Clinical nephrology最新文献

{"title":"Rituximab for double-positive anti-GBM antibody and ANCA-associated glomerulonephritis: The first reported case in Asia and literature review.","authors":"Chang-Ying Chen, Ying-Ren Chen, Wei-Ren Lin, Wei-Hung Lin","doi":"10.5414/CN111588","DOIUrl":"10.5414/CN111588","url":null,"abstract":"<p><strong>Background: </strong>Double-positive patients exhibit both anti-glomerular basement membrane antibody and anti-neutrophil cytoplasmic antibody. Its initial treatment includes induction cyclophosphamide, glucocorticoids, and plasmapheresis, followed by maintenance therapy similar to that for anti-neutrophil cytoplasmic antibody-associated vasculitis. However, some patients suffer from refractoriness and intolerance to cyclophosphamide, creating an unmet need for second-line therapy. Moreover, no guidance has been provided on the choice of immunosuppressant agents for maintenance therapy.</p><p><strong>Case presentation: </strong>A 55-year-old Asian woman presented with post-prandial vomiting and a persistent high fever for 1 month. She was diagnosed as a double-positive patient after developing rapidly progressive glomerulonephritis, with a creatinine level of 332 μmol/L. She received induction therapy with cyclophosphamide, glucocorticoids, and plasmapheresis soon after diagnosis. However, worsening renal function and severe nausea and vomiting occurred after 3 monthly doses of cyclophosphamide. Four weekly doses of re-induction rituximab at 375 mg/m², followed by maintenance rituximab 500 mg every 6 months, were administered. The patient had a stable creatinine level of 208 μmol/L 17 months after diagnosis.</p><p><strong>Conclusion: </strong>Rituximab may be a viable alternative as an induction therapy for double-positive patients when first-line cyclophosphamide is not effective or is not tolerated. Moreover, rituximab may be an effective maintenance therapy for double-positive patients. This case study demonstrates not only the efficacy of rituximab in double-positive patients but also reports the first Asian case of the disorder treated successfully with rituximab.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079686","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":"Anxiety and depression in patients with primary glomerulopathies.","authors":"Marcela Oliveira Faria Braga Borges, Edna Regina Silva Pereira, Maria Alves Barbosa, Marcos Rassi Fernandes","doi":"10.5414/CN111796","DOIUrl":"10.5414/CN111796","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the anxiety and depression domains of patients with primary glomerulopathies from the patients' perspective via patient-reported outcome measurements and to identify the factors associated with worse scores.</p><p><strong>Materials and methods: </strong>This was a cross-sectional study involving 46 patients in which a patient-reported outcome measurement instrument was applied to evaluate the domains of anxiety and depression in patients with primary glomerulopathies. Exploratory univariate statistical analyses were performed, followed by multiple linear regression analyses.</p><p><strong>Results: </strong>46 patients participated in the study. The mean age was 38.5 ± 16.4 years. The anxiety T score was 58.6%, and the depression T score was 54.7%. Female patients had worse anxiety scores (p = 0.044) and depression scores (p = 0.040). Patients under 60 years of age had worse anxiety scores (p = 0.041). A lower educational level was related to a worse depression score (p = 0.010). The concomitant presence of diabetes mellitus and a diagnosis time ≥ 9 months were associated with worse anxiety scores (p = 0.015 and p = 0.014) and depression (p = 0.012 and p = 0.007).</p><p><strong>Conclusion: </strong>Patients with primary glomerulopathies have more anxiety and depression, and the variables associated with worse scores are female sex, age under 60 years, lower educational level, time since diagnosis, and diabetes mellitus.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079680","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":"Peritoneal dialysis in neuropsychiatric systemic lupus erythematosus: A case report integrating proteomic insights into complement-mediated mechanisms.","authors":"Xinyu Wang, Litian Pu, Manxia Yu, Qinyuan Deng","doi":"10.5414/CN111812","DOIUrl":"10.5414/CN111812","url":null,"abstract":"<p><strong>Background: </strong>Neuropsychiatric systemic lupus erythematosus (NPSLE) is a severe SLE complication with limited therapeutic options. While plasma exchange is used, it carries cardiovascular risks and logistical barriers.</p><p><strong>Case report: </strong>We report a 42-year-old East Asian female with SLE who developed progressive edema, dyspnea, and seizures. Imaging and labs revealed cardiorenal dysfunction and neuroinflammatory signs. Peritoneal dialysis (PD) was initiated alongside immunosuppressive therapy (methylprednisolone, telitacicept, cyclophosphamide), leading to resolution of neuropsychiatric symptoms and improvement in renal and hematologic parameters. Proteomic findings: LC-MS/MS analysis of dialysate identified 518 proteins, with functional enrichment pointing to complement activation pathways. By day 4, levels of FCER2 (CD23) and C-reactive protein (CRP), both of which are associated with inflammation, were significantly downregulated, suggesting that PD may facilitate the removal of proinflammatory mediators.