Clinical Gastroenterology and Hepatology最新文献

{"title":"Reply.","authors":"Daan H C A Bosch, Daniel Keszthelyi","doi":"10.1016/j.cgh.2026.09.005","DOIUrl":"10.1016/j.cgh.2026.09.005","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":"148976080","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":"Reply.","authors":"Allen Lee, William Hasler","doi":"10.1016/j.cgh.2026.09.006","DOIUrl":"10.1016/j.cgh.2026.09.006","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":"148976091","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":"Assessing Strategies to Mitigate the Effect of Age When Using Fibrosis-4 Index to Screen for Metabolic Dysfunction-Associated Steatotic Liver Disease-Related Liver Fibrosis.","authors":"Jeevan Nammi, William Southall, Ky Huynh, Elainea Smith, Sameer Al Diffalha, Kenneth Cusi, Meagan Gray, Fernando Bril","doi":"10.1016/j.cgh.2026.09.003","DOIUrl":"10.1016/j.cgh.2026.09.003","url":null,"abstract":"<p><strong>Background & aims: </strong>Fibrosis-4 (FIB-4) is recommended to screen for liver fibrosis in at-risk individuals, but its performance is limited at extremes of age. This study compared different strategies to limit the effect of age on FIB-4.</p><p><strong>Methods: </strong>Using 2 independent metabolic dysfunction-associated steatotic liver disease cohorts, we assessed FIB-4 and 4 alternative strategies to detect ≥ F2, ≥F3, and cirrhosis. The strategies assessed were: (1) standard FIB-4 with 1.3 as cutoff; (2) FIB-4, but using a cutoff of 2.0 for ≥65 years; (3) FIB-3 where age was removed from the FIB-4 formula; (4) capped FIB-4 (where 35 or 65 years were used as age inputs in individuals <35 or >65 years, respectively), and (5) log-transformed FIB-4, where the natural logarithm of age was used. Magnetic resonance elastography was used as reference in cohort #1 (n = 604), and liver biopsy in cohort #2 (n = 334). The National Health and Nutrition Examination Survey, 2017 to 2020, was used to assess the strategies in an unselected cohort.</p><p><strong>Results: </strong>Among 938 participants (age, 54 ± 12 years; 50% female; body mass index, 34.7 ± 6.7 kg/m²; 42% with diabetes), 20% had ≥ F2, 13% ≥F3, and 3% cirrhosis. All strategies had similar areas under the receiver operating characteristic curve (AUROCs) for detection of ≥F2 or ≥ F3 vs magnetic resonance elastography (AUROCs, 0.76-0.78) or liver biopsy (AUROCs, 0.77-0.81). Based on prespecified or calculated cutoff points, strategies differed in sensitivity and specificity, but without major impact on positive predictive value and negative predictive value. FIB-3 demonstrated a balanced sensitivity-specificity trade-off at age extremes (<35 and ≥65 year old individuals).</p><p><strong>Conclusions: </strong>In adults with metabolic dysfunction-associated steatotic liver disease, strategies to limit age effect on FIB-4 maintained discrimination relative to standard FIB-4. An age-independent approach (FIB-3) maintains diagnostic accuracy across diverse age strata, supporting further prospective evaluation in primary care screening populations.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929003","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":"Spleen and Liver 2-Dimensional Shear Wave Elastography for Clinically Significant Portal Hypertension.","authors":"Christian Sebesta, Mathias Jachs, Lukas Hartl, Michael Schwarz, Lorenz Balcar, Benedikt S Hofer, Nina Dominik, Georg Kramer, Paul Thöne, Annalisa Berzigotti, Josune Cabello Calleja, Juan Carlos García-Pagán, Ioana Morosan, Martin Sebastian McCoy, Bogdan Procopeț, Horia Ștefănescu, Jonel Trebicka, Frank Erhard Uschner, Laure Elkrief, Pierre-Emmanuel Rautou, Bernhard Scheiner, Albert F Stättermayer, Benedikt Simbrunner, Till Schöchtner, Friedrich Haimberger, Nicolas Balutsch, Michael Trauner, Mattias Mandorfer, Thomas Reiberger, David J M Bauer","doi":"10.1016/j.cgh.2026.09.002","DOIUrl":"10.1016/j.cgh.2026.09.002","url":null,"abstract":"<p><strong>Background & aims: </strong>Liver (LSM) and spleen (SSM) stiffness measurements correlate with hepatic venous pressure gradient (HVPG), the reference standard for defining clinically significant portal hypertension (CSPH; ie, HVPG ≥10 mm Hg). LSM, SSM, and derived scores have been proposed for noninvasive CSPH risk assessment.