Clinical Microbiology Reviews最新文献

{"title":"Advances in medical and surgical management of <i>Acanthamoeba</i> keratitis: a comprehensive review.","authors":"Matthew Azzopardi, Yu Jeat Chong, Ella P Smith, Eman Khalid Barahim, Thomas Jenyon, Hany M Elsheikha, Nicole Carnt, Rajamani Lakshminarayanan, Jodhbir S Mehta, Saaeha Rauz, Darren S J Ting","doi":"10.1128/cmr.00277-25","DOIUrl":"10.1128/cmr.00277-25","url":null,"abstract":"<p><p>SUMMARYAcanthamoeba keratitis (AK) is a rare but sight-threatening corneal infection with rising global incidence, largely driven by increased contact lens use. Management remains challenging due to limited therapeutic options, variable clinical responses, and a lack of standardized treatment guidelines. Diagnosis is frequently delayed because of the non-specific clinical presentation, and early use of topical corticosteroids can exacerbate disease severity and worsen outcomes. The formation of highly drug-resistant cysts in chronic infection further complicates treatment. Currently, prolonged combination therapy with topical biguanides and aromatic diamidines remains the mainstay of treatment. However, recent evidence supports the use of topical biguanide monotherapy (in higher concentrations) in AK with comparable outcomes to combination treatment. Adjunctive therapies, including azoles, miltefosine, and corticosteroids, may be beneficial in refractory disease. Surgical interventions, such as therapeutic keratoplasty, are often required in advanced or non-responsive cases. The choice of therapy is frequently empirical, guided by clinician experience and drug availability. Emerging therapeutic approaches, including antimicrobial peptides, synthetic polymers, bioactive natural compounds, and ultraviolet C therapy, show promise as more effective or better-tolerated alternatives. This review provides an up-to-date overview of current medical and surgical treatments, explores novel interventions in the pipeline, and highlights the need for evidence-based, individualized management strategies in AK.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0027725"},"PeriodicalIF":20.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204354","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":"The gut microbiome in preterm infants: development, dysbiosis, and disease implications.","authors":"Enfu Tao, Lizhen Wang, Tianming Yuan","doi":"10.1128/cmr.00088-26","DOIUrl":"10.1128/cmr.00088-26","url":null,"abstract":"<p><p>SUMMARYPreterm infants face a unique trajectory of gut microbiome assembly, shaped by the convergence of physiological immaturity, necessary clinical interventions, and the neonatal intensive care unit environment. This dysbiotic ecosystem-characterized by low diversity, depletion of beneficial commensals such as <i>Bifidobacterium</i>, and expansion of pathobionts, including Enterobacteriaceae-is increasingly recognized as a central mediator of neonatal morbidity. This review synthesizes current evidence on preterm microbiome development, its role in necrotizing enterocolitis through mechanisms involving Toll-like receptor 4 signaling, bile acid dysmetabolism, and immune dysregulation, and its systemic impact via gut-organ axes linking the intestine to the brain, lung, eye, and systemic circulation. We critically evaluate microbiome-targeted interventions across the translational spectrum, from foundational practices such as human milk feeding and antibiotic stewardship to active modulation with probiotics and prebiotics, and emerging precision strategies, including postbiotics, phage therapy, and fecal microbiota transplantation. Methodological advances in multi-omics, machine learning, and digital twin modeling are paving the way for personalized, predictive microbiome-mediated care. We also address the hidden burden of antimicrobial resistance in the preterm gut and the challenges of translating mechanistic insights into clinical practice. Looking forward, embracing the complexity of the preterm microbiome as a dynamic, multi-kingdom ecosystem is essential for developing holistic interventions that improve both short-term survival and long-term neurodevelopmental, respiratory, and metabolic outcomes.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0008826"},"PeriodicalIF":20.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249371","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":"The black aspergilli (<i>Aspergillus niger</i> complex) and their role in human, animal, and plant diseases.","authors":"Felix Bongomin, Maarten Punt, Auke de Jong, Paul E Verweij, Norman van Rhijn, David W Denning","doi":"10.1128/cmr.00158-25","DOIUrl":"10.1128/cmr.00158-25","url":null,"abstract":"<p><p>SUMMARYThe <i>Aspergillus niger</i> complex, also known as the black aspergilli or section <i>Nigri</i>, comprises a diverse group of filamentous fungi with wide-ranging ecological, industrial, and pathogenic significance. While traditionally associated with food spoilage and industrial fermentation, black aspergilli have emerged as opportunistic pathogens affecting humans, animals, and plants. This review provides a comprehensive synthesis of the taxonomy, ecology, pathogenicity, and antifungal resistance of the <i>A. niger</i> complex. Advances in phylogenetics and whole-genome sequencing have clarified the taxonomy of section <i>Nigri</i>, now comprising six core species in series <i>Nigri</i>. Clinically, <i>A. niger</i> complex