Pub Date : 2025-10-01DOI: 10.1016/j.anpedi.2025.503957
Gema Martínez Espinosa , David Muñoz-Santanach , en representación del Grupo de Trabajo de Simulación de la Sociedad Española de Urgencias de Pediatría
{"title":"Actividades basadas en simulación: ¿cómo empezar?","authors":"Gema Martínez Espinosa , David Muñoz-Santanach , en representación del Grupo de Trabajo de Simulación de la Sociedad Española de Urgencias de Pediatría","doi":"10.1016/j.anpedi.2025.503957","DOIUrl":"10.1016/j.anpedi.2025.503957","url":null,"abstract":"","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"103 4","pages":"Article 503957"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189789","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}
Pub Date : 2025-10-01DOI: 10.1016/j.anpedi.2025.503965
Javier Alvarez Aldeán , Francisco José Alvarez García , Marta Cruz Cañete , María Fernández Prada , Laura Francisco González , Ana María Grande Tejada , Antonio Iofrío de Arce , Alejandra Méndez Sánchez , Fernando Moraga Llop , Ignacio Salamanca de la Cueva , en representación del Comité Asesor de Vacunas de la Asociación Española, de Pediatría (CAV-AEP), Sociedad Española de Infectología Pediátrica (SEIP) y Asociación Española de Vacunología (AEV)
Influenza is an important public health problem that puts healthcare systems to the test each year with outbreaks that constitute a significant social and economic burden. The proportion of the pediatric population affected during the annual influenza season ranges between 30% and 40% worldwide, with 2 to 4 million severe cases in children under 18 years of age globally. Children and adolescents are also the main transmitters of the disease.
The consensus document presented here was developed jointly by three scientific societies: the Spanish Association of Vaccinology (AEV), the Spanish Association of Pediatrics, through its Advisory Committee on Vaccines and Immunizations (CAV-AEP), and the Spanish Society of Pediatric Infectious Diseases (SEIP). Routine influenza vaccination is recommended for children from 6 months of age and for adolescents up to 17 years of age (both included). Vaccination is also recommended for any individual that could transmit the virus to groups at increased risk of developing severe forms of disease and for household or close contacts of infants aged less than 6 months. Vaccination against influenza of all health care professionals as well as pregnant women (at any time during pregnancy) is especially important. For children aged 2 years or older and adolescents, unless contraindicated, vaccination with attenuated intranasal vaccine is preferred. Efforts should be made to improve influenza vaccination coverage in all the recommended groups, with particular emphasis on at-risk groups.
{"title":"Vacunación antigripal en la infancia y la adolescencia. Consenso AEV, CAV-AEP y SEIP","authors":"Javier Alvarez Aldeán , Francisco José Alvarez García , Marta Cruz Cañete , María Fernández Prada , Laura Francisco González , Ana María Grande Tejada , Antonio Iofrío de Arce , Alejandra Méndez Sánchez , Fernando Moraga Llop , Ignacio Salamanca de la Cueva , en representación del Comité Asesor de Vacunas de la Asociación Española, de Pediatría (CAV-AEP), Sociedad Española de Infectología Pediátrica (SEIP) y Asociación Española de Vacunología (AEV)","doi":"10.1016/j.anpedi.2025.503965","DOIUrl":"10.1016/j.anpedi.2025.503965","url":null,"abstract":"<div><div>Influenza is an important public health problem that puts healthcare systems to the test each year with outbreaks that constitute a significant social and economic burden. The proportion of the pediatric population affected during the annual influenza season ranges between 30% and 40% worldwide, with 2 to 4 million severe cases in children under 18 years of age globally. Children and adolescents are also the main transmitters of the disease.</div><div>The consensus document presented here was developed jointly by three scientific societies: the Spanish Association of Vaccinology (AEV), the Spanish Association of Pediatrics, through its Advisory Committee on Vaccines and Immunizations (CAV-AEP), and the Spanish Society of Pediatric Infectious Diseases (SEIP). Routine influenza vaccination is recommended for children from 6 months of age and for adolescents up to 17 years of age (both included). Vaccination is also recommended for any individual that could transmit the virus to groups at increased risk of developing severe forms of disease and for household or close contacts of infants aged less than 6 months. Vaccination against influenza of all health care professionals as well as pregnant women (at any time during pregnancy) is especially important. For children aged 2 years or older and adolescents, unless contraindicated, vaccination with attenuated intranasal vaccine is preferred. Efforts should be made to improve influenza vaccination coverage in all the recommended groups, with particular emphasis on at-risk groups.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"103 4","pages":"Article 503965"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189731","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}
Pub Date : 2025-10-01DOI: 10.1016/j.anpedi.2025.503998
Dolores Beteta Fernández , Carlos Pérez Cánovas , Rosa Belén Martínez Egea , Julián Alcaraz Martínez , Adriana Catarina De Souza Oliveira , Manuel Pardo Ríos
Introduction
Pediatric emergency departments are high-risk environments for patient safety due to the workload, time pressure and clinical vulnerability of the population. However, there is limited evidence regarding the prevalence, characteristics and associated factors of safety incidents in this setting. Understanding these events is essential to design effective improvement strategies.
