American Journal of Otolaryngology最新文献

{"title":"The role of metformin in dysplastic mucosa of the larynx: A follow up study","authors":"Diana N. Kirke ,&nbsp;Diana S. Shaari ,&nbsp;Corina Din-Lovinescu ,&nbsp;Andrew Blitzer ,&nbsp;Marshall Strome","doi":"10.1016/j.amjoto.2025.104769","DOIUrl":"10.1016/j.amjoto.2025.104769","url":null,"abstract":"<div><h3>Objective</h3><div>This longitudinal case series reports our ongoing experience with metformin, an oral antihyperglycemic drug, as a possible agent to halt the progression of dysplastic lesions to carcinoma, in those with previously treated head and neck squamous cell carcinoma (HNSCC).</div></div><div><h3>Design</h3><div>Case series.</div></div><div><h3>Results</h3><div>Three patients were included who had laryngeal dysplasia (age 66.67 ± 7.09; range 59–73 years; 3 male) with a follow up time of 17 to 88 months. The average dose of metformin was 500 mg twice daily. Two patients showed complete or partial regression of the dysplastic mucosa, while the third demonstrated a worsening of dysplasia after he halted treatment for six weeks.</div></div><div><h3>Conclusion</h3><div>Metformin is a safe agent that has the potential to prevent progression of laryngeal dysplasia in patients with a history of HNSCC. Further studies are needed to verify and expand on this limited case series.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104769"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary study on classification and treatment of type I variant preauricular fistula","authors":"Kanu Lal Saha","doi":"10.1016/j.amjoto.2025.104781","DOIUrl":"10.1016/j.amjoto.2025.104781","url":null,"abstract":"","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104781"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenoid regrowth and obesity in a longitudinal pediatric cohort","authors":"Liliana Arida-Moody ,&nbsp;Daniel R.S. Habib ,&nbsp;Emma H. Neal ,&nbsp;Amy S. Whigham","doi":"10.1016/j.amjoto.2025.104764","DOIUrl":"10.1016/j.amjoto.2025.104764","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to elucidate the association between pediatric obesity and revision adenoidectomy in a cohort with longitudinal care needs.</div></div><div><h3>Methods</h3><div>Data were collected via chart review from a tertiary pediatric hospital for patients who underwent adenoidectomy from January 2015 to January 2016 and had 2 years of post-operative follow-up. Demographic, surgical, and clinical data were analyzed using logistic and Cox regression models to identify factors affecting the likelihood and timing of revision adenoidectomy.</div></div><div><h3>Results</h3><div>Of 461 patients, 115 (24.9 %) were obese at primary intervention. Secondary intervention was performed for 136 patients (29.5 %), with a median interval of 29 months between procedures. In the logistic regression, predictors of revision included younger age at primary intervention (OR = 0.844, <em>p</em> = 0.002), adenoidectomy over adenotonsillectomy as the initial surgery (OR = 0.3, <em>p</em> &lt; 0.001), higher BMI percentile (OR = 1.008, <em>p</em> = 0.048), and allergic rhinitis (OR = 1.722, <em>p</em> = 0.039). In the Cox regression, hazard was lower with adenotonsillectomy (HR = 0.358, <em>p</em> &lt; 0.001), older age at initial surgery (HR = 0.858, <em>p</em> = 0.001), and GERD (HR = 0.595, <em>p</em> = 0.05), but higher with laryngomalacia/tracheomalacia (HR = 1.909, <em>p</em> = 0.034). BMI percentile was not associated with revision timing in the Cox model. Model concordance was 0.694.</div></div><div><h3>Conclusion</h3><div>Odds of revision adenoidectomy in this population are increased with higher BMI percentile, younger age at primary intervention, undergoing initial adenoidectomy rather than adenotonsillectomy, and various comorbidities, with differing time-dependent effects. These findings support the potential role of obesity-related inflammation in adenoid hypertrophy and individualized surgical decision-making in pediatric patients with sleep disordered breathing.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104764"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of acupuncture combined with various traditional Chinese medicine therapies for peripheral facial paralysis: A systematic review and network meta-analysis","authors":"Mengzhong Li ,&nbsp;Wenjie Liang ,&nbsp;Wei Liang ,&nbsp;Jianguo Zhang ,&nbsp;Xiaoping Lei","doi":"10.1016/j.amjoto.2026.104787","DOIUrl":"10.1016/j.amjoto.2026.104787","url":null,"abstract":"<div><h3>Background and purpose</h3><div>This meta-analysis aimed to evaluate whether acupuncture combined with other traditional Chinese medicine (TCM) therapies is more effective in the treatment of peripheral facial palsy (PFP) than acupuncture alone.