Pub Date : 2025-03-18DOI: 10.1016/j.bja.2025.02.004
Yu-Hang Cai, Le-Qi Dong, John W Zhong, Zheng Lin, Cong-De Chen, Li-Bin Zhu, Xiao-Kun Lin, Peter Szmuk, Hua-Cheng Liu
Background: The optimal single i.v. bolus dose of remimazolam for induction of general anaesthesia in children is not defined. We aimed to determine the 50% (ED50) and 95% (ED95) effective doses of remimazolam for inducing loss of consciousness in children.
Methods: A total of 120 children, aged 1-12 yr, were divided into three groups, with 40 children in each group: toddler (1 to <3 yr), preschool (≥3 to <6 yr), and school-age group (≥6 to <12 yr). Each child received a single i.v. bolus of remimazolam, with doses determined using a biased coin design up-and-down method. The primary outcome was the ED50 and ED95 of remimazolam for inducing loss of consciousness. Secondary outcomes included the incidence of hypotension, respiratory depression, and adverse events.
Results: The ED50 and ED95 of remimazolam were 0.42 mg kg-1 (95% confidence interval [CI] 0.37-0.44) and 0.57 mg kg-1 (95% CI 0.48-0.59), respectively, in the toddler group; 0.41 mg kg-1 (95% CI 0.35-0.47) and 0.57 mg kg-1 (95% CI 0.50-0.59), respectively, in the preschool group; and 0.30 mg kg-1 (95% CI 0.28-0.34) and 0.43 mg kg-1 (95% CI 0.37-0.44), respectively, in the school-age group. No significant cases of hypotension, respiratory depression, bradycardia, or other adverse events occurred in any of the three groups.
Conclusions: A single i.v. bolus of remimazolam at estimated doses of 0.45-0.60 mg kg-1 for children aged 1-6 yr and 0.35-0.45 mg kg-1 for those aged 6-12 yr effectively induces loss of consciousness in children.
{"title":"ED50 and ED95 of remimazolam for loss of consciousness in young children.","authors":"Yu-Hang Cai, Le-Qi Dong, John W Zhong, Zheng Lin, Cong-De Chen, Li-Bin Zhu, Xiao-Kun Lin, Peter Szmuk, Hua-Cheng Liu","doi":"10.1016/j.bja.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.004","url":null,"abstract":"<p><strong>Background: </strong>The optimal single i.v. bolus dose of remimazolam for induction of general anaesthesia in children is not defined. We aimed to determine the 50% (ED50) and 95% (ED95) effective doses of remimazolam for inducing loss of consciousness in children.</p><p><strong>Methods: </strong>A total of 120 children, aged 1-12 yr, were divided into three groups, with 40 children in each group: toddler (1 to <3 yr), preschool (≥3 to <6 yr), and school-age group (≥6 to <12 yr). Each child received a single i.v. bolus of remimazolam, with doses determined using a biased coin design up-and-down method. The primary outcome was the ED50 and ED95 of remimazolam for inducing loss of consciousness. Secondary outcomes included the incidence of hypotension, respiratory depression, and adverse events.</p><p><strong>Results: </strong>The ED50 and ED95 of remimazolam were 0.42 mg kg<sup>-1</sup> (95% confidence interval [CI] 0.37-0.44) and 0.57 mg kg<sup>-1</sup> (95% CI 0.48-0.59), respectively, in the toddler group; 0.41 mg kg<sup>-1</sup> (95% CI 0.35-0.47) and 0.57 mg kg<sup>-1</sup> (95% CI 0.50-0.59), respectively, in the preschool group; and 0.30 mg kg<sup>-1</sup> (95% CI 0.28-0.34) and 0.43 mg kg<sup>-1</sup> (95% CI 0.37-0.44), respectively, in the school-age group. No significant cases of hypotension, respiratory depression, bradycardia, or other adverse events occurred in any of the three groups.</p><p><strong>Conclusions: </strong>A single i.v. bolus of remimazolam at estimated doses of 0.45-0.60 mg kg<sup>-1</sup> for children aged 1-6 yr and 0.35-0.45 mg kg<sup>-1</sup> for those aged 6-12 yr effectively induces loss of consciousness in children.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov (NCT06061159).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.bja.2025.01.040
Amjad Maniar, Rammurthy Kulkarni
{"title":"The radial trinity block of the upper extremity: combined block of the radial, median, and lateral cutaneous nerves of the forearm for radial fracture. Response to Br J Anaesth 2024; 134: 243-4.","authors":"Amjad Maniar, Rammurthy Kulkarni","doi":"10.1016/j.bja.2025.01.040","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.040","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.bja.2025.02.009
Bruno Garcia, Ashish K Khanna, Matthieu Legrand
Recent findings from Gutierrez del Arroyo and colleagues identified distinct sub-phenotypes in patients undergoing major noncardiac surgery based on biomarkers such as N terminal pro-brain natriuretic peptide, renin, aldosterone, and angiotensin-converting enzyme 2, which were associated with varying risks of postoperative myocardial injury. Although their findings highlight the potential of sub-phenotyping for advancing perioperative precision medicine, further research is needed to validate these sub-phenotypes and explore their role in tailoring perioperative management strategies.
