Clinical characteristics and short - term prognostic factors of spontaneous intracerebral hemorrhage in high-altitude plateau

doi:10.3969/j.issn.1672-6731.2025.05.009

Abstract

Abstract:

Objective: To investigate the clinical characteristics and current treatment status of spontaneous intracerebral hemorrhage (ICH) patients in Xizang Autonomous Region and to screen for factors influencing short - term poor neurological prognosis. Methods: A total of 200 spontaneous ICH patients admitted to People's Hospital of Xizang Autonomous Region between April 2020 and November 2022 were included. The modified Rankin Scale (mRS) was used to assess short - term neurological prognosis at discharge. Univariate and multivariate Logistic regression analyses were performed to identify influencing factors associated with short-term poor neurological prognosis. Results: The study included 200 patients with ICH. Their average age of onset was (65.42 ± 7.78) years, with a high prevalence of hypertension (97.50%, 195/200) and basal ganglia hemorrhage (59%, 118/200). The age at onset was older and the mortality rate (2%, 4/200) was lower than previously reported. Based on mRS score at discharge, patients were divided into a good prognosis group (0-2 points, n = 72) and a poor prognosis group (3-6 points, n = 128). Logistic regression analysis in the 148 patients without intraventricular extension showed that basal ganglia hemorrhage (OR = 7.098, 95%CI: 3.043-16.557; P = 0.000) and hemorrhage volume (per 10 ml increase; OR = 1.485, 95%CI: 1.240-1.777, P = 0.000) were risk factors for short - term poor neurological prognosis. Conclusions: Spontaneous ICH in Xizang region exhibits unique epidemiological characteristics, with a notably high prevalence of hypertension and basal ganglia hemorrhage, and a delay in the age at onset and a reduction in the mortality rate compared to previous reports. Hemorrhage volume and basal ganglia involvement are critical determinants of short - term poor neurological prognosis. Strengthening hypertension management, optimizing acute-phase treatment, and enhancing medical resource allocation are essential to improving prognosis.

Key words: Cerebral hemorrhage, Prognosis, Risk factors, Logistic models, Altitude

摘要：

目的: 总结西藏自治区自发性脑出血临床特点并分析短期神经功能预后不良影响因素。方法: 纳入2020年4月至2022年11月西藏自治区人民医院收治的200例自发性脑出血患者，出院时采用改良Rankin量表（mRS）评价短期神经功能预后，单因素和多因素Logistic回归分析筛查短期神经功能预后不良的影响因素。结果: 共200例自发性脑出血患者平均发病年龄[（65.42 ± 7.78）岁]，合并高血压比例[97.50%（195/200）]和基底节区出血比例[59%（118/200）]较高，病死率较既往报道下降[2%（4/200）]。根据出院时mRS评分分为预后良好（0 ~ 2分）组（72例）和预后不良（3 ~ 6分）组（128例）。Logistic回归分析显示，基底节区出血（OR = 7.098，95%CI：3.043 ~ 16.557；P = 0.000）和出血量增加（每增加10 ml；OR = 1.485，95%CI：1.240 ~ 1.777，P = 0.000）是自发性脑出血患者短期神经功能预后不良的危险因素。结论: 西藏地区自发性脑出血具有独特的流行病学特点，发病年龄延后，高血压和基底节区出血比例较高，病死率下降；基底节区出血和出血量增加是短期神经功能预后不良的危险因素。加强高血压管理、优化急性期治疗和提升医疗资源配置是改善预后的关键。

关键词: 脑出血, 预后, 危险因素, Logistic模型, 高海拔

Wei-wei ZHAO, Shi-yong JI, Yu-qing LIAN, Ma ZHUO, Yu-hua ZHAO, Jing YUAN. Clinical characteristics and short - term prognostic factors of spontaneous intracerebral hemorrhage in high-altitude plateau[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(5): 416-421.