Objective
To estimate the incidence of patient safety incidents in pediatric emergency departments, describe their characteristics and identify associated factors. Multicenter, observational and descriptive study based on retrospective chart review and structured incident reporting.
Methods
We identified a total of 1102 pediatric patients treated in the emergency departments of nine Spanish hospitals during the second quarter of 2021 were identified. After excluding 49 patients who could not be reached for follow-up, the final sample included 1056 cases. Of these, 90 children experienced incidents related to healthcare, with a total of 94 incidents, as four patients experienced two incidents each. A previously validated tool was used to collect demographic, clinical and organizational data, as well as information on safety incidents.
Results
The overall proportion of patients with at least one safety incident was 8.5% (95%CI: 6.0-9.0). Most incidents caused no harm (39%) or mild to moderate harm (46%), and 13% were deemed clearly preventable. Incidents mainly occurred during emergency care and were attributed to organizational, communication or human factors. There were significant differences between hospitals (P<.01), but we found no associations with shift, triage level, or mode of arrival. The hospital continued to be a significant predictor in the multivariate analysis.
Conclusions
Patient safety incidents in pediatric emergency departments are frequent and partly preventable. The variability observed between centers, which persisted after adjusting for the catchment pediatric population and staffing characteristics, suggests the influence of structural and cultural factors specific to each institution. Context-adapted institutional strategies need to be implemented to foster a proactive safety culture and effective risk management.
{"title":"Incidentes de seguridad en urgencias pediátricas: incidencia, características y variabilidad entre centros. Estudio multicéntrico nacional","authors":"Dolores Beteta Fernández , Carlos Pérez Cánovas , Rosa Belén Martínez Egea , Julián Alcaraz Martínez , Adriana Catarina De Souza Oliveira , Manuel Pardo Ríos","doi":"10.1016/j.anpedi.2025.503998","DOIUrl":"10.1016/j.anpedi.2025.503998","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric emergency departments are high-risk environments for patient safety due to the workload, time pressure and clinical vulnerability of the population. However, there is limited evidence regarding the prevalence, characteristics and associated factors of safety incidents in this setting. Understanding these events is essential to design effective improvement strategies.</div></div><div><h3>Objective</h3><div>To estimate the incidence of patient safety incidents in pediatric emergency departments, describe their characteristics and identify associated factors. Multicenter, observational and descriptive study based on retrospective chart review and structured incident reporting.</div></div><div><h3>Methods</h3><div>We identified a total of 1102 pediatric patients treated in the emergency departments of nine Spanish hospitals during the second quarter of 2021 were identified. After excluding 49 patients who could not be reached for follow-up, the final sample included 1056 cases. Of these, 90 children experienced incidents related to healthcare, with a total of 94 incidents, as four patients experienced two incidents each. A previously validated tool was used to collect demographic, clinical and organizational data, as well as information on safety incidents.</div></div><div><h3>Results</h3><div>The overall proportion of patients with at least one safety incident was 8.5% (95%<span>C</span>I: 6.0-9.0). Most incidents caused no harm (39%) or mild to moderate harm (46%), and 13% were deemed clearly preventable. Incidents mainly occurred during emergency care and were attributed to organizational, communication or human factors. There were significant differences between hospitals (<em>P</em><.01), but we found no associations with shift, triage level, or mode of arrival. The hospital continued to be a significant predictor in the multivariate analysis.</div></div><div><h3>Conclusions</h3><div>Patient safety incidents in pediatric emergency departments are frequent and partly preventable. The variability observed between centers, which persisted after adjusting for the catchment pediatric population and staffing characteristics, suggests the influence of structural and cultural factors specific to each institution. Context-adapted institutional strategies need to be implemented to foster a proactive safety culture and effective risk management.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"103 4","pages":"Article 503998"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189686","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}
