Clinical and experimental rheumatology最新文献

{"title":"Obesity in primary Sjögren's disease.","authors":"Ivette Cruz-Bautista, Donaji Gómez-Velasco, Ariel García-Torralba, Carlos A Aguilar-Salinas, Gabriela Hernandez-Molina","doi":"10.55563/clinexprheumatol/9d0mr2","DOIUrl":"https://doi.org/10.55563/clinexprheumatol/9d0mr2","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the prevalence of obesity in primary Sjögren's disease (SjD), and assess its association with clinical/serologic features, disease activity, damage, and sicca symptoms.</p><p><strong>Methods: </strong>Transversal study that included 91 patients. We registered demographics, comorbidities, glandular/extra-glandular and serologic variables. We assessed the Schirmer-I test and non-stimulated salivary flow, and scored the cumulative ESSDAI, SSDDI and ESSPRI scores. We measured the body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). We defined obesity as a BMI ≥30 kg/m2. Central obesity was defined as WC >90 cm and >80 cm; or by a WHR >0.90 and >0.85, for men and women, respectively. All patients underwent bioimpedance analysis to measure body fat mass index (FMI). An elevated/high FMI was classified as obese.</p><p><strong>Results: </strong>According to BMI, 18 patients were obese (19.7%), while 33 (36.2%) were obese according to WC, 48 (52.7%) according to WHR, and 37(40.6%) according to FMI. When we compared obese vs non-obese patients according to BMI, the first group had a higher prevalence of anti-Ro/SSA antibodies. When we then performed the same groups comparison, but now using the WC, WHR and FMI definitions, the multivariate analysis showed an association between SSDDI and obesity.</p><p><strong>Conclusions: </strong>According to BMI, at least 20% of patients were obese, this prevalence increased to 40% when BIA was used, with a higher prevalence found in central obesity. Obesity did not impact the symptoms and disease activity but might be associated with damage. Our results may have implications for weight reduction in these patients.</p>","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Triple-combination therapy did not improve prognosis in anti-MDA5 positive dermatomyositis: a multicentre longitudinal cohort study by You et al.","authors":"Wilmer Rojas-Zuleta","doi":"10.55563/clinexprheumatol/spyyh8","DOIUrl":"https://doi.org/10.55563/clinexprheumatol/spyyh8","url":null,"abstract":"","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data from a multicentric international study unveils a neglected association between chronic non-bacterial osteomyelitis and inflammatory bowel diseases.","authors":"Caterina Matucci-Cerinic, Yagmur Bayindir, Chiara Longo, Francesco Mori, Francesca Alessi, Matteo Vergani, Silvia Rosina, Alessandro Consolaro, Stefano Volpi, Roberta Caorsi, Serena Arrigo, Marco Gattorno, Seza Ozen, Clara Malattia","doi":"10.55563/clinexprheumatol/2pobji","DOIUrl":"https://doi.org/10.55563/clinexprheumatol/2pobji","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the clinical, serological, radiological characteristics and response to treatments of patients with chronic non-bacterial osteomyelitis (CNO) associated with inflammatory bowel diseases (C-IBD) in comparison to CNO patients without gastrointestinal disease.</p><p><strong>Methods: </strong>Patients with C-IBD followed in the Rheumatology Department of the Istituto Gaslini, Genova, and Hacettepe Hospital, Ankara, were retrospectively enrolled in the Eurofever Registry and compared to a group of CNO patients. A literature review on paediatric C-IBD was also performed.</p><p><strong>Results: </strong>19 C-IBD patients were compared to 57 CNO. In C-IBD, disease onset was characterised by osteoarticular symptoms in 73.6%, by gastrointestinal symptoms in 10.5%, and was simultaneous in 15.8%. Spinal involvement was more frequent in CNO (p<0.05), while sacroiliac involvement was more frequent in C-IBD (p<0.005). 42% of C-IBD presented low-grade fever (p<0.05, 15% of CNO). All C-IBD presented a CRP elevation, present in only 45% of CNO (p<0.0001). In 68.4% of C-IBD, CRP remained elevated and became negative only after IBD treatment was started. Moreover, 58% of C-IBD patients presented microcytic anaemia (present in 17.6% CNO, p=0.0005). Fecal calprotectin resulted positive in 100% of C-IBD and 10% of CNO (p<0.0001).</p><p><strong>Conclusions: </strong>This is the largest cohort of paediatric C-IBD reported in the literature. The persistence of inflammation and the presence of microcytic anaemia were associated with the development of an IBD. Given the frequent absence of intestinal symptoms, screening with fecal calprotectin is suggested in all CNO patients that present a persistent CRP elevation despite treatment, and have microcytic anaemia.