赵伟伟, 季士勇, 连雨晴, 卓玛, 赵玉华, 袁晶. 高原地区自发性脑出血临床特点及短期预后影响因素分析[J]. 中国现代神经疾病杂志, 2025, 25(5): 416-421.

/ / Recommend / Download Citations

URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2025.05.009

https://journal11.magtechjournal.com/cjcnn/EN/Y2025/V25/I5/416

Figures/Tables 5

Table 1. Comparison of clinical data between good prognosis group and poor prognosis group

观察指标	预后良好组（n = 72）	预后不良组（n = 128）	统计量值	P值	观察指标	预后良好组（n = 72）	预后不良组（n = 128）	统计量值	P值
性别[例（%）]			1.051	0.305	饮酒[例（%）]	18（25.00）	36（28.13）	0.228	0.633
男性	42（58.33）	84（65.63）			入院时收缩压（ $\bar{x}$ ±s，mm Hg）	167.80 ± 24.55	169.30 ± 23.26	- 0.420	0.672
女性	30（41.67）	44（34.38）			入院时舒张压（ $\bar{x}$ ±s，mm Hg）	100.30 ± 14.94	106.00 ± 17.14	- 2.380	0.018
年龄（ $\bar{x}$ ±s，岁）	65.65 ± 8.87	65.29 ± 7.12	0.300	0.766	脑血管畸形[例（%）]	9（12.50）	10（7.81）	1.178	0.278
民族[例（%）]			—	0.749	出血部位[例（%）]			—	0.000
藏族	68（94.44）	122（95.31）			基底节区	26（36.11）	92（71.88）
其他	4（5.56）	6（4.69）			脑叶	35（48.61）	31（24.22）
居住时间[例（%）]			—	0.425	小脑	11（15.28）	3（2.34）
≥ 20年	71（98.61）	122（95.31）			脑干	0（0.00）	2（1.56）
< 20年	1（1.39）	6（4.69）			出血破入脑室[例（%）]	11（15.28）	41（32.03）	6.722	0.010
高血压[例（%）]	68（94.44）	127（99.22）	—	0.058	出血量[M（P₂₅，P₇₅），ml]*	17.00（8.40，36.10）	37.00（17.60，62.10）	- 3.974	0.000
糖尿病[例（%）]	5（6.94）	1（0.78）	—	0.024	手术治疗[例（%）]#	8（11.11）	52（40.63）	19.114	0.000
脑出血病史[例（%）]	5（6.94）	13（10.16）	0.580	0.446	发病至手术时间[M（P₂₅，P₇₅），h]#	37.00（17.60，62.10）	24.03（10.41，28.20）	0.924	0.355
吸烟[例（%）]	15（20.83）	22（17.19）	0.406	0.524

Table 1. Comparison of clinical data between good prognosis group and poor prognosis group

观察指标	预后良好组（n = 72）	预后不良组（n = 128）	统计量值	P值	观察指标	预后良好组（n = 72）	预后不良组（n = 128）	统计量值	P值
性别[例（%）]			1.051	0.305	饮酒[例（%）]	18（25.00）	36（28.13）	0.228	0.633
男性	42（58.33）	84（65.63）			入院时收缩压（ $\bar{x}$ ±s，mm Hg）	167.80 ± 24.55	169.30 ± 23.26	- 0.420	0.672
女性	30（41.67）	44（34.38）			入院时舒张压（ $\bar{x}$ ±s，mm Hg）	100.30 ± 14.94	106.00 ± 17.14	- 2.380	0.018
年龄（ $\bar{x}$ ±s，岁）	65.65 ± 8.87	65.29 ± 7.12	0.300	0.766	脑血管畸形[例（%）]	9（12.50）	10（7.81）	1.178	0.278
民族[例（%）]			—	0.749	出血部位[例（%）]			—	0.000
藏族	68（94.44）	122（95.31）			基底节区	26（36.11）	92（71.88）
其他	4（5.56）	6（4.69）			脑叶	35（48.61）	31（24.22）
居住时间[例（%）]			—	0.425	小脑	11（15.28）	3（2.34）
≥ 20年	71（98.61）	122（95.31）			脑干	0（0.00）	2（1.56）
< 20年	1（1.39）	6（4.69）			出血破入脑室[例（%）]	11（15.28）	41（32.03）	6.722	0.010
高血压[例（%）]	68（94.44）	127（99.22）	—	0.058	出血量[M（P₂₅，P₇₅），ml]*	17.00（8.40，36.10）	37.00（17.60，62.10）	- 3.974	0.000
糖尿病[例（%）]	5（6.94）	1（0.78）	—	0.024	手术治疗[例（%）]#	8（11.11）	52（40.63）	19.114	0.000
脑出血病史[例（%）]	5（6.94）	13（10.16）	0.580	0.446	发病至手术时间[M（P₂₅，P₇₅），h]#	37.00（17.60，62.10）	24.03（10.41，28.20）	0.924	0.355
吸烟[例（%）]	15（20.83）	22（17.19）	0.406	0.524

