Clinical Gastroenterology and Hepatology最新文献

{"title":"Personalizing Aspirin Therapy in Gastrointestinal Cancer: The Critical Role of Age Stratification","authors":"Anqi Lin, Aimin Jiang, Peng Luo","doi":"10.1016/j.cgh.2024.06.013","DOIUrl":"10.1016/j.cgh.2024.06.013","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 677-678"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431511","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":"Prevalence of Endoscopically Curable Low-Risk Cancer Among Large (≥20 mm) Nonpedunculated Polyps in the Right Colon","authors":"Julia L. Gauci ,&nbsp;Anthony Whitfield ,&nbsp;Renato Medas ,&nbsp;Clarence Kerrison ,&nbsp;Francesco Vito Mandarino ,&nbsp;David Gibson ,&nbsp;Timothy O’Sullivan ,&nbsp;Oliver Cronin ,&nbsp;Sunil Gupta ,&nbsp;Brian Lam ,&nbsp;Varan Perananthan ,&nbsp;Luke Hourigan ,&nbsp;Simon Zanati ,&nbsp;Rajvinder Singh ,&nbsp;Spiro Raftopoulos ,&nbsp;Alan Moss ,&nbsp;Gregor Brown ,&nbsp;Amir Klein ,&nbsp;Lobke Desomer ,&nbsp;David J. Tate ,&nbsp;Michael J. Bourke","doi":"10.1016/j.cgh.2024.07.017","DOIUrl":"10.1016/j.cgh.2024.07.017","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic submucosal dissection is increasingly promoted for the treatment of all large nonpedunculated colorectal polyps (LNPCPs) to cure potential low-risk cancers (superficial submucosal invasion without additional high-risk histopathologic features). The effect of a universal en bloc strategy on oncologic outcomes for the treatment of LNPCPs in the right colon is unknown. We evaluated this in a large Western population.</div></div><div><h3>Methods</h3><div>A prospective cohort of patients referred for endoscopic resection (ER) of LNPCPs was analyzed. Patients found to have cancer after ER and those referred directly to surgery were included. The primary outcome was to determine the proportion of right colon LNPCPs with low-risk cancer.</div></div><div><h3>Results</h3><div>Over 180 months until June 2023, 3294 sporadic right colon LNPCPs in 2956 patients were referred for ER at 7 sites (median size 30 [interquartile range 22.5–37.5] mm). A total of 63 (2.1%) patients were referred directly to surgery, and cancer was proven in 56 (88.9%). A total of 2851 (96.4%) of 2956 LNPCPs underwent ER (median size 35 [interquartile range 25–45] mm), of which 75 (2.6%) were cancers. The overall prevalence of cancer in the right colon was 4.4% (n = 131 of 2956). Detailed histopathologic analysis was possible in 115 (88%) of 131 cancers (71 after ER, 44 direct to surgery). After excluding missing histopathologic data, 23 (0.78%) of 2940 sporadic right colon LNPCPs were low-risk cancers.</div></div><div><h3>Conclusions</h3><div>The proportion of right colon LNPCPs referred for ER containing low-risk cancer amenable to endoscopic cure was &lt;1%, in a large, multicenter Western cohort. A universal endoscopic submucosal dissection strategy for the management of right colon LNPCPs is unlikely to yield improved patient outcomes given the minimal impact on oncologic outcomes.</div><div>ClinicalTrials.gov, Numbers: <span><span>NCT01368289</span><svg><path></path></svg></span>, <span><span>NCT02000141</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 555-563.e1"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874346","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":"Transcriptomic and Metabolomic Correlates of Increased Colonic Permeability in Postinfection Irritable Bowel Syndrome","authors":"Ana Y. Caceres Lessa ,&nbsp;Adam Edwinson ,&nbsp;Hiroki Sato ,&nbsp;Lu Yang ,&nbsp;Antonio Berumen ,&nbsp;Margaret Breen-Lyles ,&nbsp;Anjali Byale ,&nbsp;Michael Ryks ,&nbsp;Ashley Keehn ,&nbsp;Michael Camilleri ,&nbsp;Gianrico Farrugia ,&nbsp;Jun Chen ,&nbsp;Marijke Decuir ,&nbsp;Kirk Smith ,&nbsp;Surendra Dasari ,&nbsp;Madhusudan Grover","doi":"10.1016/j.cgh.2024.06.028","DOIUrl":"10.1016/j.cgh.2024.06.028","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Postinfection irritable bowel syndrome (PI-IBS) is well-known epidemiologically; however, its physiological and molecular characteristics are not well studied. We aimed to determine the physiological phenotypes, colonic transcriptome, fecal microbiome, and metabolome in PI-IBS.