</p>","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Use of upadacitinib in giant cell arteritis.","authors":"Daniel Blockmans, Weihan Zhao, Arathi R Setty, Peter A Merkel","doi":"10.55563/clinexprheumatol/ozaczo","DOIUrl":"https://doi.org/10.55563/clinexprheumatol/ozaczo","url":null,"abstract":"","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the metabolic score for insulin resistance in patients with systemic lupus erythematosus.","authors":"Antonio Aznar-Esquivel, Marta Hernández-González, María García-González, Fuensanta Gómez-Bernal, Juan Carlos Quevedo-Abeledo, Cristina Almeida-Santiago, Amparo Molina-Tercero, Elena Heras-Recuero, Antonia De Vera-González, Alejandra González-Delgado, Beatriz Tejera-Segura, Miguel Ángel González-Gay, Iván Ferraz-Amaro","doi":"10.55563/clinexprheumatol/m42g9r","DOIUrl":"10.55563/clinexprheumatol/m42g9r","url":null,"abstract":"<p><strong>Objectives: </strong>The Metabolic Score for Insulin Resistance (METS-IR) is a novel, non-insulin-based marker used to assess insulin resistance and cardiovascular risk in healthy individuals. Systemic lupus erythematosus (SLE) is an autoimmune disease associated with an increased risk of cardiovascular disease. This study aimed to calculate METS-IR in a large cohort of patients with SLE and to examine its relationship with disease characteristics and cardiovascular comorbidities.</p><p><strong>Methods: </strong>A total of 308 patients with SLE were recruited. METS-IR was calculated, and the activity (SLEDAI and SLEDAS) and damage index (SDI) scores, full lipid profile, insulin resistance indices through HOMA2 (Homeostasis Model Assessment) calculation and carotid subclinical atherosclerosis were assessed. A multivariable linear regression analysis was conducted to examine the relationship between METS-IR and clinical as well as laboratory disease characteristics, with a particular focus on cardiovascular comorbidities.</p><p><strong>Results: </strong>METS-IR was not associated with SLE-related disease duration, activity, or damage. However, C-reactive protein levels, as well as positivity for anticardiolipin IgG and anti-beta2 glycoprotein I IgG antibodies, were independently associated with higher METS-IR values after multivariable analysis. Additionally, after adjusting for covariates, apolipoprotein B and A1 levels, along with the atherogenic index, showed significant positive associations with METS-IR. Furthermore, higher serum insulin and C-peptide levels, as well as HOMA-derived measures of insulin resistance and beta cell function, were positively and significantly correlated with elevated METS-IR.</p><p><strong>Conclusions: </strong>In patients with SLE, METS-IR remains associated with cardiometabolic parameters, including lipid profile and insulin resistance. However, disease-specific factors such as disease activity and accumulated damage show no association with METS-IR.</p>","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of visceral adipose tissue with inflammation and functional impairment in women with Sjögren's disease.","authors":"Andre S Franco, Igor H Murai, Thomas H Yang, Virginia L N Bonoldi, Valeria de Falco Caparbo, Lissiane Guedes, Diogo S Domiciano, Sandra G Pasoto, Camille P Figueiredo, Rosa M R Pereira","doi":"10.55563/clinexprheumatol/fa4tn3","DOIUrl":"https://doi.org/10.55563/clinexprheumatol/fa4tn3","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the association between visceral adipose tissue (VAT) levels and inflammation, disease activity, and functional impairment in women with primary Sjögren's Disease (SjD).</p><p><strong>Methods: </strong>We included 100 female patients with SjD from a tertiary care clinic who met the ACR/EULAR 2016 classification criteria. Disease activity was assessed using the ESSDAI and ESSPRI scores, while cumulative damage was evaluated by the SSDI. Inflammatory markers, synovitis (via ultrasound), and functional disability using the HAQ were measured. Body composition, including VAT, was analysed using dual-energy X-ray absorptiometry. Handgrip strength and physical activity (Baecke questionnaire) were also assessed. Patients were categorised into VAT tertiles, and comparisons were made to healthy controls. Correlations between VAT, disease activity, and synovitis were analysed using multiple regression models.</p><p><strong>Results: </strong>The patients had a mean age of 50.5±9.3 years, BMI of 28.2±5.6 kg/m², and median disease duration of 8 years. The highest VAT tertile was associated with a higher prevalence of synovitis (75.7% vs. 51.5%; p=0.041), lower handgrip strength (p=0.025), and higher HAQ scores (p<0.001). VAT mass was significantly correlated with obesity (p<0.001), functional disability (p=0.002), and ESSPRI (p=0.01). Postmenopausal patients had significantly higher VAT levels than premenopausal patients (p=0.005). There were no significant correlations between VAT and inflammation.