</div></div><div><h3>Methods</h3><div>Eight databases were searched until May 2025. Two independent reviewers extracted relevant data on study characteristics and used the Cochrane Risk of Bias Assessment Tool 2 (RoB2) to assess the risk of bias of the included studies.</div></div><div><h3>Results</h3><div>266 articles were included. Results showed that compared with acupuncture alone, acupuncture combined with tuina and cupping (surface under the cumulative ranking curve (SUCRA) = 99.33%) was the most effective intervention for improving the overall effective rate; acupuncture combined with topical application of TCM (SUCRA = 90.61%) was the optimal approach for enhancing facial nerve function (House-Brackmann (H<img>B) scale); acupuncture combined with herbal fumigation and steaming therapy (SUCRA = 80.40%) was the best intervention for improving social function (Facial Disability Index - Social Function (FDIS)) in patients with facial paralysis; acupuncture combined with pricking blood (SUCRA = 87.62%) was the most effective method for improving physical function (Facial Disability Index - Physical Function (FDIP)) in patients with facial paralysis; and acupuncture combined with cupping and pricking blood (SUCRA = 86.90%) was associated with the lowest incidence of adverse reactions.</div></div><div><h3>Conclusion</h3><div>This study showed that interventions such as acupuncture+tuina+cupping, acupuncture+topical application of TCM, acupuncture+herbal fumigation and steaming therapy, and acupuncture+pricking blood are all associated with facial nerve recovery and demonstrate superior efficacy compared with acupuncture alone.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104787"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexamethasone palmitate: A promising intratympanic treatment option for severe sudden hearing loss","authors":"Joong Ho Ahn","doi":"10.1016/j.amjoto.2025.104766","DOIUrl":"10.1016/j.amjoto.2025.104766","url":null,"abstract":"<div><div>Dexamethasone palmitate (DXP) is a lipophilic, esterified corticosteroid with sustained-release properties that may provide advantages over conventional water-soluble dexamethasone in intratympanic therapy for sudden sensorineural hearing loss (SSNHL). We report the safety and clinical outcomes of intratympanic DXP injection in three patients with profound SSNHL. All patients also received systemic steroids and hyperbaric oxygen therapy, along with six sessions of intratympanic DXP. Two patients demonstrated substantial improvement in hearing thresholds and speech discrimination within 3 months, whereas one patient who presented late showed no recovery. No adverse effects, such as pain, inflammation, or tympanic membrane complications, were observed. The increased viscosity and lipophilicity of DXP likely enhance cochlear drug delivery and prolong therapeutic retention. These findings suggest that DXP is a safe and potentially effective intratympanic option for SSNHL, particularly when administered early.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104766"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a clinical prediction model to diagnose Warthin tumor based on non-contrast computed tomography features and clinical characteristics","authors":"Danyang Chang ,&nbsp;Fan Xu ,&nbsp;Xiangming Meng ,&nbsp;Changling Sun","doi":"10.1016/j.amjoto.2025.104767","DOIUrl":"10.1016/j.amjoto.2025.104767","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to develop and validate a clinical prediction model that integrates clinical features with non-contrast CT imaging characteristics to identify Warthin tumor (WT) in the parotid gland.</div></div><div><h3>Methods</h3><div>A total of 289 patients who underwent surgical resection of parotid tumors at the Affiliated hospital of Jiangnan University from June 2018 to December 2024 were consecutively and randomly divided into training (<em>n</em> = 202) and validation (<em>n</em> = 87) cohorts at a 7:3 ratio. Demographic and non-contrast CT imaging variables were collected. Logistic regression identified predictors, and a nomogram was constructed. To further validate the model, an independent dataset comprising 84 patients from a second hospital was used. The model's performance was evaluated through receiver operating characteristic (ROC) curves, calibration curves, the Hosmer-Lemeshow test, and decision curve analysis (DCA).</div></div><div><h3>Results</h3><div>Age, smoking history, tumor distribution, earlobe position, and longitudinal-to-transverse ratio (LTR) were identified as independent predictors for differentiating WT from other parotid gland tumors. The nomogram showed high diagnostic accuracy, with the area under the curve (AUC) values of 0.942 (training), 0.937 (validation), and 0.953 (external validation). Calibration curves indicated good agreement with ideal predictions, supported by the Hosmer-Lemeshow test (<em>P</em> &gt; 0.05). DCA further demonstrated the superior clinical utility of the nomogram model.