 10 patients remained asymptomatic after treatment. The cohort analysis showed that LSTIA can be caused by both unilateral and bilateral carotid stenosis or occlusion. The prevalence within cohorts of TIA patients of LSTIA varied considerably from 3.5% to 29%.\u0000\u0000\u0000CONCLUSION\u0000A large international clinical registry is warranted to gain a better understanding of the epidemiology of LSTIA. There is insufficient evidence available to suggest a standard treatment.","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Sogbossi, Adjoua Baba-Tadja, Emilienne Nouatin, M. Agbétou, Thierry Adoukonou, O. Kossi
INTRODUCTION Cerebral palsy (CP) is the most common cause of pediatric motor disability. While epidemiological data are widespread in high-income countries, corresponding data in low-income countries in Sub-Saharan Africa are still rare. This study aimed to estimate the prevalence of CP in Northern Benin, a French-speaking low-income country in Sub-Saharan Africa. METHODS This study was a community-based door-to-door study involving children younger than 18 years old, in Parakou, a semi-urban city in Benin. We used a two-stage procedure. The first one consisted on children screening to identify potential cases of CP. During the second stage, suspected children were examined by neurologists with high experience with CP. RESULTS In total, 2630 children were screened with 10 confirmed cases of CP, resulting in a crude prevalence (95% confidence interval) of 3.8(1.4, 6.15) per 1000 children. Of the ten confirmed cases, six were younger than 5 years old, and five were male. Eight children over ten were spastic with six bilateral spastic subtype according to the SCPE classification system. Seven children had a Gross Motor Function Classification System level III-V, and six were classified level III to V of the Manual Ability Classification System. CONCLUSION Cerebral palsy is highly prevalent in Semi-Urban area in Northern Benin. Large studies on potential risk factors are needed for the development of effective preventive strategies.
{"title":"Estimating the prevalence of cerebral palsy in a semi-urban city in Benin: a door-to-door community-based study.","authors":"E. Sogbossi, Adjoua Baba-Tadja, Emilienne Nouatin, M. Agbétou, Thierry Adoukonou, O. Kossi","doi":"10.1159/000538799","DOIUrl":"https://doi.org/10.1159/000538799","url":null,"abstract":"INTRODUCTION\u0000Cerebral palsy (CP) is the most common cause of pediatric motor disability. While epidemiological data are widespread in high-income countries, corresponding data in low-income countries in Sub-Saharan Africa are still rare. This study aimed to estimate the prevalence of CP in Northern Benin, a French-speaking low-income country in Sub-Saharan Africa.\u0000\u0000\u0000METHODS\u0000This study was a community-based door-to-door study involving children younger than 18 years old, in Parakou, a semi-urban city in Benin. We used a two-stage procedure. The first one consisted on children screening to identify potential cases of CP. During the second stage, suspected children were examined by neurologists with high experience with CP.\u0000\u0000\u0000RESULTS\u0000In total, 2630 children were screened with 10 confirmed cases of CP, resulting in a crude prevalence (95% confidence interval) of 3.8(1.4, 6.15) per 1000 children. Of the ten confirmed cases, six were younger than 5 years old, and five were male. Eight children over ten were spastic with six bilateral spastic subtype according to the SCPE classification system. Seven children had a Gross Motor Function Classification System level III-V, and six were classified level III to V of the Manual Ability Classification System.\u0000\u0000\u0000CONCLUSION\u0000Cerebral palsy is highly prevalent in Semi-Urban area in Northern Benin. Large studies on potential risk factors are needed for the development of effective preventive strategies.","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to 'Nodding syndrome associated with onchocerciasis'.","authors":"Salvatore Metanmo, Andrea Sylvia Winkler","doi":"10.1159/000538697","DOIUrl":"https://doi.org/10.1159/000538697","url":null,"abstract":"","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qian Cai, Alberto E Batista, J. Börsum, Qiaoyi Zhang, Gabriel Isheden, P. Kunovszki, Kavita Gandhi, Kristin Heerlein, Susanna Brauner
INTRODUCTION Health care costs and societal impact of myasthenia gravis (MG), a potentially life-threatening rare, chronic neuromuscular disease are sparsely studied. We assessed healthcare resource utilization (HCRU) and associated costs among patients with newly diagnosed (ND) and pre-existing (PE) MG in Sweden. METHODS This observational, retrospective cohort study used data from four linkable Swedish nationwide population-based registries. Adult MG patients receiving pharmacological treatment for MG and having ≥ 24-month follow-up during the period 1/1/2010 to 12/31/2017 were included. RESULTS A total of 1,275 patients were included in the analysis, of which 554 patients were categorized into the ND MG group and 721 into the PE MG group. Mean (±SD) age was 61.3 (±17.4) years and 52.3% were female. In first year post-diagnosis, ND patients had significantly higher utilization of acetylcholinesterase inhibitors (96.0% vs 83.9%), corticosteroids (59.6% vs 45.8%), thymectomy (12.1% vs 0.7%) and plasma exchange (3.8% vs 0.6%); had higher all-cause (70.9% vs 35.8%) and MG-related (62.5% vs 18.4%) hospitalization rates with 11 more hospitalization days (all p<0.01) and an increased risk of hospitalization (odds ratio [95% CI] = 4.4 [3.43, 5.64]) than PE MG. In year 1 post-diagnosis, ND MG patients incurred €7302 (p<0.01) higher total all-cause costs than PE MG, of which 84% were estimated to be MG-related and the majority (86%) were related to inpatient care. These results remained significant also after controlling for baseline demographics and comorbidities (p<0.01). In year 2 post-diagnosis, the all-cause medical costs decreased by ~55% for ND MG from year 1 and were comparable with PE MG. CONCLUSION In this population-based study, MG patients required significantly more healthcare resources in year 1 post-diagnosis than PE MG primarily due to more pharmacological treatments, thymectomies and associated hospitalizations. These findings highlight the need to better understand potential factors including disease characteristics associated with increased health resource use and costs and need for more efficacious treatments early in the disease course.