</p><p><strong>Conclusions: </strong>Elevated VAT levels in SjD are associated with increased disease activity, a higher prevalence of synovitis, and greater functional disability, suggesting that VAT may contribute to the functional impairment observed in SjD.</p>","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lupus or not? Idiopathic full house glomerulonephritis: a rare nephropathy with unexpectedly severe outcome.","authors":"Savino Sciascia, Martina Cozzi, Amin Fadaeibahreini, Massimo Radin, Irene Cecchi, Antonella Barreca, Giorgio Amore, Emanuele De Simone, Roberta Fenoglio, Dario Roccatello","doi":"10.55563/clinexprheumatol/fl31td","DOIUrl":"10.55563/clinexprheumatol/fl31td","url":null,"abstract":"<p><strong>Objectives: </strong>A full-house pattern at immunofluorescence in kidney biopsies is usually associated with lupus nephritis. The cases that do not meet criteria for diagnosis of systemic lupus erythematosus (SLE) and have no secondary causes are classified as idiopathic full house (non-Lupus) nephropathy (iFH-N), which is a poorly defined entity. We aimed to evaluate the clinical presentation, renal outcome and development of SLE in the long term.</p><p><strong>Methods: </strong>We carried out a retrospective observational study from 2012 to 2022 on patients with iFH-N, i.e. having a full-house pattern at immunofluorescence, but not meeting the criteria for the diagnosis of SLE and without a secondary cause.</p><p><strong>Results: </strong>Of 2210 patients, 91 presented with full-house pattern at immunofluorescence: 84 had the criteria for SLE diagnosis, 2 had secondary causes, 5 were idiopathic. iFH-N cases were all young females with histological pattern of membranous nephropathy and impaired kidney function, at presentation two had a nephrotic syndrome, three a nephrotic range proteinuria. Mean serum creatinine was 2.1 mg/dl (SD± 0.47), mean eGFR 35.2 ml/min/1.73m2 (SD±11), mean proteinuria 7.1 gr/24h (SD±3.2). Four had negative antinuclear antibodies; none had anti-dsDNA, anti-extractable nuclear antigens, antiphospholipid antibodies; three had low C3 levels. All received aggressive immunosuppression (IS), including steroids, cyclophosphamide, mycophenolate mofetil or Intensified B Cell Depletion Protocol. Mean follow-up was 7.4 year (SD ± 2.4). Four patients (80%) developed end stage renal disease, three within 24 months, one patient chronic kidney disease stage 4. One subject developed SLE after two years.</p><p><strong>Conclusions: </strong>All patients with iFH-N had similar clinical presentation, appeared to be refractory to aggressive IS, and had poor renal outcome.</p>","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applications of ultrasound in autoimmune diseases: a bibliometric study (2008-2024).","authors":"Zhihao Qiu, Wenhui Zhu, Jiayue Zhou, Ye Shen, Ruibo Xia, Kepeng Yang, Zhengfu Li, Yanjie Liu","doi":"10.55563/clinexprheumatol/53qm54","DOIUrl":"https://doi.org/10.55563/clinexprheumatol/53qm54","url":null,"abstract":"<p><strong>Objectives: </strong>Autoimmune diseases (ADs) are chronic inflammatory disorders characterised by systemic or organ-specific immune hyperactivation. Ultrasound (US), a radiation-free, cost-effective, and operator-friendly imaging modality, holds significant potential for clinical management of ADs. This study aims to map the global research landscape of US in ADs through bibliometric analysis.</p><p><strong>Methods: </strong>English-language articles and reviews were retrieved from the Web of Science Core Collection. CiteSpace was used for cluster analysis and burst detection of research; VOSviewer generated co-occurrence networks; Biblioshiny R package visualised contributions by countries, institutions, authors, journals, citations, and keywords.</p><p><strong>Results: </strong>A total of 1333 publications (2008-2024) were analysed. France emerged as the leading contributor in influence metrics, with Assistance Publique-Hôpitaux de Paris as the central collaborative hub. Key researchers included Craig Sable, Andrea Beaton, and Emmy Okello. Core journals were Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques and Clinical and Experimental Rheumatology. Current research priorities focus on rheumatic heart disease (RHD) and rheumatoid arthritis (RA), while glandular and intestinal ultrasonography show emerging potential.</p><p><strong>Conclusions: </strong>Over the past 16 years, US has demonstrated versatile roles in ADs, validating its clinical utility. Future priorities include reducing the disease burden of RHD and advancing precision medicine in RA through US-guided strategies.