Pub Date : 2025-10-01DOI: 10.1016/j.anpedi.2025.503891
Álvaro Gimeno Díaz de Atauri , María Salomé Albi Rodríguez , Elena Pérez González , Jaime Javier Cuervo Valdés , Juan Ruiz-Canela Cáceres , Javier González de Dios , Comité de Trabajo de Pediatría Basada en la Evidencia
In this article, we discuss the methodology for the critical appraisal of clinical trials and systematic reviews. Studies of either type, when well designed and executed, provide the best evidence for clinical decision-making. Clinical trials are the primary source of evidence for evaluating therapeutic interventions, and systematic reviews analyze and synthesize research of a certain quality to answer a specific clinical question. To assess their validity, it is essential that they aim to answer a specific question in terms of population, intervention and outcomes, and that the risk of bias is reduced as much as possible during their development, from design to publication. The article addresses the steps to take to assess whether a clinical trial or systematic review meets the criteria for its results to be considered reliable (valid). Once their validity is confirmed, the magnitude and clinical relevance of the results must be assessed, in addition to their applicability to our patients in particular.
{"title":"Lectura crítica (ii): aplicación en artículos científicos sobre intervenciones terapéuticas, revisiones sistemáticas y metanálisis","authors":"Álvaro Gimeno Díaz de Atauri , María Salomé Albi Rodríguez , Elena Pérez González , Jaime Javier Cuervo Valdés , Juan Ruiz-Canela Cáceres , Javier González de Dios , Comité de Trabajo de Pediatría Basada en la Evidencia","doi":"10.1016/j.anpedi.2025.503891","DOIUrl":"10.1016/j.anpedi.2025.503891","url":null,"abstract":"<div><div>In this article, we discuss the methodology for the critical appraisal of clinical trials and systematic reviews. Studies of either type, when well designed and executed, provide the best evidence for clinical decision-making. Clinical trials are the primary source of evidence for evaluating therapeutic interventions, and systematic reviews analyze and synthesize research of a certain quality to answer a specific clinical question. To assess their validity, it is essential that they aim to answer a specific question in terms of population, intervention and outcomes, and that the risk of bias is reduced as much as possible during their development, from design to publication. The article addresses the steps to take to assess whether a clinical trial or systematic review meets the criteria for its results to be considered reliable (valid). Once their validity is confirmed, the magnitude and clinical relevance of the results must be assessed, in addition to their applicability to our patients in particular.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"103 4","pages":"Article 503891"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189724","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}
Pub Date : 2025-10-01DOI: 10.1016/j.anpedi.2025.503988
Carlos Baena-Palomino , Lorena Estepa-Pedregosa , Ana Castellano-Martínez , Moisés Rodríguez-González
{"title":"Experiencia con el bloqueo de interleucina-1 en la enfermedad de Kawasaki refractaria","authors":"Carlos Baena-Palomino , Lorena Estepa-Pedregosa , Ana Castellano-Martínez , Moisés Rodríguez-González","doi":"10.1016/j.anpedi.2025.503988","DOIUrl":"10.1016/j.anpedi.2025.503988","url":null,"abstract":"","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"103 4","pages":"Article 503988"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189725","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}
Pub Date : 2025-10-01DOI: 10.1016/j.anpedi.2025.503984
Alicia Berghezan-Suárez , David López-Martín , Ángel José Carbajo Ferreira , Parisá Khodayar-Pardo , Luis Ortiz González , Belén Aguirrezabalaga González , Ricardo Torres-Peral , Roi Piñeiro Pérez , María Natali Campo Fernández , Begoña Pérez-Moneo , Grupo de Trabajo de Gastroenteritis Aguda en Pediatría
