Clinical Gastroenterology and Hepatology最新文献

{"title":"Implementing Artificial Intelligence in a Gastroenterology Practice.","authors":"James Aisenberg, Neville Bamji, David Hertz, John I Allen","doi":"10.1016/j.cgh.2026.09.008","DOIUrl":"10.1016/j.cgh.2026.09.008","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001395","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":"Vedolizumab Trough Concentrations and Clinical and Endoscopic Outcomes in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.","authors":"Mostafa A Soliman, Alessandra Saraga, Ajay Gade, Sadra Habibi Moini, Benjamin Mecsas-Faxon, Loren G Rabinowitz, Isabella Midura, Tamara Knezevic Ivanovski, Xavier Roblin, Laurent Peyrin-Biroulet, Adam S Cheifetz, Konstantinos Papamichael","doi":"10.1016/j.cgh.2026.09.009","DOIUrl":"10.1016/j.cgh.2026.09.009","url":null,"abstract":"<p><strong>Background & aims: </strong>The role of therapeutic drug monitoring in optimizing vedolizumab (VDZ) therapy for Crohn's disease (CD) and ulcerative colitis (UC) remains unclear. Prior evidence was limited by small sample size and heterogeneous endpoints. We synthesized the available evidence on the association of VDZ trough concentrations with clinical (CR) and endoscopic remission (ER).</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched the literature from inception to April 2026 for studies reporting VDZ trough concentrations stratified by remission status in CD and UC. Outcomes were CR and ER. Pooled mean differences (MDs) were estimated using random-effects models with restricted maximum likelihood estimation; heterogeneity was quantified using the I² statistic.</p><p><strong>Results: </strong>Twenty-three studies (6753 patients) met inclusion criteria; 18 contributed to quantitative synthesis. Higher VDZ trough concentrations were strongly associated with ER in UC (MD, 4.86 μg/mL; 95% confidence interval, 2.75-6.98; P < .0001; I² = 0.0%). Higher concentrations were also associated with CR in UC (MD, 3.18 μg/mL; P = .025) and CD (MD, 3.08 μg/mL; P < .0001), although these clinical remission estimates were statistically heterogeneous; no association was observed for ER in CD (MD, 1.40 μg/mL; P = .453). Pooled remission-associated concentrations were presented descriptively and supported maintenance targets of ≥13 to 15 μg/mL in UC and ≥10 to 12 μg/mL in CD.</p><p><strong>Conclusions: </strong>Higher VDZ trough concentrations were associated with remission, most robustly for ER in UC. As these associations are largely cross-sectional, they may reflect reverse causation rather than a dose-response relationship. Prospective interventional trials are required before proactive therapeutic drug monitoring can be recommended.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001375","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":"Development and Clinical Evaluation of the Modified Hepatic Encephalopathy Staging Tool.","authors":"Annarein J C Kerbert, Caterina Chesta, Pooja Balachandran, Aaryan Panchal, Jing Xia, Darren Rubin, Rajeshwar Prosad Mookerjee, Tarek Hassanein, Rajiv Jalan","doi":"10.1016/j.cgh.2026.09.011","DOIUrl":"10.1016/j.cgh.2026.09.011","url":null,"abstract":"<p><strong>Background & aims: </strong>Hepatic encephalopathy (HE) is a serious complication of advanced cirrhosis, requiring accurate and consistent diagnosis and staging. The commonly used West Haven criteria have substantial interobserver variability. This study aimed to develop the modified Hepatic Encephalopathy Staging Tool (mHEST) as a more objective and reproducible HE assessment method for regulated clinical trials.</p><p><strong>Methods: </strong>This study consisted of 2 parts. In part 1, 49 health care professionals from 6 countries evaluated 6 video vignettes depicting different HE stages. After viewing a mHEST training video, participants assessed the vignettes twice (5-10 days apart). Inter- and intrarater agreement were analyzed. In Part 2, a prospective single-center study enrolled 128 hospitalized patients with decompensated cirrhosis. Trained professionals independently assessed HE using both West Haven criteria and mHEST. Diagnostic consistency, prognostic performance, and impact on established scoring systems were compared.</p><p><strong>Results: </strong>In part 1, inter-rater concordance ranged from 83.3% to 100%, and intrarater agreement from 81.0% to 100%. In part 2, inter-rater reliability was significantly higher for mHEST than West Haven (κ = 0.934 vs 0.367). mHEST improved the performance of HE-containing scores, including Child-Pugh and CLIF-C Organ Failure. Plasma ammonia levels increased stepwise with mHEST grades, but not with West Haven. mHEST grades correlated with 1-year mortality, and low mHEST grades (0-1) independently predicted improved 1-year survival.