</p><p><strong>Conclusion: </strong>PD may serve as a dual-purpose therapy in NPSLE, offering renal support and modulating complement overactivation.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999818","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 of lipoprotein glomerulopathy complicated with IgA nephropathy.","authors":"Jiajun Wu, Xian Sun","doi":"10.5414/CN111795","DOIUrl":"10.5414/CN111795","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991651","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":"Efficacy and safety of repositioning malfunctioning peritoneal dialysis catheters with fluoroscopically guided guidewire manipulation.","authors":"Ron Cheuk Lau Wong, Eric Wai Pan Cheung, Agnes Wong, Brian Kar Ho Lee, Ka King Cheng, Danny Hing Yan Cho","doi":"10.5414/CN111605","DOIUrl":"10.5414/CN111605","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of fluoroscopic-guided repositioning of peritoneal dialysis (PD) catheter using guidewire manipulation in our center in Hong Kong.</p><p><strong>Materials and methods: </strong>All patients underwent fluoroscopic-guided PD catheter repositioning in our institution between November 1, 2017 to December 31, 2022 were reviewed. Patients fulfilling the selection criteria were identified, with their clinical notes, relevant radiological reports, interventional images, and operative records retrospectively reviewed. The success rate was evaluated, with the technical success defined as improved free contrast flow or return of continuous steady stream after test injection of normal saline immediately after repositioning; clinical success defined as functional peritoneal dialysis catheter at 30 days post-repositioning. Logistic regression models were applied to evaluate the variables associated with successful manipulation. Post-manipulation complications and the PD time gained after successful manipulation were also reviewed.</p><p><strong>Results: </strong>46 patients were identified and 54 procedures were performed over the study period. 35 of the interventions (64.8%) resulted in technical success, and 25 cases (46.3%) resulted in clinical success. The median extra PD time gained after successful manipulation was 619 days (IQR, 313.5 - 1,007; range, 110 - 1,872). The median for number of days of hospital stay after the procedure was 2.5 days (IQR, 2 - 5; range, 1 - 65). Seven cases (13.0%) developed immediate complications, with most cases being peritonitis (n = 5), and all were successfully treated with intraperitoneal antibiotics. There was no associated mortality.</p><p><strong>Conclusion: </strong>Fluoroscopic-guided repositioning of the PD catheter was found to be a useful and safe treatment option for malfunctioning PD catheter and could potentially spare patients from the conventional operative intervention.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"159-169"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980290","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":"Development of autoimmune antibodies against human phospholipase A2 receptor and the application as diagnostic criteria for primary membranous nephropathy.","authors":"Shukun Wu, Yixing Zhai, Na Yang, Zhou Zhou, Yingchun Huang, Li Yang, Bing Lai, Guisen Li","doi":"10.5414/CN111747","DOIUrl":"https://doi.org/10.5414/CN111747","url":null,"abstract":"<p><strong>Introduction: </strong>Membranous nephropathy (MN) is a severe chronic kidney disease (CKD) with ~ 30% of patients progressing to end-stage renal disease within 10 years. Phospholipase A2 receptor (PLA2R) is one of the major target antigens of MN. Despite the importance of PLA2R antibodies in the pathogenesis, diagnosis, and prognosis of MN, anti-human PLA2R monoclonal antibodies have not been obtained. This lack hinders the measurement of chemical PLA2R antibody titers, which are critical for drug development.</p><p><strong>Purpose: </strong>The purpose of this study is to obtain standard anti-human PLA2R monoclonal antibodies by creating a phage antibody library to screen for antibodies.</p><p><strong>Materials and methods: </strong>Our study used CHO cells expressing the human PLA2R CysR-FnII-CTLD1 structural domain (CC1h) and obtained candidate antibodies by screening a human phage display library. These candidate antibodies were expressed in CHO cells, and their binding affinity for CC1h was determined by enzyme-linked immunosorbent assay (ELISA) and biological layer interferometry (BLI). In addition, we calibrated the representative antibody names of A13 and A13SP to obtain transforming factors using a commercial PLA2R antibody ELISA kit.