Acute gastroenteritis (AGE) is a leading cause of morbidity and mortality in pediatric patients worldwide. Microbiological testing of AGE is reserved for prolonged or complicated cases and for patients with certain risk factors. Diagnostic tests should be selected based on availability and the clinical and epidemiological context. The following tests could be requested, depending on the suspected diagnosis: stool or blood culture, rapid tests, molecular tests, ova and parasite test or serology. Complete blood counts and acute phase reactant (APR) tests are indicated in patients with signs of severe disease. Sociodemographic and climate changes have led to an increase in the incidence of pathogens previously rare in our region (emerging pathogens), which must also be considered. Microorganisms of uncertain significance may also be detected, which should either not be treated or treated only under specific circumstances. In general, empirical antibiotherapy should not be initiated for management of AGE except in specific situations: infants aged less than 3 to 6 months with suspected bacterial AGE, patients with underlying disease, signs of sepsis, institutionalized patients or settings with risk of dissemination. In cases of AGE caused by non-Typhi Salmonella and Shiga toxin-producing Escherichia coli (STEC), targeted antibiotherapy is restricted to patients at risk of systemic infection or with prolonged diarrhea. In Spain, complications of AGE are rare, and dehydration and post-enteritis syndrome are most common.
{"title":"Documento consenso SEIP/AEPap/SEPEAP/SEGHNP/SEUP sobre el diagnóstico y tratamiento etiológico de las gastroenteritis agudas de origen infeccioso","authors":"Alicia Berghezan-Suárez , David López-Martín , Ángel José Carbajo Ferreira , Parisá Khodayar-Pardo , Luis Ortiz González , Belén Aguirrezabalaga González , Ricardo Torres-Peral , Roi Piñeiro Pérez , María Natali Campo Fernández , Begoña Pérez-Moneo , Grupo de Trabajo de Gastroenteritis Aguda en Pediatría","doi":"10.1016/j.anpedi.2025.503984","DOIUrl":"10.1016/j.anpedi.2025.503984","url":null,"abstract":"<div><div>Acute gastroenteritis (AGE) is a leading cause of morbidity and mortality in pediatric patients worldwide. Microbiological testing of AGE is reserved for prolonged or complicated cases and for patients with certain risk factors. Diagnostic tests should be selected based on availability and the clinical and epidemiological context. The following tests could be requested, depending on the suspected diagnosis: stool or blood culture, rapid tests, molecular tests, ova and parasite test or serology. Complete blood counts and acute phase reactant (APR) tests are indicated in patients with signs of severe disease. Sociodemographic and climate changes have led to an increase in the incidence of pathogens previously rare in our region (emerging pathogens), which must also be considered. Microorganisms of uncertain significance may also be detected, which should either not be treated or treated only under specific circumstances. In general, empirical antibiotherapy should not be initiated for management of AGE except in specific situations: infants aged less than 3 to 6 months with suspected bacterial AGE, patients with underlying disease, signs of sepsis, institutionalized patients or settings with risk of dissemination. In cases of AGE caused by non-Typhi <em>Salmonella</em> and Shiga toxin-producing <em>Escherichia coli</em> (STEC), targeted antibiotherapy is restricted to patients at risk of systemic infection or with prolonged diarrhea. In Spain, complications of AGE are rare, and dehydration and post-enteritis syndrome are most common.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"103 4","pages":"Article 503984"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189722","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}
Pub Date : 2025-10-01DOI: 10.1016/j.anpedi.2025.504016
Jun Sun, Ya Xiao, Shu-Qin Jiang, Hong-Ru Zhang, Jin-Bo Li, Wen-Hui Shi, Wei Wang
Introduction
There are still no effective biomarkers for the diagnosis of central precocious puberty (CPP), and single metabolic indicators (such as vitamin D or insulin) are susceptible to interference from metabolic interactions. We conducted a study to assess the correlation between the vitamin D/insulin ratio (VDIR) and CPP and the screening potential of the VDIR.
