Clinical and Experimental Nephrology最新文献

{"title":"Association of polypharmacy with incidence of CKD: a retrospective cohort study: a letter to the Editor.","authors":"M I Danjuma, L Alkaabi, R Sayed, L Naseralallah","doi":"10.1007/s10157-023-02443-w","DOIUrl":"10.1007/s10157-023-02443-w","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138800212","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":"Urine albumin-to-creatinine ratio diurnal variation rate predicts outcomes in idiopathic membranous nephropathy.","authors":"Xiaoqing Chen, Yong Zhang, Liqun Yan, Yangbin Xie, Shujing Li, Yongze Zhuang, Liping Wang","doi":"10.1007/s10157-023-02444-9","DOIUrl":"10.1007/s10157-023-02444-9","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic membranous nephropathy (IMN) is a leading cause of end-stage renal disease (ESRD). The purpose of this study was to evaluate whether urinary albumin-to-creatinine ratio (UACR) diurnal variation rate calculated by spot urinary protein test predicts 1-year nephrotic outcomes as a biomarker of proteinuria severity in patients with IMN.</p><p><strong>Methods: </strong>Patients' baseline demographics, blood and urinary biomarkers, and clinical and pathological characteristics were collected retrospectively. Urine samples were collected at 7:00 (before breakfast) and 19:00 (after dinner) to calculate the UACR diurnal variation rate. A prediction model for no remission (NR) was developed statistically based on differences between prognosis groups. Receiver operating characteristic curve (ROC) analysis was performed to evaluate prediction abilities and determine optimal cut-off points of the model and UACR diurnal variation rate alone.</p><p><strong>Results: </strong>The formula for calculating the probability of NR was exp(L)/(1 + exp(L)), where the linear predictor L =  - 22.038 + 0.134 × Age (years) + 0.457 × 24-h urinary protein + 0.511 × blood urea nitrogen (BUN) + 0.014 × serum uric acid (SUA) + 2.411 if glomerular sclerosis + 0.816 × fasting blood glucose (FBG)-0.039 × UACR diurnal variation rate (%). Optimal cut-off points for NR prediction by the final model and UACR diurnal variation rate alone were 0.331 and 58.5%, respectively. Sensitivity and specificity were 0.889 and 0.859 for the final model, and 0.926 and 0.676 for UACR diurnal variation rate alone.</p><p><strong>Conclusion: </strong>UACR diurnal variation using spot urinary protein is a simpler way to predict nephrotic outcomes and is a highly sensitive screening tool for identifying patients who should undergo further comprehensive risk assessment.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11033241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139490876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting responsiveness of vadadustat in patients with anemia associated with chronic kidney disease: a post-hoc subgroup analysis of Japanese phase 3 randomized studies.","authors":"Masaomi Nangaku, Kiichiro Ueta, Kenichi Nishimura, Kazuyo Sasaki, Takafumi Hashimoto","doi":"10.1007/s10157-023-02432-z","DOIUrl":"10.1007/s10157-023-02432-z","url":null,"abstract":"<p><strong>Background: </strong>Vadadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor developed for treating anemia in chronic kidney disease (CKD). The purpose of this post-hoc analysis was to investigate the factors affecting the responsiveness to vadadustat in anemia patients with nondialysis-dependent (NDD) or hemodialysis-dependent (HDD) CKD in two Japanese phase 3 studies.</p><p><strong>Methods: </strong>Of 151 and 162 patients enrolled in NDD-CKD and HDD-CKD studies, 136 and 140 patients, respectively, were included and divided into subgroups for the analysis. To assess vadadustat responsiveness, the resistance index was defined as the mean body weight-adjusted dose of vadadustat (mg/kg) at weeks 20-24 divided by the mean hemoglobin (g/dL) at weeks 20-24. Multivariate analysis was performed to identify the variables affecting the resistance index.</p><p><strong>Results: </strong>Independent factors identified as determinants for better response to vadadustat were as follows: high baseline hemoglobin, low baseline eGFR, high week-20-24 ferritin, and CKD not caused by autoimmune disease/glomerulonephritis/vasculitis in NDD-CKD; and male sex, high baseline C-reactive protein, and low baseline erythropoiesis-stimulating agent resistance index (ERI) in HDD-CKD.</p><p><strong>Conclusions: </strong>In this post-hoc analysis, several factors were identified as affecting the response to vadadustat. These results may provide useful information leading to an appropriate dose modification for vadadustat.</p><p><strong>Clinical trial registration: </strong>NCT03329196 (MT-6548-J01) and NCT03439137 (MT-6548-J03).