</div></div><div><h3>Methods</h3><div>Fifty-one Rome III <em>Campylobacter</em> PI-IBS patients and 39 healthy volunteers (HV) were enrolled. Participants completed questionnaires, in vivo intestinal permeability, gastrointestinal transit, and rectal sensation. Fecal samples were collected for shotgun metagenomics, untargeted metabolomics, and sigmoid colonic biopsies for bulk RNAseq. Differential gene expression, differences in microbiota composition, and metabolite abundance were determined. Gene and metabolite clusters were identified via weighted gene correlation network analysis and correlations with clinical and physiological parameters determined.</div></div><div><h3>Results</h3><div>PI-IBS (59% female; 46 ± 2 years) and HV (64% female; 42 ± 2 years) demographics were comparable. Mean IBS-symptom severity score was 227; 94% were nonconstipation. Two- to 24-hour lactulose excretion was increased in PI-IBS, suggesting increased colonic permeability (4.4 ± 0.5 mg vs 2.6 ± 0.3 mg; <em>P</em> = .01). Colonic transit and sensory thresholds were similar between the 2 groups. Overall, expression of 2036 mucosal genes and 223 fecal metabolites were different, with changes more prominent in females. Fecal <em>N</em>-acetylputrescine was increased in PI-IBS and associated with colonic permeability, worse diarrhea, and negatively correlated with abundance of <em>Collinsella aerofaciens</em>. Histamine and <em>N</em>-acetylhistamine positively associated with 2- to 24-hour lactulose excretion. Eight weighted gene coexpression modules significantly correlated with phenotypes (sex, stool frequency, colonic permeability, transit).</div></div><div><h3>Conclusions</h3><div><em>Campylobacter</em> PI-IBS patients demonstrate higher colonic permeability, which associated with changes in polyamine and histamine metabolites. Female patients demonstrated greater molecular changes.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 632-643.e13"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579147","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":"Decreasing Case Fatality Rates for Patients With Cirrhosis Infected With SARS-CoV-2: A National COVID Cohort Collaborative Study","authors":"Jin Ge ,&nbsp;Aryana T. Far ,&nbsp;Jean C. Digitale ,&nbsp;Mark J. Pletcher ,&nbsp;Jennifer C. Lai","doi":"10.1016/j.cgh.2024.07.028","DOIUrl":"10.1016/j.cgh.2024.07.028","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>The virulence and severity of SARS-CoV-2 infections have decreased over time in the general population due to vaccinations and improved antiviral treatments. Whether a similar trend has occurred in patients with cirrhosis is unclear. We used the National COVID Cohort Collaborative (N3C) to describe the outcomes over time.</div></div><div><h3>Methods</h3><div>We utilized the N3C level 3 data set with uncensored dates to identify all patients with chronic liver disease (CLD) with and without cirrhosis who had SARS-CoV-2 infection as of November 2023. We described the observed 30-day case fatality rate (CFR) by month of infection. We used adjusted survival analyses to calculate relative hazard of death by month of infection compared with infection at the onset of the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>We identified 117,811 total patients with CLD infected with SARS-CoV-2 between March 2020 and November 2023: 27,428 (23%) with cirrhosis and 90,383 (77%) without cirrhosis. The observed 30-day CFRs during the entire study period were 1.1% (1016) for patients with CLD without cirrhosis and 6.3% (1732) with cirrhosis. Observed 30-day CFRs by month of infection varied throughout the pandemic and showed a sustained downward trend since 2022. Compared with infection in Quarter 2 of 2020 (at the beginning of the pandemic), the adjusted hazards of death at 30 days for infection in Quarter 3 of 2023 were 0.20 (95% confidence interval [CI], 0.08–0.50) for patients with CLD without cirrhosis and 0.35 (95% CI, 0.18–0.69) for patients with CLD with cirrhosis.</div></div><div><h3>Conclusions</h3><div>In this N3C study, we found that the observed 30-day CFR decreased progressively for patients with CLD both with and without cirrhosis, consistent with broader trends seen in the general population.