Clinical Gastroenterology and Hepatology最新文献

{"title":"Performance of AI-Enabled Electrocardiogram in the Prediction of Metabolic Dysfunction–Associated Steatotic Liver Disease","authors":"Prowpanga Udompap ,&nbsp;Kan Liu ,&nbsp;Itzhak Zachi Attia ,&nbsp;Rachel E. Canning ,&nbsp;Joanne T. Benson ,&nbsp;Terry M. Therneau ,&nbsp;Peter A. Noseworthy ,&nbsp;Paul A. Friedman ,&nbsp;Puru Rattan ,&nbsp;Joseph C. Ahn ,&nbsp;Douglas A. Simonetto ,&nbsp;Vijay H. Shah ,&nbsp;Patrick S. Kamath ,&nbsp;Alina M. Allen","doi":"10.1016/j.cgh.2024.08.009","DOIUrl":"10.1016/j.cgh.2024.08.009","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Accessible noninvasive screening tools for metabolic dysfunction–associated steatotic liver disease (MASLD) are needed. We aim to explore the performance of a deep learning–based artificial intelligence (AI) model in distinguishing the presence of MASLD using 12-lead electrocardiogram (ECG).</div></div><div><h3>Methods</h3><div>This is a retrospective study of adults diagnosed with MASLD in Olmsted County, Minnesota, between 1996 and 2019. Both cases and controls had ECGs performed within 6 years before and 1 year after study entry. An AI-based ECG model using a convolutional neural network was trained, validated, and tested in 70%, 10%, and 20% of the cohort, respectively. External validation was performed in an independent cohort from Mayo Clinic Enterprise. The primary outcome was the performance of ECG to identify MASLD, alone or when added to clinical parameters.</div></div><div><h3>Results</h3><div>A total of 3468 MASLD cases and 25,407 controls were identified. The AI-ECG model predicted the presence of MASLD with an area under the curve (AUC) of 0.69 (original cohort) and 0.62 (validation cohort). The performance was similar or superior to age- and sex-adjusted models using body mass index (AUC, 0.71), presence of diabetes, hypertension or hyperlipidemia (AUC, 0.68), or diabetes alone (AUC, 0.66). The model combining ECG, age, sex, body mass index, diabetes, and alanine aminotransferase had the highest AUC: 0.76 (original) and 0.72 (validation).</div></div><div><h3>Conclusions</h3><div>This is a proof-of-concept study that an AI-based ECG model can detect MASLD with a comparable or superior performance as compared with the models using a single clinical parameter but not superior to the combination of clinical parameters. ECG can serve as another screening tool for MASLD in the nonhepatology space.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 574-582.e3"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104962","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}

{"title":"Systematic Review and Meta-analysis: The Three-year Post-colonoscopy Colorectal Cancer Rate as per the World Endoscopy Organization Methodology","authors":"Rawen Kader ,&nbsp;Andreas V. Hadjinicolaou ,&nbsp;Nicholas E. Burr ,&nbsp;Paul Bassett ,&nbsp;Omer F. Ahmad ,&nbsp;Lasse Pedersen ,&nbsp;Manish Chand ,&nbsp;Roland Valori ,&nbsp;Danail Stoyanov ,&nbsp;Laurence B. Lovat","doi":"10.1016/j.cgh.2024.07.039","DOIUrl":"10.1016/j.cgh.2024.07.039","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>In 2018, the World Endoscopy Organization (WEO) introduced standardized methods for calculating post-colonoscopy colorectal cancer-3yr rates (PCCRC-3yr). This systematic review aimed to calculate the global PCCRC-3yr according to the WEO methodology, its change over time, and to measure the association between risk factors and PCCRC occurrences.</div></div><div><h3>Methods</h3><div>We searched 5 databases from inception until January 2024 for PCCRC-3yr studies that strictly adhered to the WEO methodology. The overall pooled PCCRC-3yr was calculated. For risk factors and time-trend analyses, the pooled PCCRC-3yr and odds ratios (ORs) of subgroups were compared.</div></div><div><h3>Results</h3><div>Several studies failed to adhere to the WEO methodology. Eight studies from 4 Western European and 2 Northern American countries were included, totalling 220,106 detected-colorectal cancers (CRCs) and 18,148 PCCRCs between 2002 and 2017. The pooled Western World PCCRC-3yr was 7.5% (95% confidence interval [CI], 6.4%–8.7%). The PCCRC-3yr significantly (<em>P</em> &lt; .05) decreased from 7.9% (95% CI, 6.6%–9.4%) in 2006 to 6.7% (95% CI, 6.1%–7.3%) in 2012 (OR, 0.79; 95% CI, 0.72–0.87). There were significantly higher rates for people with inflammatory bowel disease (PCCRC-3yr, 29.3%; OR, 6.17; 95% CI, 4.73–8.06), prior CRC (PCCRC-3yr, 29.8%; OR, 3.03; 95% CI, 1.34–4.72), proximal CRC (PCCRC-3yr, 8.6%; OR, 1.51; 95% CI, 1.41–1.61), diverticular disease (PCCRC 3-yr, 11.6%; OR, 1.74; 95% CI, 1.37–2.10), and female sex (PCCRC-3yr, 7.9%; OR, 1.15; 95% CI, 1.11–1.20).</div></div><div><h3>Conclusion</h3><div>According to the WEO methodology, the Western World PCCRC-3yr was 7.5%. Reassuringly, this has decreased over time, but further work is required to identify the reasons for PCCRCs, especially in higher-risk groups. We devised a WEO methodology checklist to increase its adoption and standardise the categorization of patients in future PCCRC-3yr studies.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 519-530"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exam 1: Additional Yield of Random Biopsy in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis","authors":"","doi":"10.1016/j.cgh.2024.12.003","DOIUrl":"10.1016/j.cgh.2024.12.003","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages e1-e2"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509350","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}