</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11033221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiotensin II and post-streptococcal glomerulonephritis.","authors":"Jesus A Mosquera-Sulbaran, Adriana Pedreañez, Yenddy Carrero, Juan Pablo Hernandez-Fonseca","doi":"10.1007/s10157-023-02446-7","DOIUrl":"10.1007/s10157-023-02446-7","url":null,"abstract":"<p><strong>Background: </strong>Post-streptococcal glomerulonephritis (PSGN) is a consequence of the infection by group A beta-hemolytic streptococcus. During this infection, various immunological processes generated by streptococcal antigens are triggered, such as the induction of antibodies and immune complexes. This activation of the immune system involves both innate and acquired immunity. The immunological events that occur at the renal level lead to kidney damage with chronic renal failure as well as resolution of the pathological process (in most cases). Angiotensin II (Ang II) is a molecule with vasopressor and pro-inflammatory capacities, being an important factor in various inflammatory processes. During PSGN some events are defined that make Ang II conceivable as a molecule involved in the inflammatory processes during the disease.</p><p><strong>Conclusion: </strong>This review is focused on defining which reported events would be related to the presence of this hormone in PSGN.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139086095","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":"A case series of Fabry diseases with CKD in Japan.","authors":"Oi Yusei, Hajime Nagasu, Naoki Nakagawa, Seigo Terawaki, Takahito Moriwaki, Seiji Itano, Seiji Kishi, Tamaki Sasaki, Naoki Kashihara, Takanobu Otomo","doi":"10.1007/s10157-023-02439-6","DOIUrl":"10.1007/s10157-023-02439-6","url":null,"abstract":"<p><strong>Background: </strong>It is well known that kidney injury is vital organ damage in Fabry disease (FD). Renin-angiotensin system (RAS) inhibitors are known to reduce proteinuria in patients with chronic kidney disease (CKD) by dilating the glomerular export arteries and reducing intraglomerular pressure. This improvement in intraglomerular pressure, although lowering the glomerular filtration rate, is thought to prevent renal damage and be renoprotective in the long term. RAS inhibitors may be effective in FD patients with proteinuria to prevent the progression of kidney disease, however, the degree to which they are used in clinical practice is unknown.</p><p><strong>Methods: </strong>The J-CKD-DB-Ex is a comprehensive multicenter database that automatically extracts medical data on CKD patients. J-CKD-DB-Ex contains data on 187,398 patients in five medical centers. FD patients were identified by ICD-10. Clinical data and prescriptions of FD patients between January 1 of 2014, and December 31 of 2020 were used for the analysis.</p><p><strong>Results: </strong>We identified 39 patients with FD from the J-CKD-DB-Ex including those with suspected FD. We confirmed 22 patients as FD. Half of the patients received RAS inhibitors. RAS inhibitors tended to be used in CKD patients with more severe renal impairment.</p><p><strong>Conclusions: </strong>This case series revealed the actual clinical practice of FD patients with CKD. In particular, we found cases in which patients had proteinuria, but were not treated with RAS inhibitors. The database was shown to be useful in assessing the clinical patterns of patients with rare diseases.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11033225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protein intake and its relationship with frailty in chronic kidney disease.","authors":"Nobuyuki Shirai, Suguru Yamamoto, Yutaka Osawa, Atsuhiro Tsubaki, Shinichiro Morishita, Toshiko Murayama, Ichiei Narita","doi":"10.1007/s10157-023-02452-9","DOIUrl":"10.1007/s10157-023-02452-9","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with chronic kidney disease (CKD) are susceptible to frailty because of a range of nutrition-related factors. While protein restriction is commonly advised to preserve kidney function in patients with CKD, insufficient protein intake could potentially exacerbate frailty risk. This study aimed to elucidate the relationship between frailty and protein intake in patients with CKD.</p><p><strong>Methods: </strong>This cross-sectional study enrolled patients with CKD stage 3-5. Frailty and prefrailty were assessed using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. To estimate dietary protein intake, Maroni's formula based on 24-h urine collection was used. The potential association between frailty/pre-frailty and protein intake was investigated using a logistic regression analysis.