</p>","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anifrolumab in systemic lupus erythematosus: real-world experience from a single academic tertiary care centre.","authors":"Paul Classen, Simone Boedecker-Lips, Vanessa Tomalla, Daniel Kraus, Andreas Kommer, Marco Stortz, Arndt Weinmann, Myriam Meineck, Sabrina Saurin, Matthias Plath, Janine Riepl, Julia Weinmann-Menke","doi":"10.55563/clinexprheumatol/728zl6","DOIUrl":"https://doi.org/10.55563/clinexprheumatol/728zl6","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effectiveness and safety of anifrolumab, a human monoclonal antibody to type I interferon receptor subunit 1, on systemic lupus erythematosus (SLE) at a German academic tertiary care centre in a real-life setting.</p><p><strong>Methods: </strong>We evaluated disease activity, clinical course and adverse events in a single-centre prospective observational cohort study of 26 SLE patients at baseline, 3, 6, 9, 12, 18 and 24 months of anifrolumab treatment. The decision to initiate therapy was made according to current guidelines (EULAR 2024).</p><p><strong>Results: </strong>There was a significant reduction in the disease activity indices SLE-Disease Activity Index 2000 (SLEDAI-2k) (6.0±3.9 vs. 2.8±2.6, p≤0.001) and European Consensus Lupus Activity Measurement Index (ECLAM) (1.92 ±1.16 vs. 0.94±0.99, p=0.001) after just three months of treatment. After 12 months, definition of remission in SLE (DORIS) was achieved in 53% of patients and lupus low disease activity state (LLDAS) in 89% of patients. Mucocutaneous manifestations responded quickly and there were significant improvements in fatigue and arthritis/arthralgia. A favourable response was also seen in patients who had received previous therapies or after long duration of the disease. This was accompanied by a reduction in the glucocorticoid dose. Overall, the drug was safe and well tolerated.</p><p><strong>Conclusions: </strong>In our real-world experience, anifrolumab achieved sustained remission after just 3 months of treatment and a significant reduction in disease activity in most patients. These data suggest that SLE patients with active disease benefit from anifrolumab therapy regardless of prior therapies or disease duration.</p>","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary nontuberculous mycobacteria disease and anti-neutrophil cytoplasmic antibody positivity: a retrospective analysis of long-term clinical outcomes including vasculitis onset.","authors":"Nobuhiro Oda, Hiroki Matsui, Naoki Oya, Tomo Suzuki, Ryo Hazue, Ryo Rokutanda","doi":"10.55563/clinexprheumatol/2kjm03","DOIUrl":"https://doi.org/10.55563/clinexprheumatol/2kjm03","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the positivity rate of anti-neutrophil cytoplasmic antibody (ANCA) and the incidence of ANCA-associated vasculitis (AAV) in pulmonary nontuberculous mycobacterial (NTM) disease.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using electronic medical records of patients diagnosed with pulmonary NTM disease who subsequently underwent testing for myeloperoxidase (MPO) or proteinase 3 (PR3) ANCA. We identified cases of vasculitis among these patients and documented those who developed AAV. Additionally, we reviewed the literature for previously reported cases of AAV following pulmonary NTM disease.</p><p><strong>Results: </strong>We identified 63 patients with pulmonary NTM disease who subsequently underwent ANCA testing. Seven cases (11.1%) tested positive, predominantly for MPO-ANCA. Among them, five patients (71.4%) developed AAV, with three demonstrating concurrent NTM culture positivity at the time of AAV diagnosis. Three patients were diagnosed with microscopic polyangiitis, while the remaining two were diagnosed with granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis, respectively. In our case series of AAV, most patients developed glomerulonephritis. Additionally, a review of the existing literature revealed eight previously reported cases of AAV associated with pulmonary NTM disease.</p><p><strong>Conclusions: </strong>This study is one of the largest to investigate the proportion of patients positive for ANCA with pulmonary NTM infection. Our findings suggest an association between NTM infection and AAV and highlight the importance of measuring ANCA in patients with NTM. Further studies are needed to clarify the underlying mechanisms and identify risk factors.</p>","PeriodicalId":10274,"journal":{"name":"Clinical and experimental rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079780","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}