Stefan Steiner,Florian Frommlet,Florian Schwarzhans,Georg Fischer,Maximilian Pirrung,Michael Pircher,Christoph Hitzenberger,Clemens Vass
BACKGROUND/AIMSTo describe the relationship between the novel biomarker retinal nerve fibre layer thickness slope (RNFL-S), and visual field sensitivity (VFS) in healthy and early glaucoma eyes.METHODSThis prospective cross-sectional study of 50 early glaucoma and 139 healthy eyes analysed RNFL-S locally along retinal nerve fibre trajectories that were automatically traced and centred on 24-2 and 10-2 visual field (VF) test points. Corresponding virtual B-scans were extracted from stitched wide-field polarisation-sensitive optical coherence tomography images. A linear mixed-effects model (LMM) assessed the association between VFS and the factors RNFL-S, glaucoma status and age.RESULTSThe average VF mean deviation was -3.11±1.51 dB in glaucoma (mean age: 63.0±9.3 years) and -0.36±1.10 dB in healthy eyes (mean age: 47.9±16.3 years). In healthy subjects, VFS and the corresponding RNFL-S were 31.8±2.4 dB (12.5±2.9 µm/mm) in the upper hemisphere and 32.4±2.2 dB (12.5±2.5 µm/mm) in the lower hemisphere. In glaucoma patients, these values were significantly lower: 27.5±7.0 dB (8.6 ± 3.9 µm/mm, p<0.001) in the upper hemisphere and 30.1±4.3 dB (10.5±3.3 µm/mm, p<0.001) in the lower hemisphere. Significant point-wise Spearman correlation coefficients (up to r=0.61) were observed, particularly in the upper VF hemisphere within the central 10° and close to the optic nerve head. The LMM showed a positive association between VFS and RNFL-S (β=0.0415, SE=0.0023, p<0.001, R²=0.1885). Glaucoma was significantly associated with lower VFS (β=-2.468, SE=0.069, p<0.001). Age negatively correlated with VFS (β=-0.048, SE=0.002, p<0.001).CONCLUSIONLocal RNFL-S is significantly correlated with VFS, highlighting its potential as a biomarker for focal glaucoma damage.
{"title":"The retinal nerve fibre layer thickness slope: a localised biomarker of the structure-function relationship in early glaucoma.","authors":"Stefan Steiner,Florian Frommlet,Florian Schwarzhans,Georg Fischer,Maximilian Pirrung,Michael Pircher,Christoph Hitzenberger,Clemens Vass","doi":"10.1136/bjo-2025-328330","DOIUrl":"https://doi.org/10.1136/bjo-2025-328330","url":null,"abstract":"BACKGROUND/AIMSTo describe the relationship between the novel biomarker retinal nerve fibre layer thickness slope (RNFL-S), and visual field sensitivity (VFS) in healthy and early glaucoma eyes.METHODSThis prospective cross-sectional study of 50 early glaucoma and 139 healthy eyes analysed RNFL-S locally along retinal nerve fibre trajectories that were automatically traced and centred on 24-2 and 10-2 visual field (VF) test points. Corresponding virtual B-scans were extracted from stitched wide-field polarisation-sensitive optical coherence tomography images. A linear mixed-effects model (LMM) assessed the association between VFS and the factors RNFL-S, glaucoma status and age.RESULTSThe average VF mean deviation was -3.11±1.51 dB in glaucoma (mean age: 63.0±9.3 years) and -0.36±1.10 dB in healthy eyes (mean age: 47.9±16.3 years). In healthy subjects, VFS and the corresponding RNFL-S were 31.8±2.4 dB (12.5±2.9 µm/mm) in the upper hemisphere and 32.4±2.2 dB (12.5±2.5 µm/mm) in the lower hemisphere. In glaucoma patients, these values were significantly lower: 27.5±7.0 dB (8.6 ± 3.9 µm/mm, p<0.001) in the upper hemisphere and 30.1±4.3 dB (10.5±3.3 µm/mm, p<0.001) in the lower hemisphere. Significant point-wise Spearman correlation coefficients (up to r=0.61) were observed, particularly in the upper VF hemisphere within the central 10° and close to the optic nerve head. The LMM showed a positive association between VFS and RNFL-S (β=0.0415, SE=0.0023, p<0.001, R²=0.1885). Glaucoma was significantly associated with lower VFS (β=-2.468, SE=0.069, p<0.001). Age negatively correlated with VFS (β=-0.048, SE=0.002, p<0.001).CONCLUSIONLocal RNFL-S is significantly correlated with VFS, highlighting its potential as a biomarker for focal glaucoma damage.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"7 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joanna Mair,Lana Bush,Sophia Halliday,David McMaster,Edward Sellon,Marcus H Colyer,Scott F McClellan,Grant A Justin,Annette K Hoskin,Kara M Cavuoto,James Leong,Andrés Rousselot,Fasika Woreta,Kyle E Miller,William G Gensheimer,Thomas H Williamson,Felipe E Dhawahir-Scala,Peter Shah,Gangadhara Sundar,Robert A Mazzoli,Ferenc Kuhn,Malcolm Woodcock,Stephanie Watson,Renata S M Gomes,Rupesh Agrawal,Richard J Blanch