Table 2. Variable assignment table of influencing factors for short - term poor neurological prognosis in spontaneous ICH patients

变量	赋值
变量	0	1
神经功能预后	良好	不良
性别	女性	男性
民族	其他	藏族
居住史≥ 20年	否	是
高血压	否	是
糖尿病	否	是
脑出血病史	否	是
吸烟	否	是
饮酒	否	是
脑血管畸形	否	是
出血部位	其他	基底节区
出血破入脑室	否	是
手术治疗	否	是

Table 3. Univariate Logistic regression analysis of influencing factors for short - term poor neurological prognosis in spontaneous ICH patients

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
性别	0.155	0.152	1.048	0.306	1.364	0.753 ~ 2.469
年龄	- 0.006	0.019	0.101	0.751	0.994	0.958 ~ 1.032
民族	0.179	0.663	0.073	0.787	1.196	0.326 ~ 4.386
居住史≥ 20年	- 1.250	1.090	1.315	0.252	0.286	0.034 ~ 2.427
高血压	2.010	1.128	3.177	0.075	7.465	0.818 ~ 68.080
糖尿病	- 2.249	1.106	4.136	0.042	0.106	0.012 ~ 0.922
脑出血病史	0.415	0.548	0.574	0.449	1.515	0.517 ~ 4.435
吸烟	- 0.237	0.373	0.405	0.524	0.789	0.380 ~ 1.638
饮酒	0.160	0.336	0.228	0.633	1.174	0.608 ~ 2.267
脑血管畸形	- 0.522	0.485	1.158	0.282	0.593	0.229 ~ 1.535
出血部位	1.509	0.314	23.031	0.000	4.521	2.441 ~ 8.373
出血破入脑室	0.961	0.378	6.445	0.011	2.613	1.245 ~ 5.487
出血量*	0.262	0.074	12.454	0.000	1.299	1.123 ~ 1.502
手术治疗	1.700	0.416	16.700	0.000	5.472	2.422 ~ 12.364

Table 4. Multivariate stepwise Logistic regression analysis of influencing factors for short - term poor neurological prognosis in spontaneous ICH patients (Model 1)

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
出血量*	0.262	0.074	12.454	0.000	1.299	1.123 ~ 1.502
常数项	- 0.510	0.283	3.253	0.071

Table 5. Multivariate stepwise Logistic regression analysis of influencing factors for short - term poor neurological prognosis in spontaneous ICH patients (Model 2 and 3)

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
出血部位	1.960	0.432	20.567	0.000	7.098	3.043 ~ 16.557
出血量*	0.395	0.092	18.577	0.000	1.485	1.240 ~ 1.777
常数项	- 1.932	0.466	17.198	0.000