{"title":"Advancing surgical outcomes through cardiovascular biomarker sub-phenotyping.","authors":"Bruno Garcia, Ashish K Khanna, Matthieu Legrand","doi":"10.1016/j.bja.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.009","url":null,"abstract":"<p><p>Recent findings from Gutierrez del Arroyo and colleagues identified distinct sub-phenotypes in patients undergoing major noncardiac surgery based on biomarkers such as N terminal pro-brain natriuretic peptide, renin, aldosterone, and angiotensin-converting enzyme 2, which were associated with varying risks of postoperative myocardial injury. Although their findings highlight the potential of sub-phenotyping for advancing perioperative precision medicine, further research is needed to validate these sub-phenotypes and explore their role in tailoring perioperative management strategies.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.bja.2025.01.038
Jashvant Poeran, Yhan Colon Iban, Haoyan Zhong, Alex Illescas, Crispiana Cozowicz, Lisa Reisinger, Jiabin Liu, Stavros Memtsoudis
{"title":"Preoperative GLP-1 agonist use is not associated with perioperative aspiration or pneumonia: an observational study using US national data.","authors":"Jashvant Poeran, Yhan Colon Iban, Haoyan Zhong, Alex Illescas, Crispiana Cozowicz, Lisa Reisinger, Jiabin Liu, Stavros Memtsoudis","doi":"10.1016/j.bja.2025.01.038","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.038","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.bja.2025.02.008
James H Bamber, Felicity Plaat
A recent report on maternal deaths in Japan attributed to anaesthesia highlights the value of a national enquiry process which can review each death to determine the likely cause. It is through national enquiries, such as the UK Confidential Enquiries into Maternal Deaths, that deficiencies in care, including anaesthetic practice, can be identified and improvements made to effect better patient outcomes. The report also underlines that safe anaesthetic practice, particularly in the challenging environment of obstetrics, is best delivered by specialists trained in anaesthesia but who might be in short supply, even in large developed countries such as Japan.
{"title":"Beyond the numbers: obstetric anaesthesia and maternal deaths.","authors":"James H Bamber, Felicity Plaat","doi":"10.1016/j.bja.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.008","url":null,"abstract":"<p><p>A recent report on maternal deaths in Japan attributed to anaesthesia highlights the value of a national enquiry process which can review each death to determine the likely cause. It is through national enquiries, such as the UK Confidential Enquiries into Maternal Deaths, that deficiencies in care, including anaesthetic practice, can be identified and improvements made to effect better patient outcomes. The report also underlines that safe anaesthetic practice, particularly in the challenging environment of obstetrics, is best delivered by specialists trained in anaesthesia but who might be in short supply, even in large developed countries such as Japan.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.bja.2025.02.014
Ana M Cabanas, Pilar Martín-Escudero, Josué Pagán, Domingo Mery
Pulse oximetry, although generally effective under ideal conditions, faces challenges in accurately estimating peripheral oxygen saturation (SpO2) in complex clinical scenarios, particularly at lower saturation levels and in patients with darker skin pigmentation. Artificial intelligence (AI) offers the potential to improve SpO2 monitoring by enabling more accurate, equitable, and accessible estimations. We highlight key challenges in developing AI-enhanced pulse oximetry, including the need for diverse and representative datasets, refined validation protocols addressing ethical concerns such as algorithmic bias, expanded SpO2 measurement ranges encompassing hypoxaemic levels, and enhanced model interpretability. We emphasise the importance of transitioning from subjective skin tone assessments to quantitative methods to ensure equity and mitigate bias. Finally, we propose a development pipeline and discuss strategies for robust, fair AI-based SpO2 monitoring, including aligning validation with global regulatory frameworks and fostering interdisciplinary collaboration. These advances will improve the reliability and fairness of pulse oximetry, ultimately contributing to enhanced global patient care.