IMPORTANCEPrimary repair of open globe injury (OGI) is typically undertaken urgently. Imaging plays an important role in the preoperative assessment, including detection of an OGI and presence of an intraocular foreign body (IOFB). Evidence is lacking on the utility of preoperative imaging in diagnosing OGI and IOFB.OBJECTIVEThe primary objective is to assess the role of pre-operative imaging in OGI. Studies including patients who had sustained an OGI and reporting the findings of radiologic imaging in pre-operative assessment of OGI were eligible for inclusion.DATA SOURCESA systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, searching the Cochrane Central Register of Controlled Trials, PubMed, Medline and ClinicalTrials.gov.STUDY SELECTIONProspective and retrospective studies reporting preoperative imaging assessment after OGI were included with no restriction on language or start date up until 15 December 2023.DATA EXTRACTION AND SYNTHESISEleven studies, 10 retrospective and 1 prospective, with a total of 1126 patients were included, of which 8 assessed computed tomography (CT) detection of OGI and 3 assessed ultrasound for the detection of IOFB. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) tool.MAIN OUTCOMES AND MEASURESSensitivity of CT detection for OGI compared with clinical examination by an ophthalmologist and IOFB detection using intraoperative examination findings as gold standard. Preoperative B Scan ultrasonography (US) sensitivity for IOFB detection compared with CT.RESULTSCT was 74% sensitive (95% CI 66.4% to 80.0%) and 93% specific (95% CI 88.2% to 95.4%) in OGI detection compared with clinical diagnosis. CT findings associated with OGI included scleral deformity, altered anterior chamber (AC) depth, lens abnormality and vitreous haemorrhage. CT was 69% sensitive (95% CI 51.4% to 82.0%) for IOFB detection using intraoperative examination findings as the gold standard.Preoperative B Scan US was not examined for OGI detection but had 86% sensitivity for IOFB detection (95% CI 77% to 92%) compared with the gold standard of CT, but safety with respect to pressure on the globe extruding intraocular contents was not studied.CONCLUSIONS AND RELEVANCECT had moderate sensitivity but high specificity for OGI detection, and therefore cannot replace clinical assessment by an ophthalmologist. A negative CT does not exclude an IOFB.
开放性球损伤（OGI）的初级修复通常是紧急进行的。影像学检查在术前评估中起着重要的作用，包括OGI的检测和眼内异物（IOFB）的存在。术前影像学在OGI和IOFB诊断中的应用尚缺乏证据。目的探讨术前影像学在OGI诊断中的作用。包括持续OGI患者并报告术前OGI评估中放射成像结果的研究符合纳入条件。根据PRISMA（系统评价和荟萃分析首选报告项目）声明进行系统评价，检索Cochrane中央对照试验注册库、PubMed、Medline和ClinicalTrials.gov.STUDY selection纳入报告OGI后术前影像学评估的前瞻性和回顾性研究，不受语言或开始日期限制，截止日期为2023年12月15日。资料提取与综合纳入11项研究，10项回顾性研究，1项前瞻性研究，共纳入1126例患者，其中8例评估OGI的CT检测，3例评估IOFB的超声检测。使用诊断准确性研究质量评估工具-2 （QUADAS-2）工具评估偏倚风险。CT检测OGI的敏感性与眼科医生的临床检查和以术中检查结果为金标准的IOFB检测相比较。术前B超（US）对IOFB检测的敏感性与CT比较。结果与临床诊断相比，sct检测OGI的敏感性为74% (95% CI 66.4% ~ 80.0%)，特异性为93% （95% CI 88.2% ~ 95.4%）。与OGI相关的CT表现包括巩膜畸形、前房（AC）深度改变、晶状体异常和玻璃体出血。以术中检查结果为金标准，CT对IOFB检测的敏感性为69% （95% CI为51.4% ~ 82.0%）。术前B扫描US未检查OGI检测，但与CT金标准相比，IOFB检测灵敏度为86% (95% CI为77%至92%)，但未研究球体挤压眼内内容物的安全性。结论：和relevance ect对OGI检测的敏感性中等，但特异性较高，因此不能取代眼科医生的临床评估。CT阴性不排除IOFB。
{"title":"Use of preoperative imaging in open globe injury management: a systematic review.","authors":"Joanna Mair,Lana Bush,Sophia Halliday,David McMaster,Edward Sellon,Marcus H Colyer,Scott F McClellan,Grant A Justin,Annette K Hoskin,Kara M Cavuoto,James Leong,Andrés Rousselot,Fasika Woreta,Kyle E Miller,William G Gensheimer,Thomas H Williamson,Felipe E Dhawahir-Scala,Peter Shah,Gangadhara Sundar,Robert A Mazzoli,Ferenc Kuhn,Malcolm Woodcock,Stephanie Watson,Renata S M Gomes,Rupesh Agrawal,Richard J Blanch","doi":"10.1136/bjo-2025-327387","DOIUrl":"https://doi.org/10.1136/bjo-2025-327387","url":null,"abstract":"IMPORTANCEPrimary repair of open globe injury (OGI) is typically undertaken urgently. Imaging plays an important role in the preoperative assessment, including detection of an OGI and presence of an intraocular foreign body (IOFB). Evidence is lacking on the utility of preoperative imaging in diagnosing OGI and IOFB.OBJECTIVEThe primary objective is to assess the role of pre-operative imaging in OGI. Studies including patients who had sustained an OGI and reporting the findings of radiologic imaging in pre-operative assessment of OGI were eligible for inclusion.DATA SOURCESA systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, searching the Cochrane Central Register of Controlled Trials, PubMed, Medline and ClinicalTrials.gov.STUDY SELECTIONProspective and retrospective studies reporting preoperative imaging assessment after OGI were included with no restriction on language or start date up until 15 December 2023.DATA EXTRACTION AND SYNTHESISEleven studies, 10 retrospective and 1 prospective, with a total of 1126 patients were included, of which 8 assessed computed tomography (CT) detection of OGI and 3 assessed ultrasound for the detection of IOFB. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) tool.MAIN OUTCOMES AND MEASURESSensitivity of CT detection for OGI compared with clinical examination by an ophthalmologist and IOFB detection using intraoperative examination findings as gold standard. Preoperative B Scan ultrasonography (US) sensitivity for IOFB detection compared with CT.RESULTSCT was 74% sensitive (95% CI 66.4% to 80.0%) and 93% specific (95% CI 88.2% to 95.4%) in OGI detection compared with clinical diagnosis. CT findings associated with OGI included scleral deformity, altered anterior chamber (AC) depth, lens abnormality and vitreous haemorrhage. CT was 69% sensitive (95% CI 51.4% to 82.0%) for IOFB detection using intraoperative examination findings as the gold standard.Preoperative B Scan US was not examined for OGI detection but had 86% sensitivity for IOFB detection (95% CI 77% to 92%) compared with the gold standard of CT, but safety with respect to pressure on the globe extruding intraocular contents was not studied.CONCLUSIONS AND RELEVANCECT had moderate sensitivity but high specificity for OGI detection, and therefore cannot replace clinical assessment by an ophthalmologist. A negative CT does not exclude an IOFB.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"3 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Automated pupillometry (AP) has been studied in established optic neuropathies. This prospective, sequential AP evaluation of 62 newly diagnosed adult patients with pulmonary/extra-pulmonary tuberculosis, showed a statistically significant change in the amplitude of contraction (p=0.018), percent pupillary contraction and velocity of dilation (p=0.003). Although there was a significant decrease in retinal nerve fibre layer thickness in three quadrants (p<0.001) and an increase in the latency of pattern visual evoked potential (p<0.001), none of these changes reached the pre-defined cut-off values for subclinical ethambutol-induced optic neuropathy. Temporal quadrant retinal nerve fibre layer change is correlated with pupillometry changes. AP holds promise for the early detection of ethambutol-induced optic neuropathy.
{"title":"Evaluation of automated pupillometry for early detection of ethambutol-induced optic neuropathy.","authors":"Paromita Dutta,Sachin Verma,Palash Patni,Parul Jain,Sumeet Singla,Kartika Anand,Sonam Singh,Namita Kedia,Yashita Rao","doi":"10.1136/bjo-2025-328575","DOIUrl":"https://doi.org/10.1136/bjo-2025-328575","url":null,"abstract":"Automated pupillometry (AP) has been studied in established optic neuropathies. This prospective, sequential AP evaluation of 62 newly diagnosed adult patients with pulmonary/extra-pulmonary tuberculosis, showed a statistically significant change in the amplitude of contraction (p=0.018), percent pupillary contraction and velocity of dilation (p=0.003). Although there was a significant decrease in retinal nerve fibre layer thickness in three quadrants (p<0.001) and an increase in the latency of pattern visual evoked potential (p<0.001), none of these changes reached the pre-defined cut-off values for subclinical ethambutol-induced optic neuropathy. Temporal quadrant retinal nerve fibre layer change is correlated with pupillometry changes. AP holds promise for the early detection of ethambutol-induced optic neuropathy.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"49 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mathilde Mussmann von Arenstorff,Line Kessel,Marie Louise Roed Rasmussen,Per Riise,Daniella Bach-Holm
BACKGROUNDThe purpose of this study is to assess the 24-month outcomes of trabeculotomy in paediatric patients with steroid-induced ocular hypertension or glaucoma who did not achieve adequate intraocular pressure (IOP) control under maximal medical therapy.METHODSA retrospective case series was conducted at Copenhagen University Hospital-Rigshospitalet between February 2018 and January 2022. 13 eyes of eight consecutive paediatric patients (aged 7-17 years) undergoing trabeculotomy for steroid-induced ocular hypertension or glaucoma were included. IOP, the number of pressure-lowering medications (PLMs) used, steroid exposure, visual acuity and postoperative complications were documented over a 24-month follow-up. Complete success was defined as achieving IOP of ≤21 mm Hg without the need for PLMs.RESULTSMean preoperative IOP was 29.7 mm Hg despite intensive use of PLMs. Postoperatively, mean IOP decreased significantly, remaining below 16 mm Hg at all postoperative follow-ups with a mean IOP of 15.1 mm Hg at 24 months. All eyes were off PLMs postoperatively, and complete success was achieved in all eyes through 24 months with no postoperative complications. Visual acuity showed slight improvement, though this was not statistically significant. Despite continued corticosteroid use for underlying conditions, no IOP elevation recurred.CONCLUSIONTrabeculotomy is a safe and effective surgical option for paediatric steroid-induced ocular hypertension or glaucoma, ensuring long-term IOP control without the need for further medication or surgical intervention. This procedure should be considered early in paediatric steroid responders when medical therapy fails to manage IOP adequately, minimising the risk of steroid-induced glaucoma.