References 21

1	Puy L , Parry - Jones AR , Sandset EC , Dowlatshahi D , Ziai W , Cordonnier C . Intracerebral haemorrhage. Nat Rev Dis Primers, 2023, 9: 14. doi: 10.1038/s41572-023-00424-7
2	Lee TH . Intracerebral hemorrhage. Cerebrovasc Dis Extra, 2025, 15: 1- 8.
3	Gerstl JVE , Blitz SE , Qu QR , Yearley AG , Lassarén P , Lindberg R , Gupta S , Kappel AD , Vicenty-Padilla JC , Gaude E , Atchaneeyasakul KC , Desai SM , Yavagal DR , Peruzzotti-Jametti L , Patel NJ , Aziz - Sultan MA , Du R , Smith TR , Bernstock JD . Global, regional, and national economic consequences of stroke. Stroke, 2023, 54: 2380- 2389. doi: 10.1161/STROKEAHA.123.043131
4	Tu WJ , Zhao Z , Yin P , Cao L , Zeng J , Chen H , Fan D , Fang Q , Gao P , Gu Y , Tan G , Han J , He L , Hu B , Hua Y , Kang D , Li H , Liu J , Liu Y , Lou M , Luo B , Pan S , Peng B , Ren L , Wang L , Wu J , Xu Y , Xu Y , Yang Y , Zhang M , Zhang S , Zhu L , Zhu Y , Li Z , Chu L , An X , Wang L , Yin M , Li M , Yin L , Yan W , Li C , Tang J , Zhou M , Wang L . Estimated burden of stroke in China in 2020. JAMA Netw Open, 2023, 6: e231455. doi: 10.1001/jamanetworkopen.2023.1455
5	Hou JG , Da W , Li YM , Zhou YC , Zhao AD , Li H . Clinical characteristics of 515 cases of spontaneous intracerebral hemorrhage in Rikaze, Xizang Autonomous Region. Zhonghua Shen Jing Wai Ke Za Zhi, 2019, 35: 70- 72. doi: 10.3760/cma.j.issn.1001-2346.2019.01.018
	侯继广, 达瓦, 李一民, 周义成, 赵安迪, 李浩. 西藏自治区日喀则地区515例自发性脑出血患者的临床特点. 中华神经外科杂志, 2019, 35: 70- 72. doi: 10.3760/cma.j.issn.1001-2346.2019.01.018
6	Ren Z , Zha D , Yuan KH , Liu HD , Cao XD . Analysis of clinical characteristics of hypertensive intracerebral hemorrhage in Tibetan population in Xizang region. Xizang Ke Ji, 2018 (6): 50- 52.
	仁增, 扎多, 袁可寰, 刘欢东, 曹旭东. 西藏地区藏族高血压脑出血临床特点分析. 西藏科技, 2018 (6): 50- 52.
7	Chinese Society of Neurology , Chinese Stroke Society . Chinese guidelines for diagnosis and treatment of acute intracerebral hemorrhage 2019. Zhonghua Shen Jing Ke Za Zhi, 2019, 52: 994- 1005. doi: 10.3760/cma.j.issn.1006-7876.2019.12.003
	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019). 中华神经科杂志, 2019, 52: 994- 1005. doi: 10.3760/cma.j.issn.1006-7876.2019.12.003
8	Chinese Society of Neurology , Chinese Stroke Society . Chinese guidelines for diagnosis and treatment of intracerebral hemorrhage 2014. Zhonghua Shen Jing Ke Za Zhi, 2015, 48: 435- 444. doi: 10.3760/cma.j.issn.1006-7876.2015.06.002
	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014). 中华神经科杂志, 2015, 48: 435- 444. doi: 10.3760/cma.j.issn.1006-7876.2015.06.002
9	Wilson JT , Hareendran A , Grant M , Baird T , Schulz UG , Muir KW , Bone I . Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke, 2002, 33: 2243- 2246. doi: 10.1161/01.STR.0000027437.22450.BD
10	Tu WJ , Wang LD , Special Writing Group of China Stroke Surveillance Report . China stroke surveillance report 2021. Mil Med Res, 2023, 10: 33.