{"title":"Technical and regulatory challenges in artificial intelligence-based pulse oximetry: a proposed development pipeline.","authors":"Ana M Cabanas, Pilar Martín-Escudero, Josué Pagán, Domingo Mery","doi":"10.1016/j.bja.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.014","url":null,"abstract":"<p><p>Pulse oximetry, although generally effective under ideal conditions, faces challenges in accurately estimating peripheral oxygen saturation (SpO<sub>2</sub>) in complex clinical scenarios, particularly at lower saturation levels and in patients with darker skin pigmentation. Artificial intelligence (AI) offers the potential to improve SpO<sub>2</sub> monitoring by enabling more accurate, equitable, and accessible estimations. We highlight key challenges in developing AI-enhanced pulse oximetry, including the need for diverse and representative datasets, refined validation protocols addressing ethical concerns such as algorithmic bias, expanded SpO<sub>2</sub> measurement ranges encompassing hypoxaemic levels, and enhanced model interpretability. We emphasise the importance of transitioning from subjective skin tone assessments to quantitative methods to ensure equity and mitigate bias. Finally, we propose a development pipeline and discuss strategies for robust, fair AI-based SpO<sub>2</sub> monitoring, including aligning validation with global regulatory frameworks and fostering interdisciplinary collaboration. These advances will improve the reliability and fairness of pulse oximetry, ultimately contributing to enhanced global patient care.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.bja.2025.01.029
Esther M Pogatzki-Zahn, Sarah De Lucia, Claudia Weinmann, Hauke Heitkamp, Lone Hummelshoj, Hiltrud Liedgens, Winfried Meissner, Katy Vincent, Jan Vollert, Peter Zahn, Ulrike Kaiser, Daniela C Rosenberger
Background: Effective perioperative pain management is crucial to prevent patient suffering, delayed recovery, chronic postsurgical pain, and long-term opioid use. However, the heterogeneous use of outcomes in studies complicates evidence synthesis and might not accurately reflect the experiences of individual patients. We initiated a consensus process to establish a core outcome set (COS) of patient-reported outcome measures (PROMs) in postoperative pain, building upon the earlier consensus on a COS of domains.
Methods: Potential PROMs were identified via systematic literature searches for the domains pain intensity (with subdomains at rest and during activity), physical function, self-efficacy, and adverse events, followed by appraisal of psychometric properties according to the COnsensus-based Standards for the selection of health Measurement INstruments methodology. Then, a consensus meeting was convened, followed by a Delphi process with an international, multiprofessional panel of stakeholders, including those with lived experience. A conclusive consensus meeting approved the final COS of PROMs.
Results: The final COS consists of one unidimensional numerical rating scale for assessing pain intensity on average, worst pain intensity, pain intensity at rest, and procedure-specific pain intensity during activity; one unidimensional scale for pain interfering with activities in bed; one procedure-specific scale for assessing physical function; the IMI-PainCare PROMPT adaptation of the Arthritis Self-Efficacy Scale for assessing self-efficacy; and the IMI-PainCare PROMPT adaptation of the Opioid-Related Symptom Distress Scale for assessing adverse events.
Conclusions: Comprehensive use of a core outcome set will help harmonise outcome assessment, facilitate comparisons between studies, promote patient-centred research, and improve postoperative pain care.