{"title":"After Surgically Induced Remission, Ileal and Colonic Mucosa-Associated Microbiota Predicts Crohn’s Disease Recurrence","authors":"Cristian Hernández-Rocha ,&nbsp;Williams Turpin ,&nbsp;Krzysztof Borowski ,&nbsp;Joanne M. Stempak ,&nbsp;Ksenija Sabic ,&nbsp;Kyle Gettler ,&nbsp;Christopher Tastad ,&nbsp;Colleen Chasteau ,&nbsp;Ujunwa Korie ,&nbsp;Mary Hanna ,&nbsp;Abdul Khan ,&nbsp;Emebet Mengesha ,&nbsp;Alain Bitton ,&nbsp;Marc B. Schwartz ,&nbsp;Arthur Barrie ,&nbsp;Lisa W. Datta ,&nbsp;Mark Lazarev ,&nbsp;Steven R. Brant ,&nbsp;John D. Rioux ,&nbsp;Dermot P.B. McGovern ,&nbsp;Mark S. Silverberg","doi":"10.1016/j.cgh.2024.06.022","DOIUrl":"10.1016/j.cgh.2024.06.022","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Investigating the tissue-associated microbiota after surgically induced remission may help to understand the mechanisms initiating intestinal inflammation in Crohn’s disease.</div></div><div><h3>Methods</h3><div>Patients with Crohn’s disease undergoing ileocolic resection were prospectively recruited in 6 academic centers. Biopsy samples from the neoterminal ileum, colon, and rectosigmoid were obtained from colonoscopies performed after surgery. Microbial DNA was extracted for 16S rRNA gene sequencing. Microbial diversity and taxonomic differential relative abundance were analyzed. A random forest model was applied to analyze the performance of clinical and microbial features to predict recurrence. A Rutgeerts score ≥i2 was deemed as endoscopic recurrence.</div></div><div><h3>Results</h3><div>A total of 349 postoperative colonoscopies and 944 biopsy samples from 262 patients with Crohn’s disease were analyzed. Ileal inflammation accounted for most of the explained variance of the ileal and colonic mucosa-associated microbiota. Samples obtained from 97 patients who were in surgically induced remission at first postoperative colonoscopy who went on to develop endoscopic recurrence at second colonoscopy showed lower diversity and microbial deviations when compared with patients who remained in endoscopic remission. Depletion of genus <em>Anaerostipes</em> and increase of several genera from class Gammaproteobacteria at the 3 biopsy sites increase the risk of further recurrence. Gut microbiome was able to predict future recurrence better than clinical features.</div></div><div><h3>Conclusions</h3><div>Ileal and colonic mucosa-associated microbiome deviations precede development of new-onset ileal inflammation after surgically induced remission and show good predictive performance for future recurrence. These findings suggest that targeted microbial modulation is a plausible modality to prevent postoperative Crohn’s disease recurrence.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 612-620.e10"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537682","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}