</p><p><strong>Results: </strong>43 high-affinity candidate antibodies were obtained by screening human phage display libraries, and 9 groups of IgG antibodies and their IgG4SP subtype antibodies showed high affinity by CHO cell expression, ELISA, and BLI experiments, and we screened 1 group of antibodies with high protein expression levels and high affinity names of A13 and A13SP subtypes from these 9 antibodies. A few of the remaining 8 groups of antibodies and subtypes also showed high protein expression levels and high affinity, and these antibodies can also be used as alternative antibodies. In addition, we calibrated the representative antibody A13 using a commercial PLA2R antibody ELISA kit and obtained an average conversion factor of 1 RU = 70 ng, and we found that the standard curves of the A13 and A13SP subtype antibody groups exhibited a high concordance with that of the commercial PLA2R antibody ELISA kit, which was higher than that of the other alternative antibodies, and therefore this also indicates that the A13 and A13SP subtype antibodies are the most preferred antibody groups in our antibody library.</p><p><strong>Conclusion: </strong>The A13 and A13SP subtype antibodies showed high protein expression levels and high antibody affinity, and the standard curves showed high concordance with the commercial kits, and this conclusion suggests that the A13 and A13SP subtype antibodies can be used as standard antibodies in the ELISA kits for the quantitative detection of human PLA2R antibodies.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945115","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":"Lenalidomide-induced refractory hypocalcemia in a patient with chronic kidney disease and multiple myeloma: case report and review of the literature.","authors":"Denise Maria do Nascimento Costa, Italo Rafael Correia Alves, Luiz Fernando Menezes Soares de Azevedo, Luis Eduardo Ferreira De Biase, Lucas Rafael Ferrevira Soares, Luís Gustavo Cardoso Rabelo, Klebson Fellipe Feijó de Melo, Ana Paula Santana Gueiros","doi":"10.5414/CN111763","DOIUrl":"https://doi.org/10.5414/CN111763","url":null,"abstract":"<p><p>Lenalidomide is an immunomodulatory medication widely used in the treatment of multiple myeloma. However, hypocalcemia associated with lenalidomide is a little-known side effect. We report on a 52-year-old woman with stage G4 - 5 chronic kidney disease (CKD) secondary to multiple myeloma who developed lenalidomide-induced symptomatic hypocalcemia. Her serum calcium (Ca) was 8.6 mg/dL before treatment. After a month on lenalidomide, the patient developed refractory symptomatic hypocalcemia (Ca 6.3 - 7.6 mg/dL). Despite oral supplementation with high-dose calcitriol and calcium carbonate, she persisted with hypocalcemia and had increased serum phosphorus (5.5 mg/dL) and intact parathyroid hormone (616 pg/mL). Renal replacement therapy was indicated to control the bone mineral disorder but was unsuccessful after 4 months of treatment. Control of the hypocalcemia (Ca 8.6 mg/dL) was only achieved 1 month after lenalidomide withdraw due to thrombocytopenia. Renal replacement therapy was discontinued, and the patient remained on conservative treatment for CKD, with no recurrence of hypocalcemia in the following months. The chronology of events in this case strongly suggests causality between lenalidomide and refractory hypocalcemia. This case report is a warning to hematologists and nephrologists about the potential risk of lenalidomide-induced hypocalcemia in CKD patients.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945108","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":"Age and sex-specific association between dyslipidemia treatment and mortality in elderly Korean hemodialysis patients: A retrospective cohort study by the Korean Society of Geriatric Nephrology.","authors":"Seong Geun Kim, Eun Hee Park, Woo Yeong Park, Jang-Hee Cho, Byung Chul Yu, Miyeun Han, Sang Heon Song, Gang-Jee Ko, Jae Won Yang, Sungjin Chung, Yu Ah Hong, Young Youl Hyun, Eunjin Bae, In O Sun, Hyunsuk Kim, Won Min Hwang, Sung Joon Shin, Soon Hyo Kwon, Hyoungnae Kim, Kyung Don Yoo","doi":"10.5414/CN111681","DOIUrl":"https://doi.org/10.5414/CN111681","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are critical public health issues in South Korea, with an increasing number of dialysis patients. Cardiovascular outcomes, significantly affected by dyslipidemia, remain the leading cause of morbidity and mortality. This study explores the age and sex-specific impacts of dyslipidemia treatment on mortality in elderly hemodialysis patients.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study with 2,736 newly diagnosed hemodialysis patients aged 70 years and older from 16 Korean hospitals (January 2010 to December 2017). The impact of statin therapy on mortality was assessed considering baseline characteristics, comorbidities, and lipid profiles. Statistical analyses included Kaplan-Meier survival curves and Cox proportional hazards models with covariate adjustments.