</div></div><div><h3>Conclusion</h3><div>The nomogram model incorporating clinical and non-contrast CT features demonstrates high accuracy for differentiating WT from other parotid gland tumors in clinical practice.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104767"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservation of adaptive immunity is associated with survival in invasive fungal sinusitis","authors":"Iris Lee ,&nbsp;Sonam Verma ,&nbsp;John S. Schneider ,&nbsp;Nyssa F. Farrell ,&nbsp;Peggy L. Kendall ,&nbsp;Lauren T. Roland","doi":"10.1016/j.amjoto.2025.104779","DOIUrl":"10.1016/j.amjoto.2025.104779","url":null,"abstract":"<div><h3>Background</h3><div>Invasive Fungal Sinusitis (IFS) is a deadly and morbid disease of the paranasal sinuses. Immunocompromised patients are at risk of developing IFS, and survival at 6 months is approximately 50%. Previously studied treatments such as granulocyte stimulating factor have not improved survival. Thus, the immune cells responsible for survival in this vulnerable population are not well defined.</div></div><div><h3>Objective</h3><div>The goal of this study was to immunophenotype cells associated with IFS survival.</div></div><div><h3>Methods</h3><div>Blood samples from consenting patients were collected at the time of surgery for IFS between April 2022 and December 2023. Peripheral blood mononuclear cells (PBMCs) were evaluated for major lymphoid and myeloid subsets using mass Cytometry by Time of Flight (CyTOF) between IFS survivors and non-survivors, defined by vital status 6 months after the time of diagnosis. Data were analyzed using the dimensionality reduction algorithm optimized t-distributed stochastic neighbor embedding (opt-SNE).</div></div><div><h3>Results</h3><div>Seven patients had PBMCs viable for analysis (3 survivors and 4 non-survivors). Total white blood cell counts were lower in non-survivors. Total T cell and B cell counts were decreased in non-survivors as compared to survivors, but there were no differences in other immune cell populations, such as NK cells or monocytes. Percentage differences were identified as deficiencies in CD4 T cells, particularly memory cells, in the IFS non-survivors.</div></div><div><h3>Conclusion</h3><div>Future work includes the investigation of CD4 T cells as a biomarker for IFS survival and the study of T cell manipulation or stimulation in IFS patients.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104779"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Warthin's tumor of the parotid gland: A 14-year retrospective review of surgical outcomes, diagnostic accuracy and patient-reported aesthetic satisfaction","authors":"Ethem İlhan ,&nbsp;Melek Uyar ,&nbsp;Sibel Bektaş ,&nbsp;Çağla Arukan","doi":"10.1016/j.amjoto.2025.104775","DOIUrl":"10.1016/j.amjoto.2025.104775","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the incidence, diagnostic accuracy, surgical outcomes, complications, and patient-reported aesthetic satisfaction among patients with surgically treated Warthin's tumor (WT) over a 14-year period in a single tertiary center.</div></div><div><h3>Methods</h3><div>A retrospective review of 150 patients undergoing parotidectomy (2009–2022) was performed. Fifty-four patients with histopathologically confirmed WT comprised the primary analysis group. Demographics, smoking history, preoperative diagnostics [fine-needle aspiration cytology (FNAC), ultrasonography (US), magnetic resonance imaging (MRI)], surgical technique, and outcomes were recorded. Aesthetic satisfaction was assessed in a prospective subgroup (<em>n</em> = 37) using a 5-point Likert scale. Statistical analyses were applied with significance at <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>WT accounted for 41.2 % of benign parotid tumors, nearly equal to pleomorphic adenoma (42.0 %). Mean age was 59.5 ± 8.9 years; 75.9 % were male. Mean smoking exposure was 42 ± 12.5 pack-years, and all patients with metachronous contralateral tumors continued smoking. FNAC sensitivity was 77.8 % overall and 91.3 % for adequate samples (PPV 94.4 %). US suggested WT in 5/43 (11.6 %) of reported examinations; MRI suggested WT in 34/39 (87.2 %) of US/MRI reports available. Superficial parotidectomy was performed in 70.4 % and partial superficial parotidectomy in 29.6 %. The most common complication was great auricular nerve sensory deficit (35.2 %); permanent facial nerve paralysis occurred in 1.9 %. In the aesthetic subgroup, 8.1 % rated contour deformity as “Poor/Very Poor,” and 10.8 % reported similar dissatisfaction with scarring.