{"title":"Predictors of Functional Cure of Chronic Hepatitis B Virus Infection: A Long-Term Follow-Up Study","authors":"Jia-Feng Wu ,&nbsp;Chi-San Tai ,&nbsp;Kai-Chi Chang ,&nbsp;Yuh-Jue Chen ,&nbsp;Chien-Ting Hsu ,&nbsp;Huey-Ling Chen ,&nbsp;Yen-Hsuan Ni ,&nbsp;Mei-Hwei Chang","doi":"10.1016/j.cgh.2024.07.036","DOIUrl":"10.1016/j.cgh.2024.07.036","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>A functional cure is an essential endpoint in the management of patients with chronic hepatitis B virus (HBV) infection. We evaluated the cumulative probability and predictors of functional cure in patients with chronic HBV infection after hepatitis B e antigen (HBeAg) seroconversion.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 413 (249 males and 164 females) initially HBeAg-positive chronic HBV–infected patients who were followed up for a mean of 26.36 ± 0.53 years. All underwent HBeAg seroconversion during follow-up. A functional cure was defined as durable HBsAg and HBV DNA loss without antiviral treatment for more than 24 weeks.</div></div><div><h3>Results</h3><div>After 10,888 person-years of follow-up, the cumulative probability of functional cure was 14.53% (n = 60). There were 24 (40%) subjects with functional cure after antiviral therapy. The annual functional cure rate was 0.55% per person-year, and increased to 0.96% per person-year after HBeAg seroconversion. In subjects with functional cure, the HBsAg and HBV DNA titers after HBeAg seroconversion were positively correlated with the time to functional cure (<em>P</em> &lt; .001 and &lt; .001, respectively). Multivariate Cox proportional hazards analysis of the cohort revealed that HBeAg seroconversion at &lt;18 years of age, high-genetic-barrier nucleos(t)ide analogue(s) therapy before HBeAg seroconversion, and a serum HBsAg titer &lt;1000 IU/mL at 18 months after HBeAg seroconversion were significant predictors of functional cure (<em>P</em> &lt; .001, .001, and .001, respectively).</div></div><div><h3>Conclusions</h3><div>In a cohort of chronic HBV–infected patients with long-term follow-up, HBeAg seroconversion in childhood, high-genetic-barrier nucleos(t)ide analogue(s) therapy, and low HBsAg titers after HBeAg seroconversion were significant predictors of functional cure.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 583-590.e3"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104963","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}

{"title":"Fecal Microbiota Transplantation (FMT) in Ulcerative Colitis: Holding Out for a Superdonor?","authors":"Jennifer D. Claytor,&nbsp;Jeremiah J. Faith","doi":"10.1016/j.cgh.2024.07.047","DOIUrl":"10.1016/j.cgh.2024.07.047","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 516-518"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496261","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}

{"title":"Natural History of Clinically Suspected Isolated Perianal Fistulizing Crohn’s Disease","authors":"Lodoe Sangmo,&nbsp;Baseer Quraishi,&nbsp;Palak Rajauria,&nbsp;Elisabeth Giselbrecht,&nbsp;Jean-Frederic Colombel,&nbsp;Ryan Ungaro,&nbsp;Serre-Yu Wong","doi":"10.1016/j.cgh.2024.09.016","DOIUrl":"10.1016/j.cgh.2024.09.016","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 671-673.e2"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496185","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}

{"title":"Elsewhere in the AGA Journals","authors":"","doi":"10.1016/S1542-3565(25)00049-7","DOIUrl":"10.1016/S1542-3565(25)00049-7","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages A25-A27"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509459","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}