导言对重症肌无力（MG）这种可能危及生命的罕见慢性神经肌肉疾病的医疗成本和社会影响的研究很少。我们评估了瑞典新诊断（ND）和原有（PE）重症肌无力患者的医疗资源利用率（HCRU）和相关费用。结果共有1275名患者被纳入分析，其中554名患者被归入ND MG组，721名患者被归入PE MG组。平均（±SD）年龄为 61.3（±17.4）岁，52.3% 为女性。确诊后第一年，ND 患者使用乙酰胆碱酯酶抑制剂（96.0% vs 83.9%）、皮质类固醇（59.6% vs 45.8%）、胸腺切除术（12.1% vs 0.7%）和血浆置换术（3.8% vs 0.6%）；与 PE MG 相比，其全因（70.9% vs 35.8%）和 MG 相关（62.5% vs 18.4%）住院率更高，住院天数增加 11 天（均 p<0.01），住院风险增加（几率比 [95% CI] = 4.4 [3.43, 5.64]）。在确诊后的第 1 年，ND MG 患者的全因总费用比 PE MG 患者高出 7302 欧元（P<0.01），其中 84% 估计与 MG 有关，大部分（86%）与住院治疗有关。在控制了基线人口统计学和并发症后，这些结果仍有意义（P<0.01）。结论在这项基于人群的研究中，MG 患者在确诊后第 1 年所需的医疗资源明显多于 PE MG，这主要是由于更多的药物治疗、胸腺切除术和相关住院所致。这些发现突出表明，有必要更好地了解潜在的因素，包括与医疗资源使用和成本增加相关的疾病特征，以及在病程早期对更有效治疗的需求。
{"title":"Long-term Healthcare Resource Utilization and Costs among Patients with Myasthenia Gravis: A Swedish Nationwide Population-based Study.","authors":"Qian Cai, Alberto E Batista, J. Börsum, Qiaoyi Zhang, Gabriel Isheden, P. Kunovszki, Kavita Gandhi, Kristin Heerlein, Susanna Brauner","doi":"10.1159/000538640","DOIUrl":"https://doi.org/10.1159/000538640","url":null,"abstract":"INTRODUCTION\u0000Health care costs and societal impact of myasthenia gravis (MG), a potentially life-threatening rare, chronic neuromuscular disease are sparsely studied. We assessed healthcare resource utilization (HCRU) and associated costs among patients with newly diagnosed (ND) and pre-existing (PE) MG in Sweden.\u0000\u0000\u0000METHODS\u0000This observational, retrospective cohort study used data from four linkable Swedish nationwide population-based registries. Adult MG patients receiving pharmacological treatment for MG and having ≥ 24-month follow-up during the period 1/1/2010 to 12/31/2017 were included.\u0000\u0000\u0000RESULTS\u0000A total of 1,275 patients were included in the analysis, of which 554 patients were categorized into the ND MG group and 721 into the PE MG group. Mean (±SD) age was 61.3 (±17.4) years and 52.3% were female. In first year post-diagnosis, ND patients had significantly higher utilization of acetylcholinesterase inhibitors (96.0% vs 83.9%), corticosteroids (59.6% vs 45.8%), thymectomy (12.1% vs 0.7%) and plasma exchange (3.8% vs 0.6%); had higher all-cause (70.9% vs 35.8%) and MG-related (62.5% vs 18.4%) hospitalization rates with 11 more hospitalization days (all p<0.01) and an increased risk of hospitalization (odds ratio [95% CI] = 4.4 [3.43, 5.64]) than PE MG. In year 1 post-diagnosis, ND MG patients incurred €7302 (p<0.01) higher total all-cause costs than PE MG, of which 84% were estimated to be MG-related and the majority (86%) were related to inpatient care. These results remained significant also after controlling for baseline demographics and comorbidities (p<0.01). In year 2 post-diagnosis, the all-cause medical costs decreased by ~55% for ND MG from year 1 and were comparable with PE MG.\u0000\u0000\u0000CONCLUSION\u0000In this population-based study, MG patients required significantly more healthcare resources in year 1 post-diagnosis than PE MG primarily due to more pharmacological treatments, thymectomies and associated hospitalizations. These findings highlight the need to better understand potential factors including disease characteristics associated with increased health resource use and costs and need for more efficacious treatments early in the disease course.","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Asikainen, M. Korja, Jaakko Kaprio, Ilari Rautalin