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 591-601.e2"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055083","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":"Harm-to-Benefit Ratio of Fecal Immunochemical Test–Based Screening for Colorectal Cancer Given Prior Fecal Hemoglobin Concentrations","authors":"Esther Toes-Zoutendijk ,&nbsp;Hilliene J. van de Schootbrugge-Vandermeer ,&nbsp;Maria A. Katsara ,&nbsp;Lucie de Jonge ,&nbsp;Manon C.W. Spaander ,&nbsp;Anneke J. van Vuuren ,&nbsp;Folkert J. van Kemenade ,&nbsp;Evelien Dekker ,&nbsp;Iris D. Nagtegaal ,&nbsp;Monique E. van Leerdam ,&nbsp;Iris Lansdorp-Vogelaar ,&nbsp;Reinier G.S. Meester","doi":"10.1016/j.cgh.2024.08.041","DOIUrl":"10.1016/j.cgh.2024.08.041","url":null,"abstract":"<div><h3>Background and Aims</h3><div>This study aimed to provide evidence on the harm-to-benefit ratio of fecal immunochemical test (FIT)–based colorectal cancer (CRC) screening by previous fecal hemoglobin (f-Hb) concentrations, as reflected in the number needed to screen (NNS) and number needed to scope (NNSc).</div></div><div><h3>Methods</h3><div>Participants in up to 4 FIT screening rounds of the Dutch CRC screening program were included. The main outcomes of this study were the NNS and NNSc to detect 1 CRC and/or advanced neoplasia (AN) in screening rounds 2, 3, or 4, conditional on previous f-Hb concentrations. Outcomes were compared between participants using chi-square tests and logistic regression.</div></div><div><h3>Results</h3><div>In total, 2,428,883 study participants completed at least 2 consecutive FITs, 1,308,684 completed 3 FITs, and 150,958 completed 4 FITs. There were 31,400, 16,060, and 2007 ANs detected by round, respectively. The NNS for individuals with vs without a history of detectable f-Hb differed significantly irrespective of screening round. Individuals without detectable f-Hb in previous negative FITs had almost 9 times the NNS to detect 1 AN compared with those with detectable f-Hb (odds ratio, 8.71; 95% confidence interval, 8.51–8.92). A similar directional pattern was observed for NNSc, although the differences were smaller (odds ratio, 2.7; 95% confidence interval, 2.7–2.8).</div></div><div><h3>Conclusions</h3><div>The harm-to-benefit ratio of FIT-based screening is substantially greater in individuals without vs with prior detectable f-Hb. Less intensive screening should be considered for this lower-risk group.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 653-661.e3"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459522","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":"Prevalence of Gastroparesis in Chronic Pancreatitis and Predictive Factors: A Machine Learning Prediction Model","authors":"Daryl Ramai,&nbsp;Chun-Wei Pan,&nbsp;David M. Troendle,&nbsp;Marcello Maida,&nbsp;Antonio Facciorusso,&nbsp;Jorge D. Machicado","doi":"10.1016/j.cgh.2024.09.023","DOIUrl":"10.1016/j.cgh.2024.09.023","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 668-670.e1"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567798","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":"Comments on “Enduring Clinical Remission in Refractory Celiac Disease Type II with Tofacitinib: An Open-Label Clinical Study”","authors":"Manjeet Kumar Goyal","doi":"10.1016/j.cgh.2024.07.004","DOIUrl":"10.1016/j.cgh.2024.07.004","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 678-679"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787377","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":"Additional Yield of Random Biopsy in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis","authors":"Li Gao ,&nbsp;Ke Fang ,&nbsp;Xin Dong ,&nbsp;Jiawei Bai ,&nbsp;Kai Liu ,&nbsp;Yue Wang ,&nbsp;Mi Wang ,&nbsp;Ying Han ,&nbsp;Zhiguo Liu","doi":"10.1016/j.cgh.2024.05.045","DOIUrl":"10.1016/j.cgh.2024.05.045","url":null,"abstract":"<div><h3>Background</h3><div>There are limited clinical data regarding the additional yields of random biopsies (RBs) during colorectal cancer surveillance in patients with inflammatory bowel disease. To assess the additional yield of RB, a systematic review and meta-analysis was conducted.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies investigating the preferred colonoscopy surveillance approach for inflammatory bowel disease patients. The additional yield, detection rate, procedure time, and withdrawal time were pooled.</div></div><div><h3>Results</h3><div>Thirty-seven studies (48 arms) were included in the meta-analysis with 9051 patients. The additional yields of RB were 10.34% in per-patient analysis and 16.20% in per-lesion analysis. The detection rates were 1.31% and 2.82% in per-patient and per-lesion analysis, respectively. Subgroup analysis showed a decline in additional yields from 14.43% to 0.42% in the per-patient analysis and from 19.20% to 5.32% in the per-lesion analysis for studies initiated before and after 2011. In per-patient analysis, the additional yields were 4.83%, 10.29%, and 56.05% for primary sclerosing cholangitis (PSC) proportions of 0% to 10%, 10% to 30%, and 100%, respectively. The corresponding detection rates were 0.56%, 1.40%, and 19.45%. In the per-lesion analysis, additional yields were 11.23%, 21.06%, and 45.22% for PSC proportions of 0% to 10%, 10% to 30%, and 100%, respectively. The corresponding detection rates were 2.09%, 3.58%, and 16.24%.