is implicated in various conditions, including otomycosis, keratitis, cutaneous infections, onychomycosis, chronic pulmonary aspergillosis, and, less commonly, invasive aspergillosis. In animals, black aspergilli have been isolated from respiratory, cutaneous, and systemic infections, particularly in immunocompromised or stressed hosts. Plant pathogenicity is significant, with <i>A. niger</i> complex contributing to pre- and post-harvest spoilage and producing mycotoxins such as ochratoxin A and oxalic acid. The common finding of elevated minimum inhibitory concentrations (MICs) to triazoles, particularly in both environmental and clinical isolates, raises concern, with underlying mechanisms differing from those characterized in <i>A. fumigatus</i>. Reduced susceptibility is potentially driven by efflux pumps and environmental exposure to azole fungicides. Due to commonly higher MICs, antifungal therapy with itraconazole and isavuconazole may have reduced efficacy, and alternatives such as voriconazole or posaconazole should be considered, guided by susceptibility testing where available. This review emphasizes the need for a One Health approach to managing black aspergilli, integrating surveillance, diagnostics, and targeted interventions across human, veterinary, and agricultural sectors.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0015825"},"PeriodicalIF":20.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142930","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":"Coxsackievirus A6 on the rise: epidemiology, pathogenicity, evolutionary dynamics, and antiviral strategy.","authors":"Xianfeng Zhou, Fenglan He, Ziqi Lin, Weijie Wen, Shu Yang, Tielong Xu, Hui Li","doi":"10.1128/cmr.00015-26","DOIUrl":"10.1128/cmr.00015-26","url":null,"abstract":"<p><p><b>SUMMARY</b>In recent years, coxsackievirus A6 (CVA6) has become a predominant cause of hand, foot, and mouth disease (HFMD) worldwide, surpassing enterovirus A71 (EV-A71) and CVA16. The rise of CVA6 is of particular public health concern due to its association with atypical and severe clinical presentations, including extensive vesiculobullous eruptions and neurological complications. These diverse and often non-classical manifestations, which also occur in adults, complicate clinical diagnosis and highlight the need for enhanced molecular surveillance. Furthermore, the potential impact of enteroviral infection during pregnancy and on neonatal outcomes remains an important clinical consideration. While both structural and non-structural proteins of CVA6 are known to contribute to viral virulence, the underlying pathogenic mechanisms are not fully understood. Continuous evolution of CVA6 through genetic variation and frequent recombination has led to the emergence of distinct lineages and recombinants, posing substantial challenges to the development of effective antivirals and vaccines. To address these gaps, this review systematically examines the global epidemiology, pathogenic mechanisms, evolutionary dynamics, current diagnostic tools, and antiviral strategies for CVA6. By integrating these perspectives, this work aims to inform public health preparedness and guide future research toward mitigating outbreaks driven by emerging recombinants and novel enterovirus serotypes.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0001526"},"PeriodicalIF":20.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270378","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":"Marburg virus disease: a comprehensive review.","authors":"Courtney Woolsey, Thomas W Geisbert","doi":"10.1128/cmr.00097-23","DOIUrl":"10.1128/cmr.00097-23","url":null,"abstract":"<p><p>SUMMARYMarburg virus disease (MVD) is a highly fatal illness closely resembling Ebola disease, caused by either Marburg virus (MARV) or Ravn virus (RAVV). It typically begins with a sudden onset of high fever, headache, and malaise, followed by severe gastrointestinal symptoms, bleeding disorders, and, in the most severe cases, multi-organ failure. Case fatality rates vary widely, from 24% up to 90%. MARV and RAVV are zoonotic pathogens, with fruit bats recognized as the main reservoir. Human-to-human transmission generally occurs through direct exposure to infected bodily fluids. Historically, MVD outbreaks were primarily restricted to Central and Eastern Africa. In recent years, however, the disease has appeared in new regions: Ghana recorded its first cases in 2022, followed by concurrent outbreaks in Equatorial Guinea and Tanzania in 2023. Rwanda and Ethiopia experienced their debut outbreaks in 2024 and 2025, respectively, and another outbreak occurred in early 2025 in Tanzania. These incidents point to a troubling rise in annual MVD outbreaks and emphasize the ongoing risk of spillover from wildlife reservoirs and continued human-to-human transmission. Currently, there are no approved vaccines or antiviral treatments for MVD. Patient care focuses on supportive therapies, including aggressive fluid resuscitation, management of blood pressure and circulation, and intensive critical care. Nonetheless, promising countermeasures, such as monoclonal antibodies and antiviral drugs, are advancing through research and clinical trials. Experimental vaccines, particularly those based on viral-vector technologies, have demonstrated robust immune responses and are undergoing human testing. This review provides clinicians with the most recent knowledge of MVD, with a focus on epidemiological patterns, diagnostic procedures, clinical management, and the latest progress in developing medical countermeasures.