Methods
Case-control study in a sample of 170 girls aged 6 to 10 years, including 85 girls with CPP and 85 girls with normal growth and development. We collected data on growth and developmental indicators and laboratory test results for both groups. The association between the VDIR and CPP/gonadal development was assessed by means of multivariate logistic and linear regression analyses. The diagnostic value of VDIR was evaluated by means of receiver operating characteristic (ROC) curve analysis.
Results
The VDIR in the CPP group was lower than in the control group (3.45 vs 6.18). The area under the ROC curve (AUC) of the VDIR for diagnosis of CPP was 0.731, with a sensitivity of 70.59% and a specificity of 67.06%, higher compared to vitamin D alone (AUC = 0.682) or insulin alone (AUC = 0.690). The multivariate logistic/linear regression analysis revealed that for every 1-unit increase in VDIR, there was a 0.814-fold decrease in the risk of CPP and a 233.54 mm3 decrease in uterine volume.
Conclusion
By integrating the metabolic interactions between vitamin D and insulin, VDIR shows promising value in assessing the risk of CPP. As a potential biomarker, it may offer dual clinical value by enabling early screening of high-risk individuals prior to the definitive diagnosis, as well as providing guidance for personalized interventions.
{"title":"La correlación entre el ratio vitamina D/insulina y la pubertad precoz central en niñas y su potencial para el cribado","authors":"Jun Sun, Ya Xiao, Shu-Qin Jiang, Hong-Ru Zhang, Jin-Bo Li, Wen-Hui Shi, Wei Wang","doi":"10.1016/j.anpedi.2025.504016","DOIUrl":"10.1016/j.anpedi.2025.504016","url":null,"abstract":"<div><h3>Introduction</h3><div>There are still no effective biomarkers for the diagnosis of central precocious puberty (CPP), and single metabolic indicators (such as vitamin D or insulin) are susceptible to interference from metabolic interactions. We conducted a study to assess the correlation between the vitamin D/insulin ratio (VDIR) and CPP and the screening potential of the VDIR.</div></div><div><h3>Methods</h3><div>Case-control study in a sample of 170 girls aged 6 to 10 years, including 85 girls with CPP and 85 girls with normal growth and development. We collected data on growth and developmental indicators and laboratory test results for both groups. The association between the VDIR and CPP/gonadal development was assessed by means of multivariate logistic and linear regression analyses. The diagnostic value of VDIR was evaluated by means of receiver operating characteristic (ROC) curve analysis.</div></div><div><h3>Results</h3><div>The VDIR in the CPP group was lower than in the control group (3.45 vs 6.18). The area under the ROC curve (AUC) of the VDIR for diagnosis of CPP was 0.731, with a sensitivity of 70.59% and a specificity of 67.06%, higher compared to vitamin D alone (AUC<!--> <!-->=<!--> <!-->0.682) or insulin alone (AUC<!--> <!-->=<!--> <!-->0.690). The multivariate logistic/linear regression analysis revealed that for every 1-unit increase in VDIR, there was a 0.814-fold decrease in the risk of CPP and a 233.54 mm<sup>3</sup> decrease in uterine volume.</div></div><div><h3>Conclusion</h3><div>By integrating the metabolic interactions between vitamin D and insulin, VDIR shows promising value in assessing the risk of CPP. As a potential biomarker, it may offer dual clinical value by enabling early screening of high-risk individuals prior to the definitive diagnosis, as well as providing guidance for personalized interventions.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"103 4","pages":"Article 504016"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189683","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}
Pub Date : 2025-10-01DOI: 10.1016/j.anpedi.2025.503968
Irati Goienetxe Muñoz, Frederic Samson
{"title":"Las controversias en la elección de la longitud de la aguja para la canalización de acceso vascular intraóseo","authors":"Irati Goienetxe Muñoz, Frederic Samson","doi":"10.1016/j.anpedi.2025.503968","DOIUrl":"10.1016/j.anpedi.2025.503968","url":null,"abstract":"","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"103 4","pages":"Article 503968"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189726","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}
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