</p><p><strong>Conclusions: </strong>MHEST is a user-friendly, reliable, and prognostically accurate HE assessment tool that outperforms West Haven criteria and has been accepted by the United States Food and Drug Administration as a clinical trial endpoint.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001379","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":"Alcohol Consumption Increases Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B.","authors":"Yukai Chen, Fajuan Rui, Siyu Zhang, Xiaoqing Wu, Shaoya Li, Jiawei Cui, Yaoyao Mao, Zhandong Lin, Xiangxin Qin, Yikang Song, Qianqian Zheng, Ying Zhang, Jin Chai, Jun Chen, Chao Sun, Jie Li, Yuemin Nan","doi":"10.1016/j.cgh.2026.09.010","DOIUrl":"10.1016/j.cgh.2026.09.010","url":null,"abstract":"<p><strong>Background & aims: </strong>Both chronic hepatitis B (CHB) and alcohol consumption are risk factors for hepatocellular carcinoma (HCC). However, their synergistic effect on HCC development is not fully elucidated. Therefore, we evaluated the association between alcohol consumption and HCC development in patients with CHB.</p><p><strong>Methods: </strong>Patients with CHB were enrolled between March 1, 2005, and December 30, 2025, at 2 medical centers in China. Cox proportional hazards regression model and Kaplan-Meier curves were used to evaluate the association between alcohol consumption and HCC risk in patients with CHB.</p><p><strong>Results: </strong>A total of 1010 patients with CHB were included, among whom 129 (12.77%) developed HCC during 3684 person-years of follow-up. Compared with those without HCC, patients with CHB and HCC had higher alcohol intake levels (2.00 vs 0.00 × 100 g/week; P < .001). Multivariable Cox regression showed that each 100 g/week increase in alcohol intake was associated with a higher risk of HCC (adjusted hazard ratio [aHR], 1.33; P < .001) in patients with CHB. Compared with low (<140/210 g/week) and low-to-moderate (≤350/420 g/week) alcohol intake, high alcohol intake (>350/420 g/week) was associated with an increased risk of HCC (aHR, 4.00 and 3.48, respectively; both P < .001). In stratified analyses, similar associations were observed in both cirrhotic (aHR, 1.32, 4.36, and 3.23, respectively) and noncirrhotic patients with CHB (aHR, 1.44, 4.59, and 4.97, respectively). These associations were consistent across subgroups defined by age, hepatitis B e antigen status, hepatitis B virus DNA level, aMAP score, and mPAGE-B score.</p><p><strong>Conclusions: </strong>Alcohol consumption independently increases HCC risk among patients with CHB, regardless of cirrhosis status. These findings highlight the importance of systematic assessment and control of alcohol intake to reduce HCC risk in patients with CHB.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001307","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":"Letter to the Editor Re: A Randomized Trial of Rifaximin vs Low FODMAP Diet.","authors":"Robert Burke, Claire Shortt, Aonghus Shortt","doi":"10.1016/j.cgh.2026.08.035","DOIUrl":"10.1016/j.cgh.2026.08.035","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988532","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":"Risk Factors and Definition of Younger-Onset Metabolic Dysfunction-Associated Steatotic Liver Disease Cirrhosis.","authors":"Veeral Ajmera, Linus Schwantes-An, Luis Antonio Díaz, Callie Zaborenko, Katherine P Yates, Naga P Chalasani, Rohit Loomba","doi":"10.1016/j.cgh.2026.08.033","DOIUrl":"10.1016/j.cgh.2026.08.033","url":null,"abstract":"<p><strong>Background & aims: </strong>Cirrhosis from metabolic dysfunction-associated steatotic liver disease (MASLD) usually develops with advancing age, yet a subset of patients presents at younger ages. We examined genetic and metabolic factors associated with younger-onset MASLD cirrhosis.</p><p><strong>Methods: </strong>Adults with biopsy-proven MASLD enrolled in the NASH CRN were included. DNA was genotyped, and a genetic risk score (GRS) was calculated as the sum of risk alleles in PNPLA3 and TM6SF2 plus the wild-type HSD17B13 allele, dichotomized at the median (low vs high), in addition to evaluation of previously published weighted GRSs. Younger-onset cirrhosis was defined as the youngest quartile among participants with cirrhosis. Multivariable logistic regression evaluated factors associated with younger-onset cirrhosis.