</div></div><div><h3>Conclusions</h3><div>The additional yields of RB were 10.34% and 16.20% for per-patient and per-lesion analyses, respectively. Considering the decreased additional yields in studies initiated after 2011, and the influence of PSC, endoscopy centers lacking full high-definition equipment should consider incorporating RB in the standard colonoscopy surveillance for inflammatory bowel disease patients, especially in those with PSC.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 542-554.e21"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554318","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":"Blue Notes","authors":"Charles J. Kahi MD, MS, AGAF","doi":"10.1016/j.cgh.2024.12.004","DOIUrl":"10.1016/j.cgh.2024.12.004","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 501-502"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508797","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":"Rigorous Donor Selection for Fecal Microbiota Transplantation in Active Ulcerative Colitis: Key Lessons From a Randomized Controlled Trial Halted for Futility","authors":"Clara Caenepeel ,&nbsp;Sara Deleu ,&nbsp;Jorge Francisco Vazquez Castellanos ,&nbsp;Kaline Arnauts ,&nbsp;Sara Braekeleire ,&nbsp;Kathleen Machiels ,&nbsp;Filip Baert ,&nbsp;Fazia Mana ,&nbsp;Lieven Pouillon ,&nbsp;Pieter Hindryckx ,&nbsp;Triana Lobaton ,&nbsp;Edouard Louis ,&nbsp;Denis Franchimont ,&nbsp;Bram Verstockt ,&nbsp;Marc Ferrante ,&nbsp;João Sabino ,&nbsp;Sara Vieira-Silva ,&nbsp;Gwen Falony ,&nbsp;Jeroen Raes ,&nbsp;Séverine Vermeire","doi":"10.1016/j.cgh.2024.05.017","DOIUrl":"10.1016/j.cgh.2024.05.017","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Rigorous donor preselection on microbiota level, strict anaerobic processing, and repeated fecal microbiota transplantation (FMT) administration were hypothesized to improve FMT induction of remission in ulcerative colitis (UC).</div></div><div><h3>Methods</h3><div>The RESTORE-UC trial was a multi-centric, double-blind, sham-controlled, randomized trial. Patients with moderate to severe UC (defined by total Mayo 4–10) were randomly allocated to receive 4 anaerobic-prepared allogenic or autologous donor FMTs. Allogenic donor material was selected after a rigorous screening based on microbial cell count, enterotype, and the abundance of specific genera. The primary endpoint was steroid-free clinical remission (total Mayo ≤2, no sub-score &gt;1) at week 8. A pre-planned futility analysis was performed after 66% (n = 72) of intended inclusions (n = 108). Quantitative microbiome profiling (n = 44) was performed at weeks 0 and 8.</div></div><div><h3>Results</h3><div>In total, 72 patients were included, of which 66 received at least 1 FMT (allogenic FMT, n = 30 and autologous FMT, n = 36). At week 8, respectively, 3 and 5 patients reached the primary endpoint of steroid-free clinical remission (<em>P</em> = .72), indicating no treatment difference of at least 5% in favor of allogenic FMT. Hence, the study was stopped due to futility. Microbiome analysis showed numerically more enterotype transitions upon allogenic FMT compared with autologous FMT, and more transitions were observed when patients were treated with a different enterotype than their own at baseline (<em>P</em> = .01). Primary response was associated with lower total Mayo scores, lower bacterial cell counts, and higher Bacteroides 2 prevalence at baseline.</div></div><div><h3>Conclusion</h3><div>The RESTORE-UC trial did not meet its primary endpoint of increased steroid-free clinical remission at week 8. Further research should additionally consider patient selection, sterilized sham-control, increased frequency, density, and viability of FMT prior to administration.</div><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, Number: <span><span>NCT03110289</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 621-631.e7"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092623","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}