</div></div><div><h3>Conclusion</h3><div>Our 14-year analysis confirms that WT now constitutes a substantial proportion of benign parotid tumors, approaching the incidence of pleomorphic adenoma, with a strong association with smoking. FNAC and MRI demonstrated high diagnostic accuracy, supporting their role in reliable preoperative evaluation. While surgical treatment remains safe, postoperative sensory deficits and aesthetic concerns are not uncommon and may meaningfully affect patient satisfaction, even after limited surgery. Individualized management—particularly active surveillance for small, asymptomatic tumors in elderly or comorbid patients—may help balance oncologic safety with quality-of-life considerations.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104775"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145720103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunctive dual biologic therapy for persistent nasal symptoms in eosinophilic granulomatosis with polyangiitis (EGPA)","authors":"Giulia Gramellini ,&nbsp;Marco Borin ,&nbsp;Matteo Lazzeroni ,&nbsp;Alberto Giulio Dragonetti ,&nbsp;Pasquale Capaccio ,&nbsp;Niccolò Mevio ,&nbsp;Jan Walter Volk Schroeder","doi":"10.1016/j.amjoto.2025.104761","DOIUrl":"10.1016/j.amjoto.2025.104761","url":null,"abstract":"<div><div>Eosinophilic granulomatosis with polyangiitis (EGPA) is an eosinophilic vasculitis frequently involving both upper and lower airways, commonly associated with severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Although anti-IL-5/IL-5R biologics such as mepolizumab and benralizumab are established therapies for maintaining systemic remission, a subset of patients continues to experience refractory sinonasal symptoms. We report two EGPA cases with well-controlled systemic disease under anti-IL-5/IL-5R therapy but persistent uncontrolled CRSwNP, who were treated with add-on dupilumab. Both patients demonstrated substantial improvement in sinonasal outcomes, as reflected by reductions in SNOT-22 and nasal polyp scores, alongside maintenance of systemic remission (BVAS = 0). These findings highlight the potential role of dual biologic therapy targeting distinct inflammatory pathways in selected EGPA patients with refractory CRSwNP. Careful patient selection and close multidisciplinary monitoring are essential to ensure safety and optimize efficacy. Further studies are warranted to confirm long-term effectiveness and safety profiles.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104761"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-scale fusion vision transformer model for vocal cord leukoplakia risk stratification: A multicenter study","authors":"Jie-Lin Huang ,&nbsp;Li-Juan Li ,&nbsp;Ji-Qing Zhu ,&nbsp;Li-Zhou Dou ,&nbsp;Yu-Meng Liu ,&nbsp;Yan Ke ,&nbsp;Yu-Da Zhao ,&nbsp;Mei-Ling Wang ,&nbsp;Jian-Hui Wang ,&nbsp;Quan-Mao Zhang ,&nbsp;Xiao-Guang Ni","doi":"10.1016/j.amjoto.2026.104789","DOIUrl":"10.1016/j.amjoto.2026.104789","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to develop an artificial intelligence (AI) system for accurate three-tier risk stratification of vocal cord leukoplakia (VCL), with particular focus on distinguishing high-risk lesions (severe dysplasia and carcinoma in situ) from low-risk and malignant lesions, while enhancing diagnostic performance among clinicians with limited experience.</div></div><div><h3>Methods</h3><div>This retrospective multicenter study analyzed 8510 laryngoscopic images from 743 patients across three tertiary hospitals in China. A dual-scale Vision Transformer (ViT) architecture was constructed, integrating multi-scale feature analysis with cross-attention fusion mechanisms. The model was rigorously evaluated through internal-external validation and a prospective reader study involving 12 endoscopists of varying expertise.</div></div><div><h3>Results</h3><div>The AI system demonstrated superior performance in three-tier classification, achieving F1-scores of 0.883 (95% CI: 0.869–0.896) and 0.861 (95% CI: 0.844–0.878) for high-risk lesion identification in internal and external validation, respectively. AI assistance significantly improved junior endoscopists' sensitivity from 67.1% to 81.4% (<em>P</em> &lt; 0.001), effectively narrowing diagnostic performance disparities with senior experts. The system maintained robust generalizability across institutions, with 90.5% accuracy under heterogeneous imaging protocols.</div></div><div><h3>Conclusion</h3><div>The proposed AI framework provides a clinically effective solution for reliable VCL risk stratification and reduces diagnostic variability between clinicians. Validated across multiple centers, this dual-scale ViT approach establishes a novel paradigm for laryngoscopic diagnosis and holds significant potential to standardize diagnostic workflows in resource-limited settings.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104789"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}