</p><p><strong>Results: </strong>Among 2395 participants, 234 (9.8%) had MASLD cirrhosis (median age, 58.4 years; body mass index, 34.9 kg/m²; 66% with type 2 diabetes mellitus [T2DM]). Younger-onset cirrhosis was defined as the lowest quartile, which was <50 years and was associated with a lower prevalence of the protective HSD17B13 variant (24% vs 34%; P = .004). Compared with participants with noncirrhotic MASLD under 50 years (n = 999), those with cirrhosis more often had T2DM, body mass index ≥35kg/m², higher alkaline phosphatase, and lower alanine aminotransferase. In multivariable models adjusting for demographic and metabolic factors, high GRS (odds ratio, 2.33; 95% confidence interval, 1.26-4.23; P = .006) and T2DM (odds ratio, 3.74; 95% confidence interval, 2.08-6.82; P < .001) remained independently associated with cirrhosis under age 50.</p><p><strong>Conclusions: </strong>One-quarter of participants with MASLD cirrhosis present before age 50 years and have distinct features, including higher genetic risk and a greater prevalence of T2DM.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982063","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":"Integrated Metabolomic and Genetic Profiling Implicates Loss of Docosahexaenoic Acid in the Link Between Ultraprocessed Foods and Crohn's Disease.","authors":"Sidan Wang, Lintao Dan, Xixian Ruan, Judith Wellens, Yuhao Sun, Jialu Yao, Li Tian, Rahul Kalla, Evropi Theodoratou, Shuai Yuan, Susanna C Larsson, Jonas F Ludvigsson, Laurent Peyrin-Biroulet, Jack Satsangi, Fernando Magro, Xue Li, Xiaoyan Wang, Jie Chen","doi":"10.1016/j.cgh.2026.09.004","DOIUrl":"10.1016/j.cgh.2026.09.004","url":null,"abstract":"<p><strong>Background & aims: </strong>Although increased intake of ultraprocessed food may elevate the risk of Crohn's disease, the biological mechanisms involved remain unexplored. We aimed to profile ultraprocessed food-related metabolomic features linked to incident Crohn's disease and to localize key mediators.</p><p><strong>Methods: </strong>This study involved two parts: construction of an ultraprocessed food metabolic signature in the discovery cohort (n = 10,229, UK Biobank), with internal (n = 91,306) and external validation (n = 7893, Whitehall II Study), and validation of key metabolic drivers in 2 Western cohorts and 1 Eastern cohort (n = 752, Omics, Nutrition, and Environment Synthesis for Inflammatory Bowel Disease). High-throughput metabolomics platforms were used to measure circulating metabolites. Elastic net regression was applied to derive the ultraprocessed food metabolic signature. Key metabolites were prioritized by integrating multivariable regression, network-based clustering, prospective association analyses, and mediation analyses. We further explored genetic mechanisms by Mendelian randomization, colocalization, and gene-environment analyses.</p><p><strong>Results: </strong>An ultraprocessed food metabolic signature of 73 metabolites was constructed and validated across cohorts (Spearman ρ: 0.20-0.25). A more pronounced ultraprocessed food metabolic signature was associated with increased Crohn's disease risk (hazard ratio per SD, 2.65; 95% confidence interval, 1.57-4.48). Within the identified metabolite cluster, docosahexaenoic acid was among the most consistently prioritized metabolites, mediating 17.1% of the ultraprocessed food-Crohn's disease association. Validation in Omics, Nutrition, and Environment Synthesis for Inflammatory Bowel Disease supported the linking of ultraprocessed food to Crohn's disease incidence. Mendelian randomization revealed a protective effect of ultraprocessed food on Crohn's disease (odds ratio, 0.70; 95% confidence interval, 0.60-0.81), and colocalization implicated rs174546 in FADS1 as a key genetic locus.</p><p><strong>Conclusions: </strong>Our findings suggest that lower circulating docosahexaenoic acid may represent a metabolic pathway linking ultraprocessed food intake to increased Crohn's disease risk, apart from additive harm to metabolic depletion. This highlights potential targets for precision nutrition in Crohn's disease prevention in future trials.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982023","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":"Baseline Magnetic Resonance Enterography Stratifies Persistence Risk of Crohn's Disease Strictures.","authors":"Kento Takenaka, Junichi Tsuchiya, Ami Kawamoto, Momo Wakui, Shuji Hibiya, Akiko Tamura, Sakurako Kobayashi, Hiromichi Shimizu, Toshimitsu Fujii, Kazuo Ohtsuka, Ryuichi Okamoto","doi":"10.1016/j.cgh.2026.09.007","DOIUrl":"10.1016/j.cgh.2026.09.007","url":null,"abstract":"<p><strong>Background & aims: </strong>Crohn's disease strictures are clinically important, but persistence after advanced therapy remains difficult to assess. We developed and temporally validated a magnetic resonance enterography-based framework integrating activity-related and structural imaging severity to stratify stricture nonimprovement.