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0009723"},"PeriodicalIF":20.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249385","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":"Atypical infections caused by pathogenic <i>Neisseria</i> species <i>N. meningitidis</i> and <i>N. gonorrhoeae</i>.","authors":"Siobhan Hurley, Monica M Lahra, Tanya L Applegate, Sebastiaan van Hal","doi":"10.1128/cmr.00091-26","DOIUrl":"https://doi.org/10.1128/cmr.00091-26","url":null,"abstract":"<p><p>SUMMARYAtypical pathogenic <i>Neisseria</i> infections, including disseminated gonococcal infection, primary meningococcal conjunctivitis, and urogenital meningococcal infection, are clinically important yet under-recognized syndromes that challenge traditional species-disease paradigms. The increasing use of whole-genome sequencing has revealed adaptive convergence within the <i>Neisseria</i> genus, providing new insights into the evolution, pathophysiology, and tissue tropism of these infections. This review aims to outline current epidemiological, clinical, and genomic evidence to define transmission, risk factors, and molecular determinants underpinning disease. Improved understanding of these conditions is essential to optimize diagnosis, treatment, and public health guidance.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0009126"},"PeriodicalIF":20.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911008","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":"Eschar in scrub typhus: clinical signature, immunopathogenesis, and diagnostic implications.","authors":"Ju Hyeon Kim, Jin Park, Jin Kyeong Choi, Il-Hwan Kim, Chang-Seop Lee","doi":"10.1128/cmr.00348-25","DOIUrl":"https://doi.org/10.1128/cmr.00348-25","url":null,"abstract":"<p><p><b>SUMMARY</b>Scrub typhus, caused by <i>Orientia tsutsugamushi</i>, remains a major cause of acute undifferentiated febrile illness with an expanding global footprint. Early diagnosis is frequently delayed because of nonspecific systemic manifestations and geographic heterogeneity. The eschar, traditionally regarded as a characteristic but unreliable clinical sign, is better understood as a dynamic and biologically active lesion rather than a static cutaneous finding. Accumulating clinical, epidemiologic, and pathologic evidence demonstrates that eschar morphology and detectability vary widely with timing, anatomical location, host factors, and prior exposure, whereas its presence does not predict disease severity. Importantly, the eschar represents the primary site of pathogen inoculation, local amplification, and lymphatic dissemination preceding systemic endothelial infection. This biology has direct diagnostic implications: minimally invasive eschar swab-based molecular diagnostics consistently outperform blood-based assays during the early stages of illness and provide an optimal platform for emerging technologies. Furthermore, early eschar-based recognition dictates the timely initiation of targeted antimicrobial therapy, optimizing standard regimens and guiding safe treatment in vulnerable populations, while highlighting the need for novel therapeutics against drug-resistant strains. Reframing the eschar as a central clinical, diagnostic, and therapeutic axis offers a coherent framework for improving early recognition and future management strategies in scrub typhus.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0034825"},"PeriodicalIF":20.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890772","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":"Human vascular pythiosis: pathogenesis, diagnosis, and evidence-informed management.","authors":"Nitipong Permpalung, Sadeep Medhasi, Pattama Torvorapanit, Rongpong Plongla, Navaporn Worasilchai","doi":"10.1128/cmr.00209-25","DOIUrl":"https://doi.org/10.1128/cmr.00209-25","url":null,"abstract":"<p><p><b>SUMMARY</b>Human vascular pythiosis is a rare, life-threatening angioinvasive infection caused predominantly by the oomycete <i>Pythium insidiosum</i>. Unlike ocular or cutaneous pythiosis, the vascular form is defined by arterial wall invasion, long-segment thrombosis, limb ischemia, aneurysmal complications, and high risks of amputation and death. Although <i>P. insidiosum</i> is broadly distributed in freshwater environments, reported human vascular disease remains concentrated in Thailand, indicating that exposure alone is insufficient for disease development. Available evidence supports a multifactorial model centered on repeated freshwater exposure and host susceptibility, particularly hemoglobinopathies and iron dysregulation, while the rarity of comparable vascular disease elsewhere remains unexplained. Because vascular-specific mechanistic data are limited, evidence from animal pythiosis, nonvascular human disease, environmental studies, genomic analyses, and experimental models must be interpreted selectively and linked explicitly to vascular pathogenesis, diagnosis, or management. Infection usually begins at sites of skin disruption after freshwater exposure and progresses through soft tissue and perivascular planes into the arterial wall. Longitudinal intramural extension, rather than typical hematogenous dissemination, explains long-segment arterial occlusion, proximal progression, and relapse after incomplete source control. Diagnosis requires early suspicion, serology, vascular imaging, and tissue-based confirmation. Management depends on prompt and complete surgical removal of infected arterial tissue, supported by adjunctive protein-synthesis-inhibiting antibacterial therapy, particularly when residual disease is suspected. Conventional antifungals have limited activity, and <i>Pythium</i> antigen immunotherapy remains historically important but of uncertain independent benefit. Earlier recognition, better surgical-margin assessment, standardized diagnosis, and prospective treatment data are needed.