背景：本研究的目的是评估小梁切开术治疗类固醇性高眼压或青光眼患者24个月的预后，这些患者在最大药物治疗下眼压（IOP）未得到足够的控制。方法于2018年2月至2022年1月在哥本哈根大学医院进行回顾性病例系列研究。连续8例（7-17岁）因激素性高眼压或青光眼接受小梁切开术的13只眼。在24个月的随访中记录了IOP、使用的降压药（PLMs）数量、类固醇暴露、视力和术后并发症。完全成功被定义为眼压≤21 mm Hg而不需要plm。结果尽管大量使用PLMs，术前平均眼压为29.7 mm Hg。术后平均IOP显著下降，所有术后随访均低于16 mm Hg， 24个月时平均IOP为15.1 mm Hg。所有眼术后均无PLMs，术后24个月全部成功，无术后并发症。视力略有改善，但没有统计学意义。尽管继续使用皮质类固醇治疗基础疾病，没有IOP升高复发。结论小梁切开术是治疗儿童类固醇性高眼压或青光眼的安全有效的手术选择，可确保长期IOP控制，无需进一步的药物治疗或手术干预。当药物治疗不能充分控制IOP时，应在对类固醇有反应的儿童早期考虑该手术，以尽量减少类固醇性青光眼的风险。
{"title":"Trabeculotomy outcomes in paediatric patients with steroid-induced ocular hypertension or glaucoma: a case series and literature review.","authors":"Mathilde Mussmann von Arenstorff,Line Kessel,Marie Louise Roed Rasmussen,Per Riise,Daniella Bach-Holm","doi":"10.1136/bjo-2025-327519","DOIUrl":"https://doi.org/10.1136/bjo-2025-327519","url":null,"abstract":"BACKGROUNDThe purpose of this study is to assess the 24-month outcomes of trabeculotomy in paediatric patients with steroid-induced ocular hypertension or glaucoma who did not achieve adequate intraocular pressure (IOP) control under maximal medical therapy.METHODSA retrospective case series was conducted at Copenhagen University Hospital-Rigshospitalet between February 2018 and January 2022. 13 eyes of eight consecutive paediatric patients (aged 7-17 years) undergoing trabeculotomy for steroid-induced ocular hypertension or glaucoma were included. IOP, the number of pressure-lowering medications (PLMs) used, steroid exposure, visual acuity and postoperative complications were documented over a 24-month follow-up. Complete success was defined as achieving IOP of ≤21 mm Hg without the need for PLMs.RESULTSMean preoperative IOP was 29.7 mm Hg despite intensive use of PLMs. Postoperatively, mean IOP decreased significantly, remaining below 16 mm Hg at all postoperative follow-ups with a mean IOP of 15.1 mm Hg at 24 months. All eyes were off PLMs postoperatively, and complete success was achieved in all eyes through 24 months with no postoperative complications. Visual acuity showed slight improvement, though this was not statistically significant. Despite continued corticosteroid use for underlying conditions, no IOP elevation recurred.CONCLUSIONTrabeculotomy is a safe and effective surgical option for paediatric steroid-induced ocular hypertension or glaucoma, ensuring long-term IOP control without the need for further medication or surgical intervention. This procedure should be considered early in paediatric steroid responders when medical therapy fails to manage IOP adequately, minimising the risk of steroid-induced glaucoma.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"33 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND/AIMSDeveloping high-quality multiple-choice questions (MCQs) for medical education is a challenging and time-consuming task. This study aimed to assess the applicability of Chat Generative Pre-trained Transformer (ChatGPT) in generating MCQs for ophthalmology residents.METHODSChatGPT 4 was used to generate 100 MCQs, while an additional 100 MCQs were authored by university faculty. Item-writing flaws in both sets of questions were evaluated by a single reviewer. A quality assessment panel, consisting of board-certified ophthalmology subspecialists, compared the quality of two sets. Ophthalmology residents then answered all MCQs in a randomised order. The item difficulty and discrimination indices were calculated and compared between the two sets of questions.RESULTSItem-writing flaws were more frequent in ChatGPT-generated MCQs (56%) compared with human-authored MCQs (27%, p<0.001). While ChatGPT-generated questions were comparable to human-written ones in most quality parameters, the distractor quality was significantly higher in human-generated MCQs (p=0.006). The mean resident scores were 46.5±9.5 for the ChatGPT-generated MCQs and 49.0±10.9 for the human-written MCQs (p=0.051). The difficulty index was 0.47±0.21 and 0.51±0.19, respectively (p=0.12). The discrimination index was significantly lower in the ChatGPT questions (0.20±0.19 vs 0.28±0.16, p<0.001).CONCLUSIONSWhile ChatGPT can efficiently generate MCQs for ophthalmology residents, it has notable limitations, including higher rates of item-writing flaws and lower-quality distractors. Additionally, ChatGPT-generated MCQs are less effective at distinguishing high-performing from low-performing examinees. Integrating ChatGPT with human expertise is essential to enhance the quality and reliability of artificial intelligence-generated MCQs.