</p><p><strong>Results: </strong>Statin use significantly reduced all-cause mortality in both men and women (hazard ratio (HR), 0.76 (0.66 - 0.87) in men; HR, 0.85 (0.73 - 0.99) in women). This benefit was not statistically significant in patients aged 80 and above, especially among females. An inverse relationship between low-density lipoprotein (LDL) levels, and mortality was observed in men, while a U-shaped relationship was noted in females. The unfavorable effects associated with lower LDL levels were more pronounced in the female group.</p><p><strong>Conclusion: </strong>Dyslipidemia treatment improves survival in elderly hemodialysis patients, particularly in males, though benefits diminish in those aged 80 and above. Effective patient outcomes require addressing malnutrition and inflammation alongside lipid levels. Further research is necessary to refine treatment guidelines for this demographic.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945162","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":"Body composition changes and influencing factors of phase angle in maintenance hemodialysis patients with diabetic nephropathy.","authors":"Yuanzhao Xu, Chenxin Wang, Yixuan Li, Gaofeng Song, Cai Xu, Shuyi Ling, Airong Qi","doi":"10.5414/CN111704","DOIUrl":"https://doi.org/10.5414/CN111704","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective longitudinal cohort study aimed to compare the clinical differences between patients with diabetic nephropathy (DN) and non-diabetic nephropathy (NDN) undergoing maintenance hemodialysis and to investigate the influencing factors and clinical significance of phase angle (PhA) in DN patients.</p><p><strong>Materials and methods: </strong>Hemodialysis patients (n = 48), including 23 with DN and 25 with NDN, were enrolled in this study. Body composition parameters were assessed using bioelectrical impedance analysis (BIA), and various biochemical indices were collected. The follow-up period was extended to 5 years. To investigate the relationship between PhA, nutritional status, and other clinical factors, univariate analysis, principal component analysis (PCA), and logistic regression analysis were employed.</p><p><strong>Results: </strong>Comparative analysis demonstrated significant pathophysiological divergence between groups. DN patients exhibited reduced dialysis adequacy (kt/V: 1.424 ± 0.215 vs. 1.57 ± 0.210, p = 0.021) and impaired cellular integrity evidenced by lower PhA values (4.358 ± 1.044 vs. 5.031 ± 1.23°, p = 0.048). Fluid overload patterns distinctly characterized DN patients, with elevated extracellular water ratios (ECW/TBW: 40.265 ± 1.262% vs. 39.282 ± 1.858%, p = 0.039; ECW/ICW: 63.426 ± 3.774 vs. 61.128 ± 3.244, p = 0.028). PhA demonstrated strong inverse correlations with fluid retention parameters (ECW/TBW: r = -0.954, p < 0.001; ECW/ICW: r = -0.946, p < 0.001) and positive associations with nutritional metrics including Fat-Free Mass Index (FFMI)(r = 0.496, p = 0.016), muscle circumference index (MCI) (r = 0.494, p = 0.017), Geriatric Nutritional Risk Index (GNRI) (r = 0.511, p = 0.013), and serum creatinine (Cr) levels (r = 0.448, p = 0.032). High hydration status and low muscle mass were identified as critical factors influencing the reduced PhA observed in DN patients.</p><p><strong>Conclusion: </strong>Significant differences in body composition and PhA exist between maintenance hemodialysis patients with DN and NDN. Low PhA is closely associated with malnutrition and can serve as an effective indicator for evaluating the nutritional status of DN patients.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945105","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":"Angiotensin receptor-neprilysin inhibitor in the management of heart failure in patients with an episode of malignant hypertension and advanced kidney dysfunction: A case series and literature review.","authors":"Tomohiro Saito, Masahide Mizobuchi, Mitsuru Kawanishi, Kazuki Abe, Yuki Kajio, Risa Samejima, Yuuki Mima, Hirokazu Honda","doi":"10.5414/CN111487","DOIUrl":"10.5414/CN111487","url":null,"abstract":"<p><p>Although malignant hypertension (MH) treatment has significantly advanced with the introduction of modern antihypertensive agents, progression to end-stage renal disease remains a significant cause of morbidity and mortality. Additionally, the efficacy of sacubitril/valsartan, which is an angiotensin receptor-neprilysin inhibitor (ARNI), for patients with advanced kidney dysfunction and MH remains unknown. We report the cases of two patients with severe kidney and cardiac dysfunction who received uninterrupted antihypertensive treatment, including sacubitril/valsartan and experienced significant clinical improvement in proteinuria and renal function as well as left ventricular reverse remodeling. This report highlights the benefits of ARNI therapy for MH and its renoprotective effects.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"218-225"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198404","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}