</p><p><strong>Methods: </strong>Patients with compensated advanced chronic liver disease undergoing same-day HVPG, SuperSonic Imagine (SSI)-LSM, and SSI-SSM were prospectively included. Reliable SSI-LSM and SSI-SSM were defined by interquartile range/median ≤30%. SSI-LSM, SSI-SSM, and derived Baveno VII rules, Anticipate-SSI, liver-platelet-spleen (LPS)-SSI, and the newly developed SSI-4PH (LSM and SSM, platelet count, body mass index) model were evaluated in a derivation cohort (DeCo) and an external validation cohort (VaCo).</p><p><strong>Results: </strong>The DeCo comprised 220 patients, paired reliable SSI-LSM and SSI-SSM measurements were available in 118 patients (53.6%) including 74.6% with CSPH. The VaCo comprised 86 eligible patients, of whom 73 (84.9%) had paired reliable measurements including 43.8% with CSPH. In reliable paired analyses, the areas under the receiver operating characteristic curve for CSPH detection in the DeCo were 0.84 for Anticipate-SSI, 0.87 for LPS-SSI, and 0.90 for SSI-4PH; the corresponding areas under the receiver operating characteristic curve in the VaCo were 0.78, 0.77, and 0.73. At the fixed ≥75% predicted risk threshold, the specificity of SSI-4PH was 83.3% in the DeCo and 87.8% in the VaCo.</p><p><strong>Conclusions: </strong>Reliable SSI-LSM and SSI-SSM provide robust noninvasive assessment of CSPH risk; however, the requirement of reliable (interquartile range/median ≤30%) paired measurements may limit applicability. Combined SSI-LSM- and SSM-based rules and multivariable models reduced the gray zone, and the SSI-4PH yielded a favorable decision-curve utility for CSPH risk assessment.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918658","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":"Can Noninvasive Test Dynamics Serve as Surrogate End Points for Histologic Improvement in Metabolic Dysfunction-Associated Steatohepatitis? A Systematic Review and Bayesian Meta-Analysis.","authors":"Pedro Robson Passos, Valbert Oliveira Costa Filho, Bernardo de Faria Moraes, Igor Boechat Silveira, Leonardo Corrêa Süffert, Guilherme Grossi Lopes Cançado","doi":"10.1016/j.cgh.2026.08.030","DOIUrl":"10.1016/j.cgh.2026.08.030","url":null,"abstract":"<p><strong>Background & aims: </strong>Trials on metabolic dysfunction-associated steatohepatitis (MASH) use biopsy for efficacy assessment, despite invasiveness and cost. We aimed to assess the trial-level surrogacy and association of changes in noninvasive tests (NITs), namely liver stiffness measurement (LSM), liver fat content (LFC) by magnetic resonance imaging, Fibrosis-4 score, and Enhanced Liver Fibrosis, with histology in MASH.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Central, and ClinicalTrials.gov up to February 2026 for MASH randomized controlled trials reporting serial NIT data and histologic end points (fibrosis improvement without MASH worsening or MASH resolution without fibrosis worsening). NIT trial-level surrogacy of histologic improvement was quantified through squared Bayesian posterior correlation of treatment effects.</p><p><strong>Results: </strong>Thirty-five randomized controlled trials and 3 post hoc analyses were included. At the trial level, treatment effects on all NITs showed probable weak correlations with treatment effects on histological improvement, with the exception of LFC, which displayed probable moderate surrogacy for MASH resolution without fibrosis worsening (R² = 62%; 95% Credible Interval [CrI], 10%-95%). In contrast, variations in LSM were near-certainly associated with fibrosis improvement without MASH worsening in F4-excluded studies (odds ratio [OR], 2.67; 95% CrI, 1.33-5.12 per 30% decrease) and near-certainly associated with MASH resolution without fibrosis worsening (OR, 2.46; 95% CrI, 1.16-4.66 per 30% decrease). LFC was near-certainly associated with MASH resolution without fibrosis worsening (OR, 1.92; 95% CrI, 1.14-3.20 per 30% decrease).</p><p><strong>Conclusions: </strong>LFC and LSM dynamics were associated with histologic response at the outcome level, but surrogacy was limited and imprecise across biomarkers. This supports a lack of consistent trial-level surrogacy, although context-specific utility remains plausible.