INTRODUCTION Aneurysmal subarachnoid hemorrhage (SAH) is more common in women than in men, contrary to most cardiovascular diseases. However, it is unclear whether the case fatality rate (CFR) of SAH also differs by sex. Thus, we performed a systematic review to address the relationship between sex and SAH CFRs. METHODS We conducted a systematic literature search in PubMed, Scopus, and Cochrane library databases. We focused on population-based studies that included both non-hospitalized and hospitalized SAHs and had either reported 1-month (28-31 day) SAH CFRs separately for men and women or calculated risk estimates for SAH CFR by sex. For quality classification, we used the Cochrane Collaboration Handbook and Critical Appraisal Skills Program guidelines. We pooled the study cohorts and calculated relative risk ratios (RR) with 95 % confidence intervals (CIs) for SAH death between women and men using a random-effects meta-analysis model. RESULTS The literature search yielded 5,592 initial publications, of which 33 study cohorts were included in the final review. Of the 33 study cohorts, only three reported significant sex differences, although the findings were contradictory. In the pooled analysis of all 53,141 SAH cases (60.3 % women) from 26 countries, the 1-month CFR did not differ (RR = 0.99 [95 % CI 0.93-1.05]) between women (35.5 %) and men (35.0 %). According to our risk-of-bias evaluation, all 33 study cohorts were categorized as low quality. The most important sources of bias risks were related to the absence of proper confounding control (all 33 study cohorts), insufficient sample size (27 of 33 study cohorts), and poor/unclear diagnostic accuracy (27 of 33 study cohorts). CONCLUSION Contrary to SAH incidence rates, the SAH CFRs do not seem to differ between men and women. However, since none of the studies were specifically designed to examine the sex differences in SAH CFRs, future studies on the topic are warranted.
{"title":"Sex Differences in Case Fatality of Aneurysmal Subarachnoid Hemorrhage: A Systematic Review.","authors":"A. Asikainen, M. Korja, Jaakko Kaprio, Ilari Rautalin","doi":"10.1159/000538562","DOIUrl":"https://doi.org/10.1159/000538562","url":null,"abstract":"INTRODUCTION\u0000Aneurysmal subarachnoid hemorrhage (SAH) is more common in women than in men, contrary to most cardiovascular diseases. However, it is unclear whether the case fatality rate (CFR) of SAH also differs by sex. Thus, we performed a systematic review to address the relationship between sex and SAH CFRs.\u0000\u0000\u0000METHODS\u0000We conducted a systematic literature search in PubMed, Scopus, and Cochrane library databases. We focused on population-based studies that included both non-hospitalized and hospitalized SAHs and had either reported 1-month (28-31 day) SAH CFRs separately for men and women or calculated risk estimates for SAH CFR by sex. For quality classification, we used the Cochrane Collaboration Handbook and Critical Appraisal Skills Program guidelines. We pooled the study cohorts and calculated relative risk ratios (RR) with 95 % confidence intervals (CIs) for SAH death between women and men using a random-effects meta-analysis model.\u0000\u0000\u0000RESULTS\u0000The literature search yielded 5,592 initial publications, of which 33 study cohorts were included in the final review. Of the 33 study cohorts, only three reported significant sex differences, although the findings were contradictory. In the pooled analysis of all 53,141 SAH cases (60.3 % women) from 26 countries, the 1-month CFR did not differ (RR = 0.99 [95 % CI 0.93-1.05]) between women (35.5 %) and men (35.0 %). According to our risk-of-bias evaluation, all 33 study cohorts were categorized as low quality. The most important sources of bias risks were related to the absence of proper confounding control (all 33 study cohorts), insufficient sample size (27 of 33 study cohorts), and poor/unclear diagnostic accuracy (27 of 33 study cohorts).\u0000\u0000\u0000CONCLUSION\u0000Contrary to SAH incidence rates, the SAH CFRs do not seem to differ between men and women. However, since none of the studies were specifically designed to examine the sex differences in SAH CFRs, future studies on the topic are warranted.","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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