</p><p><strong>Methods: </strong>This 2-stage study included patients with Crohn's disease who initiated advanced therapy and underwent baseline and follow-up magnetic resonance enterography. An activity-related score (A-score) and a persistence-associated structural score (P-score) were derived from a development cohort (2012-2020) and applied to a temporally separated validation cohort (2021-2024). The primary end point was stricture-level nonimprovement on follow-up magnetic resonance enterography; intestinal surgery was also evaluated.</p><p><strong>Results: </strong>The development cohort included 115 patients with 161 strictures, and the validation cohort included 72 patients with 104 strictures. The A-score comprised bowel wall thickness >6 mm, ulceration, and comb sign; the P-score comprised stricture length >3 cm, prestenotic bowel diameter >3 cm, and a lack of intramural edema. A-score and P-score positivity were each associated with stricture nonimprovement after multivariable adjustment (adjusted odds ratios, 18.68 and 19.75, respectively; P < .01 for both). The summed A + P score showed an area under the curve of 0.90 and a higher discrimination than either score, the segmental magnetic resonance index of activity, or the segmental simplified Magnetic Resonance Index of Activity alone. Improvement rates decreased with increasing A-scores and remained low at higher P-scores. Baseline A/P strata also differed in surgery-free survival (P < .01).</p><p><strong>Conclusions: </strong>Baseline magnetic resonance enterography integrating activity-related and structural imaging severity stratified stricture persistence and was associated with subsequent surgery. This framework should be interpreted as a baseline imaging severity and risk stratification tool rather than an inflammatory-fibrotic phenotype classifier.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976064","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":"Endoscopist Adherence to Postpolypectomy Surveillance Interval Recommendations Following Removal of 1 to 4 Nonadvanced Adenomas.","authors":"Jeffrey M Hendel, Christopher D Jensen, Sophie A Merchant, Willa Xie, Pradeep C Koripella, Sachin Shah, Joshua R Nugent, Theodore Levin, Douglas Corley, Jeffrey K Lee","doi":"10.1016/j.cgh.2026.08.036","DOIUrl":"10.1016/j.cgh.2026.08.036","url":null,"abstract":"<p><strong>Background & aims: </strong>Current postpolypectomy surveillance guidelines (updated in 2020) recommend a 7- to 10-year surveillance interval for patients with 1 to 2 nonadvanced adenomas (NAAs) and a 3- to 5-year interval for those with 3 to 4 NAAs; however, endoscopist adherence to guideline recommendations is unknown. Therefore, we evaluated endoscopist adherence to guideline recommendations and use of interval ranges in a large integrated health care system.</p><p><strong>Methods: </strong>The cross-sectional study was conducted with average-risk adult Kaiser Permanente Northern California patients who underwent a colonoscopy with removal of 1 to 4 NAAs in 2019 to 2024. Surveillance intervals were obtained from colonoscopy procedure flowsheets. The proportion of colonoscopies with a guideline adherent surveillance interval and use of interval ranges were calculated annually.</p><p><strong>Results: </strong>Endoscopist adherence to the 7- to 10-year interval for patients with 1 to 2 NAAs improved from 68.1% in 2021 to 71.9% in 2024. In contrast, adherence to the 3- to 5-year interval for patients with 3 to 4 NAAs was consistently greater than 90.0%. For both 1 to 2 and 3 to 4 NAAs groups, endoscopists predominantly assigned the upper or lower bound of the interval range rather than the middle years. In 2021 to 2024, a 10-year interval was assigned in 45.9%-47.2% of patients with 1 to 2 NAAs. A 5-year interval was assigned in 37.6%-39.5% of patients with 3 to 4 NAAs.</p><p><strong>Conclusions: </strong>Since the update to postpolypectomy surveillance guidelines in 2020, endoscopist adherence to recommended follow-up intervals for patients with 1 to 2 NAAs has improved. However, adherence to recommended follow-up intervals remains lower for patients with 1 to 2 NAAs compared with those with 3 to 4 NAAs. These disparate adherence rates suggest that the potential for oversurveillance is substantially higher for patients with 1 to 2 vs 3 to 4 NAAs.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976094","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":"Negative Clinical Trials Can Yield Positive Insights.","authors":"Jerry D Gardner","doi":"10.1016/j.cgh.2026.08.034","DOIUrl":"10.1016/j.cgh.2026.08.034","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976051","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}