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911071","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":"Personalized Prediction of the Individual Risk of Liver-Related Events in Metabolic Dysfunction-Associated Steatotic Liver Disease Using the Dynamics of Noninvasive Tests.","authors":"Clemence Moreau, Marine Roux, Jeremie Riou, Hannes Hagström, Huapeng Lin, Hye Won Lee, Terry Cheuk-Fung Yip, Emmanuel Tsochatzis, Salvatore Petta, Elisabetta Bugianesi, Masato Yoneda, Ming-Hua Zheng, José Luis Calleja, George Boon-Bee Goh, Wah-Kheong Chan, Rocio Gallego-Durán, Arun J Sanyal, Victor de Lédinghen, Philip N Newsome, Jian-Gao Fan, Laurent Castéra, Michelle Lai, Céline Fournier-Poizat, Grace Lai-Hung Wong, Grazia Pennisi, Angelo Armandi, Atsushi Nakajima, Wen-Yue Liu, Ying Shang, Marc de Saint-Loup, Elba Llop, Kevin Kim Jun Teh, Carmen Lara-Romero, Amon Asgharpour, Sara Mahgoub, Mandy Sau-Wai Chan, Manuel Romero-Gomez, Seung Up Kim, Vincent Wai-Sun Wong, Jérôme Boursier","doi":"10.1016/j.cgh.2026.08.032","DOIUrl":"10.1016/j.cgh.2026.08.032","url":null,"abstract":"<p><strong>Background & aims: </strong>The evolution of noninvasive tests of liver fibrosis during follow-up of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains difficult to interpret in clinical practice. We aimed to translate the dynamics of noninvasive tests into a personalized prediction of liver-related events (LREs) in MASLD.</p><p><strong>Methods: </strong>We used the international multicenter VCTE-Prognosis cohort including adult patients with MASLD who underwent liver stiffness measurements (LSMs) by vibration-controlled transient elastography. The study outcome was LRE, a composite endpoint including cirrhosis decompensation or hepatocellular carcinoma. A joint latent class model (JLCM) was used to compute dynamic predictions resulting in a personalized estimation of the risk of LREs (0%-100% at chosen time horizons).</p><p><strong>Results: </strong>A total of 13,627 patients were included, with 238 LREs occurring during the median follow-up of 4.0 years (interquartile range, 2.1-5.9 years). LSM trajectory adjusted on the Fibrosis-4 Index and sex (longitudinal part) and age with platelets (survival part) were selected by the JLCM for LRE prediction. Calibration plots showed very good agreement between the predicted and the observed risk of LRE. The JLCM provided excellent discrimination for LRE with integrated areas under the receiver operating characteristic curve increasing from 88.2% at baseline to 92.2% at the 5-year follow-up visit. At the different study visits, 61%-80% of the patients who experienced LREs were identified as high risk by the JLCM, vs 39%-56% with LSM and 32%-60% with the Fibrosis-4 Index.</p><p><strong>Conclusions: </strong>By automatically integrating and interpreting the dynamics of noninvasive tests of liver fibrosis, JLCM enables the personalized prediction of the risk of hard outcomes, rather than the imperfect evaluation of histologic surrogates.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910447","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":"Influence of Socioeconomic Development on Incidence and Disease Phenotype in Inflammatory Bowel Disease: A Population-Based Incident Study Across 16 Regions.","authors":"Joyce W Y Mak, Agnes H Y Hom, Alicia K W Chan, Yinglei Miao, Yang Sun, Hang Viet Dao, Jamilya Kaibullayeva, Mukesh Sharma Paudel, Julajak Limsrivilai, Shu Chen Wei, Mansour Altuwaijri, Murdani Abdullah, Jesus K Yamamoto-Furusho, Domingo Balderramo, Raja Affendi Raja Ali, Ida Hilmi, Ka Kei Ng, Paul Kelly, Vui Heng Chong, Beatriz Iade Vergara, Yee Kit Tse, Ivan S F Lau, Julia Gorospe, Lindsay Hracs, Stephanie Coward, Joseph W Windsor, Gilaad G Kaplan, Siew C Ng","doi":"10.1016/j.cgh.2026.08.031","DOIUrl":"10.1016/j.cgh.2026.08.031","url":null,"abstract":"<p><strong>Background & aims: </strong>The global rise in inflammatory bowel disease (IBD) parallels socioeconomic development, but its influence on disease epidemiology and phenotype remains unclear. We aimed to characterize IBD incidence, clinical features, and associations with socioeconomic indices across newly industrialized countries.</p><p><strong>Methods: </strong>This prospective population-based study spanned 16 regions in Africa, Asia, Latin America, and the Middle East from October 2021 for 1 year. Poisson regression estimated incidence rate ratios (IRRs) for Human Development Index (HDI), Sociodemographic Index, subnational HDI, and urban population percentage. Mixed-effects models examined associations with disease phenotype, activity, and treatment.