</p><p><strong>Results: </strong>Ninety-seven individuals with CKD were included in the study, with a median age of 73.0 years (interquartile range: 67.0, 82.0). Among them, 34 were women (35.1%), and the estimated glomerular filtration rate (eGFR) was 36.3 mL/min/1.73 m² (interquartile range: 26.9, 44.1). Frailty and pre-frailty were identified in 13.4% and 55.7% of participants, respectively. Comparing the groups, protein intake in the frailty/pre-frailty group (0.83 g/kgBW/day [0.72, 0.93]) was lower than that in the robust group (0.89 g/kgBW/day [0.84, 1.19], p = 0.002). Upon logistic regression analysis, protein intake exhibited an independent association with frailty/pre-frailty (odds ratio: 0.72, 95% confidence interval: 0.59-0.89, p = 0.003).</p><p><strong>Conclusion: </strong>Reduced protein intake in patients with CKD is associated with frailty and pre-frailty. It is advisable to ensure that patients with CKD who are at risk of frailty consume an adequate amount of protein.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139696977","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":"Design and rationale for an open-label, randomized, controlled pilot trial to evaluate the changes in blood uremic toxins in patients with chronic kidney disease by dietary therapy with sake lees.","authors":"Toshiaki Tokumaru, Tadashi Toyama, Yusuke Nakade, Hisayuki Ogura, Megumi Oshima, Shiori Nakagawa, Motoe Furuichi, Shinji Kitajima, Norihiko Sakai, Miho Shimizu, Yasunori Iwata, Takashi Wada","doi":"10.1007/s10157-023-02450-x","DOIUrl":"10.1007/s10157-023-02450-x","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) reportedly show dysbiosis, which is the imbalance of gut microbiome. Dysbiosis increases the uremic toxin level in the intestine, and uremic toxins transfer into the blood, causing CKD progression. Sake lees, a traditional Japanese fermented food, may help reduce uremic toxins by altering the gut microbiome. Additionally, D-alanine, which is present in sake lees, may have a renoprotective effect. The present pilot study aims to evaluate the effect of adding sake lees to the standard CKD dietary therapy in reducing blood uremic toxins.</p><p><strong>Methods: </strong>This pilot study is a single-center, open-label, randomized controlled trial. Twenty-four patients with CKD will be enrolled and allocated 1:1 to the intervention and control groups. The intervention group will receive standard CKD dietary therapy with an additional intake of 50 g of sake lees per day for 8 weeks, whereas the control group will only receive standard CKD dietary therapy. The primary endpoint is the change in serum indoxyl sulfate after 8 weeks. The secondary endpoint is the plasma D-alanine and fecal microbiome changes.</p><p><strong>Conclusion: </strong>This pilot study provides insight into the development of a new diet focused on gut microbiome and D-amino acids in patients with CKD.</p><p><strong>Clinical trial registration: </strong>This protocol was approved by the Clinical Trial Review Board of Kanazawa University Hospital on October 27, 2022 (2022-001 [6139]) and available to the public on the website of the Japan Registry of Clinical Trials on November 22, 2022 (jRCT1040220095).</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11033224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139715883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of ChatGPT and Bard in self-assessment questions for nephrology board renewal.","authors":"Ryunosuke Noda, Yuto Izaki, Fumiya Kitano, Jun Komatsu, Daisuke Ichikawa, Yugo Shibagaki","doi":"10.1007/s10157-023-02451-w","DOIUrl":"10.1007/s10157-023-02451-w","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) have impacted advances in artificial intelligence. While LLMs have demonstrated high performance in general medical examinations, their performance in specialized areas such as nephrology is unclear. This study aimed to evaluate ChatGPT and Bard in their potential nephrology applications.</p><p><strong>Methods: </strong>Ninety-nine questions from the Self-Assessment Questions for Nephrology Board Renewal from 2018 to 2022 were presented to two versions of ChatGPT (GPT-3.5 and GPT-4) and Bard. We calculated the correct answer rates for the five years, each year, and question categories and checked whether they exceeded the pass criterion. The correct answer rates were compared with those of the nephrology residents.</p><p><strong>Results: </strong>The overall correct answer rates for GPT-3.5, GPT-4, and Bard were 31.3% (31/99), 54.5% (54/99), and 32.3% (32/99), respectively, thus GPT-4 significantly outperformed GPT-3.5 (p < 0.01) and Bard (p < 0.01). GPT-4 passed in three years, barely meeting the minimum threshold in two. GPT-4 demonstrated significantly higher performance in problem-solving, clinical, and non-image questions than GPT-3.5 and Bard. GPT-4's performance was between third- and fourth-year nephrology residents.