{"title":"Emergency Department Utilization and Outcomes Among Adults With Cirrhosis From 2008 to 2022 in the United States","authors":"Hirsh Elhence ,&nbsp;Jennifer L. Dodge ,&nbsp;Jennifer A. Flemming ,&nbsp;Brian P. Lee","doi":"10.1016/j.cgh.2024.07.029","DOIUrl":"10.1016/j.cgh.2024.07.029","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Globally, emergency departments (ED) are experiencing rising costs and crowding. Despite its importance, ED utilization and outcomes among patients with cirrhosis are understudied.</div></div><div><h3>Methods</h3><div>We analyzed Optum’s de-identified Clinformatics Data Mart Database, between 2008 and 2022, including adults with at least 180 days of enrollment. Liver transplant recipients were censored at the year of transplant. ED visits (stratified by liver vs non-liver related) were identified using validated billing code definitions. Linear regression was used to assess ED visits per year, and logistic regression was used to assess 90-day mortality rates and discharge dispositions, with models adjusted for patient- and visit-level characteristics.</div></div><div><h3>Results</h3><div>Among 38,419,650 patients<strong>,</strong> 198,439 were with cirrhosis (median age, 66 [interquartile range, 57–72 years]; 54% male; 62% White). In age-adjusted analysis, ED visits per person-year were 1.72 (95% confidence interval [CI], 1.71–1.74) with cirrhosis vs 0.46 (95% CI, 0.46–0.46) without cirrhosis, 1.66 (95% CI, 1.66–1.66) for congestive heart failure (CHF), and 1.22 (95% CI, 1.22–1.22) for chronic obstructive pulmonary disease (COPD). Age-adjusted 90-day mortality rates were 12.2% (95% CI, 12.1%–12.4%) with cirrhosis vs 4.8% [95% CI, 4.8%–4.8%) without cirrhosis, 6.9% (95% CI, 6.9%–6.9%) for CHF, and 6.3% (95% CI, 6.3%–6.4%) for COPD. Non-liver (vs liver-related) ED visits were more likely to lead to discharge home among patients with compensated (52.8%; 95% CI, 52.2%–53.5% vs 39.2%; 95% CI, 38.5%–39.8%) and decompensated (42.2%; 95% CI, 41.5%–42.8% vs 29.5%; 95% CI, 29.0%–30.1%) cirrhosis. In exploratory analysis, among patients who remained alive and were not readmitted for 30 days after ED discharge, those without any outpatient follow-up had higher 90-day mortality (22.0%; 95% CI, 21.0%–23.0%) than those with both primary care and gastroenterology/hepatology follow-up within 30-days (7.9%; 95% CI, 7.3%–8.5%).</div></div><div><h3>Conclusions</h3><div>Patients with cirrhosis have higher ED utilization and almost 2-fold higher post-ED visit mortality than CHF and COPD. These findings provide impetus for ED-based interventions to improve cirrhosis-related outcomes.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 564-573.e27"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055142","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}

{"title":"Impact of Time Period and Birth Cohort on the Trend of Advanced Neoplasm Prevalence in the 40–49 Average-Risk Screening Population","authors":"Hsu-Hua Tseng ,&nbsp;Chiu-Wen Su ,&nbsp;Wen-Chen Chang ,&nbsp;Wei-Yuan Chang ,&nbsp;Wen-Feng Hsu ,&nbsp;Li-Chun Chang ,&nbsp;Ming-Shiang Wu ,&nbsp;Han-Mo Chiu","doi":"10.1016/j.cgh.2024.07.044","DOIUrl":"10.1016/j.cgh.2024.07.044","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Early-onset colorectal cancer (CRC) is increasing globally. While the United States has lowered the age of initiation of screening to 45 years, other countries still start screening at 50 years of age. In Taiwan, the incidence of CRC has declined in 55- to 74-year-olds after the initiation of screening, but still increased in those 50–54 years of age, potentially due to the rising precancerous lesion incidence in 40- to 49-year-olds. This study aimed to explore the chronological trend of the prevalence of colorectal advanced neoplasms (AN) in the screening population 40–54 years of age.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed a screening colonoscopy cohort for prevalence of AN in average-risk subjects 40–54 years of age from 2003 to 2019. Logistic regression was used to distinguish cohort effect from time-period effect on the prevalence of AN.</div></div><div><h3>Results</h3><div>In total, 27,805 subjects (52.1% male) were enrolled. There were notable increases in prevalence of AN in all 3 age groups during the 17-year span, but these were more rapid in those 40–44 years of age (0.99% to 3.22%) and 45–49 years of age (2.50% to 4.19%). Those 50–54 years of age had a higher risk of AN (adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 1.19–2.19) in 2003–2008 but not in later periods (2009–2014: aOR, 1.08; 95% CI, 0.83–1.41; 2015–2019: aOR, 0.76; 95% CI, 0.56–1.03) when compared with those 45–49 years of age.</div></div><div><h3>Conclusion</h3><div>The prevalence of AN in those 40–54 years of age increased in the Taiwanese population, with a later birth cohort having a higher prevalence of AN. However, the prevalence of AN in those 45–49 years of age increased more remarkably and approximated that in those 50–54 years of age, which may justify earlier initiation of CRC screening in those 45 years of age.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 644-652.e5"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}