背景/目的为医学教育开发高质量的多项选择题（mcq）是一项具有挑战性且耗时的任务。本研究旨在评估聊天生成预训练转换器（ChatGPT）在眼科住院医师mcq生成中的适用性。方法使用schatgpt 4生成100个mcq，另外100个mcq由大学教师撰写。两组问题的项目写作缺陷都是由一个评论者来评估的。由委员会认证的眼科专科医生组成的质量评估小组比较了两组的质量。然后眼科住院医生按随机顺序回答所有mcq。计算并比较两组题目的题目难度和辨别性指标。结果chatgpt生成的mcq（56%）比人工编写的mcq （27%, p<0.001）更常见。虽然chatgpt生成的问题在大多数质量参数上与人工编写的问题相当，但人工生成的mcq的分心物质量明显更高（p=0.006）。chatgpt生成的mcq的平均居民得分为46.5±9.5，人工书写的mcq的平均居民得分为49.0±10.9 （p=0.051）。难度指数分别为0.47±0.21和0.51±0.19 （p=0.12）。ChatGPT问题的歧视指数显著低于前者（0.20±0.19 vs 0.28±0.16,p<0.001）。结论ChatGPT可以有效地为眼科住院医师生成mcq，但存在写题缺陷率高、干扰物质量低等明显的局限性。此外，chatgpt生成的mcq在区分表现优异和表现不佳的考生方面效果较差。将ChatGPT与人类专业知识相结合对于提高人工智能生成的mcq的质量和可靠性至关重要。
{"title":"Applicability of ChatGPT to generate multiple-choice questions for ophthalmology resident exam.","authors":"Sepehr Feizi,Firouze Hatami,Sina Khosravi Mirzaei,Mohammad Hasan Shahriari,Mohammad Reza Dolikhani,Siavash Shirzadeh-Barough,Hamed Esfandiari","doi":"10.1136/bjo-2025-327632","DOIUrl":"https://doi.org/10.1136/bjo-2025-327632","url":null,"abstract":"BACKGROUND/AIMSDeveloping high-quality multiple-choice questions (MCQs) for medical education is a challenging and time-consuming task. This study aimed to assess the applicability of Chat Generative Pre-trained Transformer (ChatGPT) in generating MCQs for ophthalmology residents.METHODSChatGPT 4 was used to generate 100 MCQs, while an additional 100 MCQs were authored by university faculty. Item-writing flaws in both sets of questions were evaluated by a single reviewer. A quality assessment panel, consisting of board-certified ophthalmology subspecialists, compared the quality of two sets. Ophthalmology residents then answered all MCQs in a randomised order. The item difficulty and discrimination indices were calculated and compared between the two sets of questions.RESULTSItem-writing flaws were more frequent in ChatGPT-generated MCQs (56%) compared with human-authored MCQs (27%, p<0.001). While ChatGPT-generated questions were comparable to human-written ones in most quality parameters, the distractor quality was significantly higher in human-generated MCQs (p=0.006). The mean resident scores were 46.5±9.5 for the ChatGPT-generated MCQs and 49.0±10.9 for the human-written MCQs (p=0.051). The difficulty index was 0.47±0.21 and 0.51±0.19, respectively (p=0.12). The discrimination index was significantly lower in the ChatGPT questions (0.20±0.19 vs 0.28±0.16, p<0.001).CONCLUSIONSWhile ChatGPT can efficiently generate MCQs for ophthalmology residents, it has notable limitations, including higher rates of item-writing flaws and lower-quality distractors. Additionally, ChatGPT-generated MCQs are less effective at distinguishing high-performing from low-performing examinees. Integrating ChatGPT with human expertise is essential to enhance the quality and reliability of artificial intelligence-generated MCQs.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"23 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abhishek Das, Parag K Shah, Sajini Panthalodi, Prema Subramaniam, Narendran Venkatapathy
Background: Retinoblastoma is the most common intraocular tumour in children. This study aimed to assess the visual outcomes and risk factors leading to visual impairment in children with retinoblastoma in the Indian population.
Methods: This is a single-centre retrospective analysis of all patients with unilateral or bilateral retinoblastoma presenting from the year 2014 to mid-2024.
Results: A total of 426 eyes in 306 patients were included in the study. 240 (78.43%) had unilateral macular tumours, while 45 (14.71%) had bilateral macular tumours. 29 (24.17%) patients were classified as visually impaired, and 22 (18.33%) patients were legally blind. The visual impairment and legal blindness observed in groups D and E (55.18% vs 68.18%) was statistically significant compared with groups A-C, with a p value of <0.05. Visual impairment and legal blindness were noted in only 27.59% and 0.05% of patients without macular tumours. Three patients had motor and speech delay. Out of 120 patients with bilateral tumour, 45 successfully underwent occlusion therapy.
Conclusion: Macular involvement and late-stage presentation were major predictors of poor vision. This study underscores the importance of early diagnosis and treatment, and improved access to paediatric vision screening and visual rehabilitation.