{"title":"A core outcome set of measurement instruments for assessing effectiveness and efficacy of perioperative pain management: results of the international IMI-PainCare PROMPT Delphi consensus process.","authors":"Esther M Pogatzki-Zahn, Sarah De Lucia, Claudia Weinmann, Hauke Heitkamp, Lone Hummelshoj, Hiltrud Liedgens, Winfried Meissner, Katy Vincent, Jan Vollert, Peter Zahn, Ulrike Kaiser, Daniela C Rosenberger","doi":"10.1016/j.bja.2025.01.029","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.029","url":null,"abstract":"<p><strong>Background: </strong>Effective perioperative pain management is crucial to prevent patient suffering, delayed recovery, chronic postsurgical pain, and long-term opioid use. However, the heterogeneous use of outcomes in studies complicates evidence synthesis and might not accurately reflect the experiences of individual patients. We initiated a consensus process to establish a core outcome set (COS) of patient-reported outcome measures (PROMs) in postoperative pain, building upon the earlier consensus on a COS of domains.</p><p><strong>Methods: </strong>Potential PROMs were identified via systematic literature searches for the domains pain intensity (with subdomains at rest and during activity), physical function, self-efficacy, and adverse events, followed by appraisal of psychometric properties according to the COnsensus-based Standards for the selection of health Measurement INstruments methodology. Then, a consensus meeting was convened, followed by a Delphi process with an international, multiprofessional panel of stakeholders, including those with lived experience. A conclusive consensus meeting approved the final COS of PROMs.</p><p><strong>Results: </strong>The final COS consists of one unidimensional numerical rating scale for assessing pain intensity on average, worst pain intensity, pain intensity at rest, and procedure-specific pain intensity during activity; one unidimensional scale for pain interfering with activities in bed; one procedure-specific scale for assessing physical function; the IMI-PainCare PROMPT adaptation of the Arthritis Self-Efficacy Scale for assessing self-efficacy; and the IMI-PainCare PROMPT adaptation of the Opioid-Related Symptom Distress Scale for assessing adverse events.</p><p><strong>Conclusions: </strong>Comprehensive use of a core outcome set will help harmonise outcome assessment, facilitate comparisons between studies, promote patient-centred research, and improve postoperative pain care.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.bja.2025.02.005
Ulrike M Stamer, Patricia Lavand'homme, Debora M Hofer, Antonia Barke, Beatrice Korwisi
Chronic postsurgical pain (CPSP) is associated with reduced health-related quality of life and disability. In some patients, it can result in long-term opioid use even after minor surgery. Epidemiological studies have reported highly varying rates of CPSP, largely because researchers have used different definitions with self-defined cut-offs for pain scores. With the introduction of the 11th revision of the World Health Organisation International Classification of Diseases and Related Health Problems (ICD-11), chronic pain is now recognised as an entity of its own, its biopsychosocial nature is emphasised, and its definition is standardised. Compared with the ICD-11 definition, the prevalence of CPSP might have been overestimated in previous studies. The ICD-11 provides a multifactorial assessment of pain severity, referring to pain intensity, pain-related interference, and pain-related distress, which cover the biopsychosocial aspects of chronic pain. These three scores can be added as extension codes to any pain diagnosis. Harmonisation of the CPSP criteria within the different coding levels of the ICD-11 might improve discrimination of CPSP from other chronic pain conditions not induced by surgery. Although neuropathic CPSP increases pain severity and requires alternative therapeutic approaches to nociceptive pain, a specific code to differentiate between neuropathic and non-neuropathic CPSP is not available. For clinical practice and research, the evidence-based ICD-11 definition, which provides clear-cut diagnostic criteria, should generally be used instead of pain scores alone. This will improve the comparability of data, form the basis for future diagnostic and therapeutic approaches, and facilitate communication.
{"title":"Chronic postsurgical pain in the ICD-11: implications for anaesthesiology and pain medicine.","authors":"Ulrike M Stamer, Patricia Lavand'homme, Debora M Hofer, Antonia Barke, Beatrice Korwisi","doi":"10.1016/j.bja.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.005","url":null,"abstract":"<p><p>Chronic postsurgical pain (CPSP) is associated with reduced health-related quality of life and disability. In some patients, it can result in long-term opioid use even after minor surgery. Epidemiological studies have reported highly varying rates of CPSP, largely because researchers have used different definitions with self-defined cut-offs for pain scores. With the introduction of the 11th revision of the World Health Organisation International Classification of Diseases and Related Health Problems (ICD-11), chronic pain is now recognised as an entity of its own, its biopsychosocial nature is emphasised, and its definition is standardised. Compared with the ICD-11 definition, the prevalence of CPSP might have been overestimated in previous studies. The ICD-11 provides a multifactorial assessment of pain severity, referring to pain intensity, pain-related interference, and pain-related distress, which cover the biopsychosocial aspects of chronic pain. These three scores can be added as extension codes to any pain diagnosis. Harmonisation of the CPSP criteria within the different coding levels of the ICD-11 might improve discrimination of CPSP from other chronic pain conditions not induced by surgery. Although neuropathic CPSP increases pain severity and requires alternative therapeutic approaches to nociceptive pain, a specific code to differentiate between neuropathic and non-neuropathic CPSP is not available. For clinical practice and research, the evidence-based ICD-11 definition, which provides clear-cut diagnostic criteria, should generally be used instead of pain scores alone. This will improve the comparability of data, form the basis for future diagnostic and therapeutic approaches, and facilitate communication.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.bja.2025.02.011
Andrew Bowdle, Evan D Kharasch
{"title":"Etomidate and its derivatives: time to say goodbye? Br J Anaesth 2024; 134: 11-13.","authors":"Andrew Bowdle, Evan D Kharasch","doi":"10.1016/j.bja.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.011","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}