11	Guo C , Zhao YF , Zhang YZ , Guo JX , Guo J , Ma MM , Yang XD , He L , Wang ZQ , Mi SQ . Blood pressure management based on technology comprehensive demonstration of chronic disease intervention model in southwest China. Zhongguo Man Xing Bing Yu Fang Yu Kong Zhi, 2023, 31: 753- 758.
	郭藏, 赵艳芳, 张艳贞, 郭俊霞, 郭建, 马萌萌, 杨小东, 何俐, 王卓群, 米生权. 西南地区基于慢性病防控科技综合示范干预模式的血压管理研究. 中国慢性病预防与控制, 2023, 31: 753- 758.
12	Greenberg SM , Ziai WC , Cordonnier C , Dowlatshahi D , Francis B , Goldstein JN , Hemphill JC 3rd , Johnson R , Keigher KM , Mack WJ , Mocco J , Newton EJ , Ruff IM , Sansing LH , Schulman S , Selim MH , Sheth KN , Sprigg N , Sunnerhagen KS , American Heart Association/American Stroke Association . 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke, 2022, 53: e282- e361.
13	Murphy SJ , Werring DJ . Stroke: causes and clinical features. Medicine (Abingdon), 2020, 48: 561- 566.
14	Huang YW , Huang HL , Li ZP , Yin XS . Research advances in imaging markers for predicting hematoma expansion in intracerebral hemorrhage: a narrative review. Front Neurol, 2023, 14: 1176390. doi: 10.3389/fneur.2023.1176390
15	Morris NA , Simard JM , Chaturvedi S . Surgical management for primary intracerebral hemorrhage. Neurology, 2024, 103: e209714. doi: 10.1212/WNL.0000000000209714
16	Pradilla G , Ratcliff JJ , Hall AJ , Saville BR , Allen JW , Paulon G , McGlothlin A , Lewis RJ , Fitzgerald M , Caveney AF , Li XT , Bain M , Gomes J , Jankowitz B , Zenonos G , Molyneaux BJ , Davies J , Siddiqui A , Chicoine MR , Keyrouz SG , Grossberg JA , Shah MV , Singh R , Bohnstedt BN , Frankel M , Wright DW , Barrow DL , ENRICH Trial Investigators . Trial of early minimally invasive removal of intracerebral hemorrhage. N Engl J Med, 2024, 390: 1277- 1289. doi: 10.1056/NEJMoa2308440
17	Koemans EA , Chhatwal JP , van Veluw SJ , van Etten ES , van Osch MJP , van Walderveen MAA , Sohrabi HR , Kozberg MG , Shirzadi Z , Terwindt GM , van Buchem MA , Smith EE , Werring DJ , Martins RN , Wermer MJH , Greenberg SM . Progression of cerebral amyloid angiopathy: a pathophysiological framework. Lancet Neurol, 2023, 22: 632- 642. doi: 10.1016/S1474-4422(23)00114-X
18	Lin Y , Zhang YQ . Research advances in prevalence, pathogenesis, and therapeutic management of high - altitude hypertension. Zhonghua Gao Xue Ya Za Zhi, 2020, 28: 82- 86.
	林莹, 张宇清. 高原性高血压的患病率、发病机制治疗研究进展. 中华高血压杂志, 2020, 28: 82- 86.
19	Liu Y , Wang J . The application of smart healthcare in hypertension management. Man Xing Bing Xue Za Zhi, 2025, 26: 40- 42.
	刘琰, 王静. 智慧医疗在高血压管理中的应用. 慢性病学杂志, 2025, 26: 40- 42.
20	Pham K , Parikh K , Heinrich EC . Hypoxia and inflammation: insights from high - altitude physiology. Front Physiol, 2021, 12: 676782. doi: 10.3389/fphys.2021.676782
21	Yuan R , Wang D , Liu M , Liu J , He Y , Deng Y , Lei C , Hao Z , Tao W , Liu B , Chang X , Wang Q , Tan G . Long-term prognosis of spontaneous intracerebral hemorrhage on the Tibetan plateau: a prospective cohort study at 2 hospitals. World Neurosurg, 2016, 93: 6- 10. doi: 10.1016/j.wneu.2016.05.064