背景：视网膜母细胞瘤是儿童最常见的眼内肿瘤。本研究旨在评估印度人群中视网膜母细胞瘤儿童的视力结局和导致视力损害的危险因素。方法：对2014年至2024年中期所有单侧或双侧视网膜母细胞瘤患者进行单中心回顾性分析。结果：306例患者共426只眼纳入研究。单侧黄斑肿瘤240例（78.43%），双侧黄斑肿瘤45例（14.71%）。视障29例（24.17%），法定失明22例（18.33%）。与a - c组相比，D组和E组的视力损害和法定失明（55.18% vs 68.18%）有统计学意义，p值为。结论：黄斑受累和晚期表现是视力不良的主要预测因素。这项研究强调了早期诊断和治疗的重要性，以及改善儿童视力筛查和视力康复的机会。
{"title":"Visual outcomes in retinoblastoma: an analysis of 426 eyes in an Indian cohort.","authors":"Abhishek Das, Parag K Shah, Sajini Panthalodi, Prema Subramaniam, Narendran Venkatapathy","doi":"10.1136/bjo-2025-327687","DOIUrl":"10.1136/bjo-2025-327687","url":null,"abstract":"<p><strong>Background: </strong>Retinoblastoma is the most common intraocular tumour in children. This study aimed to assess the visual outcomes and risk factors leading to visual impairment in children with retinoblastoma in the Indian population.</p><p><strong>Methods: </strong>This is a single-centre retrospective analysis of all patients with unilateral or bilateral retinoblastoma presenting from the year 2014 to mid-2024.</p><p><strong>Results: </strong>A total of 426 eyes in 306 patients were included in the study. 240 (78.43%) had unilateral macular tumours, while 45 (14.71%) had bilateral macular tumours. 29 (24.17%) patients were classified as visually impaired, and 22 (18.33%) patients were legally blind. The visual impairment and legal blindness observed in groups D and E (55.18% vs 68.18%) was statistically significant compared with groups A-C, with a p value of <0.05. Visual impairment and legal blindness were noted in only 27.59% and 0.05% of patients without macular tumours. Three patients had motor and speech delay. Out of 120 patients with bilateral tumour, 45 successfully underwent occlusion therapy.</p><p><strong>Conclusion: </strong>Macular involvement and late-stage presentation were major predictors of poor vision. This study underscores the importance of early diagnosis and treatment, and improved access to paediatric vision screening and visual rehabilitation.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"89-93"},"PeriodicalIF":3.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhenbang Ruan,Jinyun Jiang,Shengsong Xu,Mingxin Lu,Wenlong Hao,Chuqi Xiang,Zhouyue Li,Xiao Yang,Yin Hu
AIMSTo identify simple and practical predictors and develop predictive models for the long-term efficacy of orthokeratology (ortho-k) treatment in myopic children.METHODSThe training and external validation cohorts were composed of children with myopia who received ortho-k treatment from two separate prospective studies conducted at Zhongshan Ophthalmic Centre, respectively. Baseline variables and the first-month change in axial length (AL) were entered into logistic regression to develop predictive models to assess the 1-year efficacy of ortho-k treatment on retarding AL elongation. Nomograms and an online calculator were used to present the final models, and receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) were used to assess model performance in both the training and external validation cohorts.RESULTSThe training and external validation cohorts comprised 150 and 88 children with myopia, respectively. Age and the first-month AL change were included in the final predictive model for excessive myopia progression with area under the ROC curves (AUC) above 0.84. Only the first-month AL change was included in the final predictive model for rapid myopia progression with AUC above 0.85. All the discrimination, calibration and clinical net benefit performed excellently in the training and external validation cohorts. The models were integrated into an open-source online risk calculator.CONCLUSIONSThe first-month AL change and age are simple and practical predictors for the long-term efficacy of ortho-k treatment in children with myopia. Predicting long-term ortho-k efficacy after the first month will provide eye care practitioners with guidance to evaluate subsequent outcomes and adjust follow-up plans.
{"title":"Development and validation of predictive models based on the first-month axial length change for the long-term efficacy of orthokeratology in myopic children.","authors":"Zhenbang Ruan,Jinyun Jiang,Shengsong Xu,Mingxin Lu,Wenlong Hao,Chuqi Xiang,Zhouyue Li,Xiao Yang,Yin Hu","doi":"10.1136/bjo-2025-327171","DOIUrl":"https://doi.org/10.1136/bjo-2025-327171","url":null,"abstract":"AIMSTo identify simple and practical predictors and develop predictive models for the long-term efficacy of orthokeratology (ortho-k) treatment in myopic children.METHODSThe training and external validation cohorts were composed of children with myopia who received ortho-k treatment from two separate prospective studies conducted at Zhongshan Ophthalmic Centre, respectively. Baseline variables and the first-month change in axial length (AL) were entered into logistic regression to develop predictive models to assess the 1-year efficacy of ortho-k treatment on retarding AL elongation. Nomograms and an online calculator were used to present the final models, and receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) were used to assess model performance in both the training and external validation cohorts.RESULTSThe training and external validation cohorts comprised 150 and 88 children with myopia, respectively. Age and the first-month AL change were included in the final predictive model for excessive myopia progression with area under the ROC curves (AUC) above 0.84. Only the first-month AL change was included in the final predictive model for rapid myopia progression with AUC above 0.85. All the discrimination, calibration and clinical net benefit performed excellently in the training and external validation cohorts. The models were integrated into an open-source online risk calculator.CONCLUSIONSThe first-month AL change and age are simple and practical predictors for the long-term efficacy of ortho-k treatment in children with myopia. Predicting long-term ortho-k efficacy after the first month will provide eye care practitioners with guidance to evaluate subsequent outcomes and adjust follow-up plans.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"370 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Hillenmayer, Bjoern Lofi, Sabrina Langhans, Carolin Elhardt, Armin Wolf, Christian Maximilian Wertheimer
Background: In an ophthalmology emergency department, determining treatment urgency is crucial for patient safety and the efficient use of resources. The aim of this study was to use artificial intelligence to develop a neural network and evaluate its accuracy in predicting treatment urgency.
Methods: In a retrospective study, a medical history questionnaire consisting of a free-text section and checkbox questions was given to 1715 patients on arrival and the responses were used as input data. The data were labelled as either emergency or non-urgent according to the patients' diagnosis and divided into a training and a test dataset. A bidirectional encoder representations from transformers (BERT) neural network for language processing was concatenated with a multilayer perceptron (MLP), and the result was processed by another MLP. Performance metrics were determined on the test dataset. Particular emphasis was placed on explainable artificial intelligence methods.