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0020925"},"PeriodicalIF":20.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886156","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":"Emerging tick-borne viral diseases in East Asia: pathology-driven insights into pathogenesis and disease causality.","authors":"Yuichiro Hirata, Yusuke Sakai, Tadaki Suzuki","doi":"10.1128/cmr.00340-25","DOIUrl":"https://doi.org/10.1128/cmr.00340-25","url":null,"abstract":"<p><p>SUMMARYTick-borne viral infections have emerged as a significant and growing public health concern. In East Asia, severe fever with thrombocytopenia syndrome (SFTS) has served as a prototypical disease in which pathological analyses have substantially advanced the understanding of disease pathogenesis. SFTS is characterized by profound immune dysregulation driven by viral tropism for plasmablast-lineage B cells, leading to cytokine storm and hemophagocytic syndrome. Complementary analyses of human clinical specimens and experimental animal models, including cats and ferrets, have provided critical insights into the immunopathogenesis of SFTS. The recent identification of additional tick-borne viruses, including Oz virus (OZV), Yezo virus (YEZV), and Alongshan virus (ALSV), has further expanded the spectrum of emerging infections in this region. Notably, pathological investigation of a fatal human case of OZV infection demonstrated direct viral localization within cardiomyocytes, establishing a causal link between infection and fulminant myocarditis and highlighting a distinct organ-specific pathogenic mechanism. Despite the advances in genomic technologies that enable rapid detection of novel viruses, establishing causal relationships between viral presence and disease remains a major challenge. Tissue-based pathological approaches, particularly <i>in situ</i> localization of viral components, are, therefore, essential for defining disease mechanisms and confirming etiological roles. This review provides a comprehensive synthesis of tick-borne viral infections in East Asia, with particular emphasis on Japan, integrating pathological, virological, and clinical perspectives. It also identifies key knowledge gaps and underscores the importance of a synergistic One Health framework that incorporates both human and veterinary pathology to advance the understanding and control of these emerging diseases.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0034025"},"PeriodicalIF":20.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886179","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":"Highly pathogenic avian influenza viruses in mammals: host-range expansion and implications of milk-borne viral shedding.","authors":"Leila Wogick, Sagar M Goyal","doi":"10.1128/cmr.00211-26","DOIUrl":"https://doi.org/10.1128/cmr.00211-26","url":null,"abstract":"<p><p>SUMMARYHighly pathogenic avian influenza (HPAI) viruses, especially subtype H5N1, have caused major outbreaks in poultry and serious human infections since the first description of \"fowl plague\" in 1878. Over time, these viruses have expanded their host range, causing huge losses in domestic poultry, spreading among wild bird populations, and occasionally infecting humans. Understanding how influenza viruses adapt and cross species barriers depends on analyzing their fundamental molecular characteristics. Key features such as the polybasic cleavage site within the hemagglutinin protein and the distinctive \"1+7\" ribonucleoprotein complex, which consists of a single polymerase core surrounded by seven RNA segments, enhance viral replication and broaden host range. Despite decades of intervention, including lessons from the 1997 Hong Kong outbreak and the continued global circulation of clade 2.3.4.4b, HPAI remains difficult to control. A major shift occurred in 2024, when H5N1 was detected in U.S. dairy cattle. This was the first confirmed instance of viral shedding into milk from a mammalian host, suggesting a new potential route of transmission beyond the traditional avian reservoirs. This review unites historical milestones, structural insights, epidemiological data, and recent cross-species findings to better define the current landscape of risk and transmission. We further discuss economic, public health, and agricultural impacts of these developments, particularly the 2024 cattle cases, and underscore the urgent need for an integrated One Health approach to better manage the growing risks posed by HPAI viruses.</p>","PeriodicalId":10378,"journal":{"name":"Clinical Microbiology Reviews","volume":" ","pages":"e0021126"},"PeriodicalIF":20.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863910","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}