[1]	Yun-xiu HUANG, Ya-nan WANG, Dong LIU, Bo WU, Jun-feng LIU. Research progress on the relationship between novel blood inflammatory markers and hemorrhagic transformation after ischemic stroke [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(5): 367-374.
[2]	Hui-zhen SONG, Xin CHENG, Ya SU. Prognostic prediction for lobar hemorrhage based on CT imaging markers [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(5): 375-380.
[3]	Hai-zhou HU, Sheng-de LI, Jun NI. Association between acute - phase volume load and clinical outcome in branch atheromatous disease-related stroke: a multicenter prospective cohort study [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(5): 381-389.
[4]	Jun-shan WANG, Wei-wei ZHAO, Ma ZHUO, Yu-xiu CHEN, Yu-hua ZHAO, Jing YUAN. Imaging characteristics of cerebral small vessel disease in high-altitude plateau [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(5): 390-395.
[5]	Chun-yu WANG, Ai-qin DONG, Wen-hui WANG, Hai-liu ZHANG. Study on the relationship between the total burden of arteriosclerotic cerebral small vessel disease and non-high-density lipoprotein cholesterol [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(5): 396-402.
[6]	Lu-lu PEI, Yuan CHAI, Jun-zhe YANG, Wen-zheng RONG, Yu-ming XU, Bo SONG. Predictive value of ASTRAL score modified by triglyceride glucose index for prognosis in ischemic stroke [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(5): 403-410.
[7]	ZHU Jin-zhao, XIE Wei-zheng, ZHANG Jian-gang, FENG Guang. Clinical effect analysis of recanalization treatment for acute ischemic stroke with large infarct core caused by intracranial atherosclerotic stenosis and cardiac embolism [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(5): 441-446.
[8]	Jia-qi ZHANG, Yang LIU, Yi SHI, Zhi-qiang REN, Bing-sha HAN, Guang FENG. Clinical study of mild hypothermia therapy after endovascular mechanical thrombectomy for acute anterior circulation massive cerebral infarction [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(4): 323-331.
[9]	Xuan ZOU, Xi-yue JING, Wen-juan ZHAO. Analysis of risk factors of respiratory and cardiac arrest after medullary infarction [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(4): 332-344.
[10]	Yang LIU, Wen-yi ZHANG, Yun-peng WANG, Kun ZHAO, Jian WANG, Ai-xian LIU. Analysis of influencing factors for subcutaneous effusion after cranioplasty [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(4): 345-349.
[11]	AIZIMAITIJIANG·Ainiwaer, PAREHATIJIANG·Yizimu, ABUDUKEYOUMU·Abudujilili. Application of 3D Slicer in the comprehensive management of spontaneous intracerebral hemorrhage [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(4): 350-356.
[12]	Jing-tao JU, Xin CHEN, Jia-bin LIU, Yong-sheng HU, Lei-ming WANG, Nan CHEN. Clinical characteristics analysis of focal cortical dysplasia with negative MRI [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(3): 259-264.
[13]	Yang NI, Fang ZHANG, Yong ZHANG, Jin-zhi LIN. Analysis of the relationship between neurovascular compression and primary trigeminal neuralgia based on radiomics [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(8): 668-673.
[14]	Jiao CHENG, Yong ZHEN, Bing-wei SONG, Jian-wei LIU, Ping GENG. Prognostic analysis of patients with high-grade aneurysmal subarachnoid hemorrhage complicated with acute intracranial hematoma [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(7): 567-572.
[15]	Bo TAN, Yue ZHANG, Jia-qiang YANG, Yong-dong LIU, Yang JIAO, Bei WANG. Risk factors analysis and Bayesian network model construction of hydrocephalus after decompressive craniectomy in patients with cerebral hernia after traumatic brain injury [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(6): 442-449.

Please choose a citation manager

Content to export