Results: The combination of BERT and MLP achieved the highest F1 score of 0.81, with sensitivity of 0.89 and specificity of 0.58. The three ophthalmologists achieved F1 scores of 0.77, 0.75 and 0.73, respectively. Most of the input features that were identified by explainable artificial intelligence methods as being responsible for the network's decision correspond to clinically relevant features for the emergency/non-urgent decision.
Conclusions: A neural network was developed to identify treatment urgency based on natural language data and checkbox questions which could complement the initial assessment. Future studies could focus on validation and improving accuracy, as well as integrating the network into workflows and discussing ethical implications.
{"title":"Neural network for natural language processing to determine treatment urgency in an ophthalmology emergency department.","authors":"Anna Hillenmayer, Bjoern Lofi, Sabrina Langhans, Carolin Elhardt, Armin Wolf, Christian Maximilian Wertheimer","doi":"10.1136/bjo-2025-327824","DOIUrl":"10.1136/bjo-2025-327824","url":null,"abstract":"<p><strong>Background: </strong>In an ophthalmology emergency department, determining treatment urgency is crucial for patient safety and the efficient use of resources. The aim of this study was to use artificial intelligence to develop a neural network and evaluate its accuracy in predicting treatment urgency.</p><p><strong>Methods: </strong>In a retrospective study, a medical history questionnaire consisting of a free-text section and checkbox questions was given to 1715 patients on arrival and the responses were used as input data. The data were labelled as either emergency or non-urgent according to the patients' diagnosis and divided into a training and a test dataset. A bidirectional encoder representations from transformers (BERT) neural network for language processing was concatenated with a multilayer perceptron (MLP), and the result was processed by another MLP. Performance metrics were determined on the test dataset. Particular emphasis was placed on explainable artificial intelligence methods.</p><p><strong>Results: </strong>The combination of BERT and MLP achieved the highest F1 score of 0.81, with sensitivity of 0.89 and specificity of 0.58. The three ophthalmologists achieved F1 scores of 0.77, 0.75 and 0.73, respectively. Most of the input features that were identified by explainable artificial intelligence methods as being responsible for the network's decision correspond to clinically relevant features for the emergency/non-urgent decision.</p><p><strong>Conclusions: </strong>A neural network was developed to identify treatment urgency based on natural language data and checkbox questions which could complement the initial assessment. Future studies could focus on validation and improving accuracy, as well as integrating the network into workflows and discussing ethical implications.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"17-24"},"PeriodicalIF":3.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12772578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiu Juan Zhang, Yuzhou Zhang, You Juan Zhang, Jun Yu, Fang Yao Tang, Yi Li, Suey Yeung, Ka Wai Kam, Kunal Agrawal, Nicholas Chieh Loh, Patrick Ip, Ian Ck Wong, Wei Zhang, Alvin L Young, Clement C Tham, Chi Pui Pang, Li Jia Chen, Jason C Yam
Purpose: To evaluate the associations between omega-3 polyunsaturated fatty acids (ω-3 PUFAs) and other dietary factors with myopia.
Methods: A total of 1005 Chinese children, aged from 6 to 8 years, from a population-based Hong Kong Children Eye Study, were included in the analysis. Diet was assessed using a validated food-frequency questionnaire. Cycloplegic spherical equivalent (SE) refraction was assessed with an autorefractometer, and axial length (AL) by an IOL Master.
Results: AL was longest in the lowest quartile group of ω-3 PUFAs intake, compared with the highest (adjusted mean (95% CI), 23.29 (23.17 to 23.40) mm vs 23.08 (22.96 to 23.19) mm, p=0.01; p-trend=0.02) after adjusting for age, sex, body mass index, near-work time, outdoor time, and parental myopia history. The corresponding trends were observed in SE (-0.13 (-0.32 to 0.07) D in the lowest and 0.23 (0.03 to 0.42) D in the highest quartile groups, p=0.01; p-trend=0.01). In contrast, AL was longest in the highest quartile group of saturated fatty acids (SFA) intake, compared with the lowest (23.30 (23.17 to 23.42) mm vs 23.13 (23.01 to 23.24) mm, p=0.05; p-trend=0.04). The corresponding trends were observed in SE (-0.12 (-0.33 to 0.09) D in the highest and 0.13 (-0.04 to 0.31) D in the lowest quartile group, p=0.06; p-trend=0.04). A lower intake of ω-3 PUFAs was associated with myopia (p-trend=0.006). None of the other nutrients were associated with SE or AL or myopia.
Conclusions: Intake of ω-3 PUFAs is a protective factor against myopia, while higher SFA intake is a risk factor. Our findings indicated a possible effect of diet on myopia, of which ω-3 PUFAs intake may play a protective role against myopia development in children.