</p><p><strong>Conclusions: </strong>GPT-4 outperformed GPT-3.5 and Bard and met the Nephrology Board renewal standards in specific years, albeit marginally. These results highlight LLMs' potential and limitations in nephrology. As LLMs advance, nephrologists should understand their performance for future applications.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139729144","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":"An integrated view of cisplatin-induced nephrotoxicity, hepatotoxicity, and cardiotoxicity: characteristics, common molecular mechanisms, and current clinical management","authors":"Caroline Assunção Oliveira, Érika Azenathe Barros Mercês, Fernanda Santos Portela, Lara Fabiana Luz Malheiro, Henrique Bruno Lopes Silva, Laís Mafra De Benedictis, Júlia Mafra De Benedictis, Clara Cotta d’Ávilla e Silva, Alberto Christian Luz Santos, Dã Pinheiro Rosa, Helloisa Souza Velozo, Telma de Jesus Soares, Liliany Souza de Brito Amaral","doi":"10.1007/s10157-024-02490-x","DOIUrl":"https://doi.org/10.1007/s10157-024-02490-x","url":null,"abstract":"<p>Cisplatin (CP) is a chemotherapy drug widely prescribed to treat various neoplasms. Although fundamental for the therapeutic action of the drug, its cytotoxic mechanisms trigger adverse effects in several tissues, such as the kidney, liver, and heart, which limit its clinical use. In this sense, studies point to an essential role of damage to nuclear and mitochondrial DNA associated with oxidative stress, inflammation, and apoptosis in the pathophysiology of tissue injuries. Due to the limitation of effective preventive and therapeutic measures against CP-induced toxicity, new strategies with potential cytoprotective effects have been studied. Therefore, this article is timely in reviewing the characteristics and main molecular mechanisms common to renal, hepatic, and cardiac toxicity previously described, in addition to addressing the main validated strategies for the current management of these adverse events in clinical practice. We also handle the main promising antioxidant substances recently presented in the literature to encourage the development of new research that consolidates their potential preventive and therapeutic effects against CP-induced cytotoxicity.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140809046","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 soluble suppression of tumorigenicity 2 with mortality and adverse outcomes in chronic kidney disease: a systematic review and meta-analysis","authors":"Ioannis Bellos, Smaragdi Marinaki, Pagona Lagiou, Vassiliki Benetou","doi":"10.1007/s10157-024-02506-6","DOIUrl":"https://doi.org/10.1007/s10157-024-02506-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Early risk stratification is necessary to prevent chronic kidney disease progression and complications. This systematic review aims to evaluate the association of soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin-1 receptor family, with all-cause mortality, cardiovascular disease and renal function deterioration among chronic kidney disease patients.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>PubMed, Scopus, Web of Science, CENTRAL and Google Scholar were systematically searched from inception to December 20, 2023. Cohort studies examining the prognostic role of sST2 levels in pre-dialysis and dialysis patients were included. In case of 3 or more studies per outcome, conventional and dose–response meta-analyses were conducted.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Overall, 21 studies were included comprising 15,100 patients. In pre-dialysis patients, the qualitative synthesis of studies suggested that high sST2 is associated with significantly increased all-cause mortality, while evidence regarding cardiovascular events or kidney disease progression was conflicting. In the dialysis population, high sST2 was linked to an elevated risk of all-cause (Hazard ratio-HR: 3.00, 95% confidence intervals-CI: 1.95–4.61) and cardiovascular (HR: 2.38, 95% CI: 1.69–3.34) mortality. Dose–response meta-analysis suggested a log-linear association of sST2 with both all-cause (<i>χ</i>^<i>2</i>: 34.65, <i>p value</i> &lt; 0.001) and cardiovascular (<i>χ</i>^<i>2</i>: 29.14, <i>p value</i> &lt; 0.001) mortality, whereas findings regarding cardiovascular events were limited with mixed results.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>High sST2 values are associated with an increased risk of all-cause mortality in pre-dialysis and dialysis patients, as well as with an elevated risk of cardiovascular mortality in the dialysis population. Further studies are needed to elucidate its potential association with cardiovascular events and kidney disease progression.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140809386","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}