</p><p><strong>Results: </strong>Of 606 incident cases (229 Crohn's disease [CD], 348 ulcerative colitis [UC], 29 IBD-unclassified), incidence varied widely. Hong Kong had the highest crude annual incidence (IBD, 7.43; CD, 2.69; UC, 3.44) and Vietnam the lowest (IBD, 0.13; CD, 0.04; UC, 0.08). Urban population (per 10% increase) was associated with a higher incidence of IBD (IRR, 1.68), CD (IRR, 1.73), and UC (IRR, 1.62). The HDI and Sociodemographic Index significantly correlated with CD (IRR, 4.05 and 2.96, respectively), but not subnational HDI. Higher HDI and subnational HDI were associated with increased odds of perianal CD (adjusted odds ratio, 2.61 and 2.40, respectively). Other disease phenotypes, activities, and treatment patterns were not significantly linked to any index.</p><p><strong>Conclusions: </strong>Higher urbanization and development are associated with higher IBD incidence, particularly CD, but not with disease activity at diagnosis. Notably, perianal CD was more common in regions with higher HDI and subnational HDI, suggesting an association with regional socioeconomic development. These highlight the need for region-specific early diagnosis strategies.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911029","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":"Increases in Probiotic Supplement Use Exceed Microbiome-Focused Dietary Changes in United States Adults and Children.","authors":"Kira L Newman, Allen A Lee, Prashant Singh, John Y Kao, William D Chey, Peter D R Higgins","doi":"10.1016/j.cgh.2026.08.029","DOIUrl":"10.1016/j.cgh.2026.08.029","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904529","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":"Phenotyping Matters: Stratifying Isolated Laryngopharyngeal Disease in Trials of the Upper Esophageal Sphincter Assist Device.","authors":"Richard Ferstenberg","doi":"10.1016/j.cgh.2026.08.021","DOIUrl":"10.1016/j.cgh.2026.08.021","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891163","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":"STARS Phase 3 Trial: Once-Weekly Apraglutide Reduces Parenteral Support in Short Bowel Syndrome-Intestinal Failure.","authors":"Francisca Joly, Tim Vanuytsel, Donald F Kirby, Simon Lal, Kelly Tappenden, Palle B Jeppesen, Robert Venick, Marek Kunecki, Kinga Szczepanek, Przemysław Matras, Carrie Li, Tomasz Masior, Patricia Valencia, Mena Boules, Kishore R Iyer","doi":"10.1016/j.cgh.2026.08.026","DOIUrl":"10.1016/j.cgh.2026.08.026","url":null,"abstract":"<p><strong>Background & aims: </strong>Patients with short bowel syndrome and intestinal failure (SBS-IF) depend on parenteral support (PS) to meet nutritional and fluid requirements. Apraglutide, a once-weekly, long-acting glucagon-like peptide-2 analog, promotes intestinal adaptation and may reduce PS dependence. The phase 3 STARS trial evaluated the efficacy and safety of apraglutide vs placebo in SBS-IF.</p><p><strong>Methods: </strong>In this global, phase 3, double-blind, placebo-controlled trial, eligible patients were randomized 2:1 to once-weekly subcutaneous apraglutide or placebo, stratified by remnant intestinal anatomy (stoma or colon-in-continuity [CIC]). The primary end point was relative change from baseline in weekly PS volume at week 24 in the overall population. Key secondary end points included relative PS volume change in the stoma subgroup, days off PS (overall and CIC), and enteral autonomy (CIC). A safety analysis was conducted.</p><p><strong>Results: </strong>Overall, 163 patients (80 stoma, 83 CIC) were randomized and dosed. Apraglutide significantly reduced weekly PS volume from baseline vs placebo at week 24 in the overall population (mean relative change, -25.5% vs -12.5%; P = .001) and stoma subgroup (-25.6% vs -7.8%; P < .001). A higher proportion of patients receiving apraglutide vs placebo achieved a reduction of ≥1 day/week of PS at week 24 (43.0% vs 27.5%; P = .040). At week 48 (CIC), in the apraglutide vs placebo arms, the proportions of patients achieving a reduction of ≥1 day/week of PS and enteral autonomy were 51.8% vs 44.4% (P = .348) and 12.5% vs 7.4% (nominal P = .387), respectively. Apraglutide was well-tolerated with a favorable safety profile.</p><p><strong>Conclusions: </strong>Once-weekly subcutaneous apraglutide significantly reduced PS requirements in patients with SBS-IF with a well-tolerated safety profile.</p><p><strong>Clinicaltrials: </strong>gov, Number: NCT04627025. ClinicalTrialsRegister.eu, Number: 2020-001202-32.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886628","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}