{"title":"Dietary omega-3 polyunsaturated fatty acids as a protective factor of myopia: the Hong Kong Children Eye Study.","authors":"Xiu Juan Zhang, Yuzhou Zhang, You Juan Zhang, Jun Yu, Fang Yao Tang, Yi Li, Suey Yeung, Ka Wai Kam, Kunal Agrawal, Nicholas Chieh Loh, Patrick Ip, Ian Ck Wong, Wei Zhang, Alvin L Young, Clement C Tham, Chi Pui Pang, Li Jia Chen, Jason C Yam","doi":"10.1136/bjo-2024-326872","DOIUrl":"10.1136/bjo-2024-326872","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the associations between omega-3 polyunsaturated fatty acids (ω-3 PUFAs) and other dietary factors with myopia.</p><p><strong>Methods: </strong>A total of 1005 Chinese children, aged from 6 to 8 years, from a population-based Hong Kong Children Eye Study, were included in the analysis. Diet was assessed using a validated food-frequency questionnaire. Cycloplegic spherical equivalent (SE) refraction was assessed with an autorefractometer, and axial length (AL) by an IOL Master.</p><p><strong>Results: </strong>AL was longest in the lowest quartile group of ω-3 PUFAs intake, compared with the highest (adjusted mean (95% CI), 23.29 (23.17 to 23.40) mm vs 23.08 (22.96 to 23.19) mm, p=0.01; p-trend=0.02) after adjusting for age, sex, body mass index, near-work time, outdoor time, and parental myopia history. The corresponding trends were observed in SE (-0.13 (-0.32 to 0.07) D in the lowest and 0.23 (0.03 to 0.42) D in the highest quartile groups, p=0.01; p-trend=0.01). In contrast, AL was longest in the highest quartile group of saturated fatty acids (SFA) intake, compared with the lowest (23.30 (23.17 to 23.42) mm vs 23.13 (23.01 to 23.24) mm, p=0.05; p-trend=0.04). The corresponding trends were observed in SE (-0.12 (-0.33 to 0.09) D in the highest and 0.13 (-0.04 to 0.31) D in the lowest quartile group, p=0.06; p-trend=0.04). A lower intake of ω-3 PUFAs was associated with myopia (p-trend=0.006). None of the other nutrients were associated with SE or AL or myopia.</p><p><strong>Conclusions: </strong>Intake of ω-3 PUFAs is a protective factor against myopia, while higher SFA intake is a risk factor. Our findings indicated a possible effect of diet on myopia, of which ω-3 PUFAs intake may play a protective role against myopia development in children.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"101-106"},"PeriodicalIF":3.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDThere are limited treatment options to improve vision in patients with infantile nystagmus. We aimed to examine the use of repeated visual stimulation with Gabor patches to improve vision.METHODSA prospective randomised (3:1) controlled single-blind study. Included were patients aged 9-55 years with infantile nystagmus, treated in one tertiary referral centre in central Israel. The treatment group underwent visual stimulation for 4 months, which consisted of treatment sessions of approximately 30 min, 3-4 times a week, using web-based dedicated software. Controls were followed without treatment.RESULTS26 patients were treated, and 10 served as controls. Mean age was 22.47±12 years. 12/26 (46%) of treated subjects achieved driving licence best corrected visual acuity (BCVA) (20/40) versus 1/10 (10%) of controls. Distance BCVA improved by 0.11±0.07 logMAR (one line) in treated patients compared with 0.013±0.06 logMAR in controls (p<0.001). Near BCVA improved by 0.20±0.18 logMAR (2 lines) in treated patients compared with 0.06±0.06 logMAR in controls (p=0.040). 88% (8/9) of study patients who had no stereopsis prior to treatment achieved stereopsis (mean 630') as opposed to 25% (1/4) of controls (p=0.10). Mean stereoacuity and contrast sensitivity improved by 802±730' and 292±391% in the study group as opposed to 246±376' and 152±67% in controls, respectively (p=0.031; p=0.157).CONCLUSIONSVisual perceptual learning using Gabor patches resulted in a significant improvement in near and distance visual acuity, as well as stereopsis. This modality may represent a promising non-invasive treatment option for improving visual function in patients with infantile nystagmus.
{"title":"Efficacy of perceptual learning among patients with infantile nystagmus: a prospective single-blind randomised controlled trial.","authors":"Idan Hecht,Claudia Yahalom,Ora Abaev,Adi Einan-Lifshitz,Eran Pras,Nir Erdinest,Sigal Zmujack-Yehiam","doi":"10.1136/bjo-2025-328227","DOIUrl":"https://doi.org/10.1136/bjo-2025-328227","url":null,"abstract":"BACKGROUNDThere are limited treatment options to improve vision in patients with infantile nystagmus. We aimed to examine the use of repeated visual stimulation with Gabor patches to improve vision.METHODSA prospective randomised (3:1) controlled single-blind study. Included were patients aged 9-55 years with infantile nystagmus, treated in one tertiary referral centre in central Israel. The treatment group underwent visual stimulation for 4 months, which consisted of treatment sessions of approximately 30 min, 3-4 times a week, using web-based dedicated software. Controls were followed without treatment.RESULTS26 patients were treated, and 10 served as controls. Mean age was 22.47±12 years. 12/26 (46%) of treated subjects achieved driving licence best corrected visual acuity (BCVA) (20/40) versus 1/10 (10%) of controls. Distance BCVA improved by 0.11±0.07 logMAR (one line) in treated patients compared with 0.013±0.06 logMAR in controls (p<0.001). Near BCVA improved by 0.20±0.18 logMAR (2 lines) in treated patients compared with 0.06±0.06 logMAR in controls (p=0.040). 88% (8/9) of study patients who had no stereopsis prior to treatment achieved stereopsis (mean 630') as opposed to 25% (1/4) of controls (p=0.10). Mean stereoacuity and contrast sensitivity improved by 802±730' and 292±391% in the study group as opposed to 246±376' and 152±67% in controls, respectively (p=0.031; p=0.157).CONCLUSIONSVisual perceptual learning using Gabor patches resulted in a significant improvement in near and distance visual acuity, as well as stereopsis. This modality may represent a promising non-invasive treatment option for improving visual function in patients with infantile nystagmus.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"15 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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