Clinics and research in hepatology and gastroenterology最新文献

{"title":"Gastrointestinal Angiectasia in patients with chronic kidney disease: A matched case-control study","authors":"Sarah Azancot ,&nbsp;Xavier Dray ,&nbsp;Parastou Moshiri ,&nbsp;Adil Soualy ,&nbsp;Antoine Guilloux ,&nbsp;Pierre Antoine Michel ,&nbsp;Jean Jacques Boffa ,&nbsp;Aymeric Becq","doi":"10.1016/j.clinre.2024.102454","DOIUrl":"10.1016/j.clinre.2024.102454","url":null,"abstract":"<div><h3>Background and study aims</h3><p>Chronic kidney disease (CKD) is a well-known risk factor of gastrointestinal angiectasia (GIA). The aim was to compare this population with CDK patients without GIA.</p></div><div><h3>Methods</h3><p>Patients followed in the Nephrology Department of Tenon Hospital for which an endoscopy was performed between 2012 and 2022 were identified. Those with at least one GIA lesion were included (\"GIA+\" group). A matched control group for age, sex and GFR stage of patients with CKD and no GIA lesion (\"GIA-\" group) was constituted. A subgroup analysis compared patients with (SB+) and without (SB-) small-bowel involvement.</p></div><div><h3>Results</h3><p>A total of 55 patients were included in the GIA+ group. 36.3 % (<em>n</em> = 20) were active smokers and 29.1 % (<em>n</em> = 16) had peripheral arterial disease versus 16.4 % (<em>n</em> = 9) (OR 2.89, <em>p</em> = 0.03), and 9.1 % (<em>n</em> = 5) (OR 4.05, <em>p</em> = 0.015) in the GIA- group. Thirteen patients (23.6 %) had a SB lesion. Duodenal involvement was present in 69.2 % of cases in the SB+ group versus 28.6 % in the SB- group (<em>p</em> = 0.02). Median number of endoscopies, hemostatic technics and hospitalizations was 7, 3 and 6, versus 2 (<em>p</em> = 0.0001), 1 (<em>p</em> = 0.001) and 1 (<em>p</em> = 0.0002) in the SB- group.</p></div><div><h3>Conclusions</h3><p>CKD patients with GIA had a greater cardiovascular risk with a higher incidence of vascular nephropathy. Small-bowel GIA were associated with a higher morbidity.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102454"},"PeriodicalIF":2.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046385","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":"Temporal trends in prevalence of liver cancer and etiology-specific liver cancer from 1990 to 2019","authors":"Chunhua Yang ,&nbsp;Jia Jia ,&nbsp;Yue Yu ,&nbsp;Hao Lu ,&nbsp;Liwei Zhang","doi":"10.1016/j.clinre.2024.102451","DOIUrl":"10.1016/j.clinre.2024.102451","url":null,"abstract":"<div><h3>Background</h3><p>Liver cancer (LC) remains a major cause of cancer death worldwide. Grasping prevalence trends is key to informing strategies for control and prevention. We analyzed the global, regional and national trends in LC prevalence and its major causes from 1990 to 2019.</p></div><div><h3>Methods</h3><p>We obtained LC age-standardized prevalence rate (ASPR) estimates from the Global Burden of Disease study 2019 and assessed trends using Joinpoint regression. LC cases were categorized into those due to hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol use, nonalcoholic steatohepatitis (NASH) and other causes.</p></div><div><h3>Results</h3><p>While the ASPR of LC has shown a global decrease, there are specific regions where an increase in ASPR has been observed, with the highest rates in America. HBV remained the leading cause of LC (41.45 %) but significant increases occurred for HCV, alcohol use and NASH. Prevalence correlated with socioeconomic development. High-income countries had higher LC rates from HCV and alcohol but lower HBV-related LC. In high-income nations, LC prevalence climbs; the converse holds in middle- and low-income countries.</p></div><div><h3>Conclusions</h3><p>Despite a global ASPR decrease, LC due to HCV, NASH, and alcohol is rising. Prevention strategies must prioritize HBV vaccination, HCV treatment, and alcohol regulation.</p></div><div><h3>Impact</h3><p>The study informs targeted LC control policies and emphasizes the importance of continued monitoring and regional cooperation to combat LC.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102451"},"PeriodicalIF":2.6,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035408","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":"Causal effects of smoking, alcohol consumption, and coffee intake on hepatobiliary and pancreatic diseases: A Mendelian randomization study","authors":"Bingbing Zhao ,&nbsp;Jiajing Xue ,&nbsp;Huaqin Zhang","doi":"10.1016/j.clinre.2024.102450","DOIUrl":"10.1016/j.clinre.2024.102450","url":null,"abstract":"<div><h3>Background</h3><p>Hepatobiliary and pancreatic diseases, such as cirrhosis, hepatocellular carcinoma, cholelithiasis, and pancreatitis, are major global health challenges. Lifestyle factors like smoking, alcohol consumption, and coffee intake are commonly studied for their health impacts. However, observational studies often face issues with confounding factors and reverse causality, making it difficult to establish causal relationships.</p></div><div><h3>Methods</h3><p>This research uses Mendelian randomization (MR) to investigate the causal effects of smoking, alcohol use, and coffee intake on 10 hepatobiliary and pancreatic diseases. Genetic data from the Sequencing Consortium of Alcohol and Nicotine Use (GSCAN) and self-reported GWAS were used to derive instrumental variables (IVs). The outcomes were obtained from the FinnGen and UK Biobank cohorts. Univariable and multivariable MR analyses were conducted to assess the associations.</p></div><div><h3>Results</h3><p>Genetic predisposition to tobacco use was associated with increased risks of acute pancreatitis, alcoholic hepatitis, chronic pancreatitis, cirrhosis, gallstones, liver cancer, and pancreatic cancer. Alcohol consumption was linked to acute pancreatitis, chronic pancreatitis, alcoholic liver disease, hepatic cancer, and cholangitis. Coffee intake showed minimal associations, with a slight protective effect against non-alcoholic steatohepatitis.</p></div><div><h3>Conclusions</h3><p>This study confirms the harmful effects of inhaling tobacco and consuming alcohol on hepatobiliary and pancreatic diseases. It highlights the need for public health strategies to reduce tobacco use and heavy alcohol consumption. Coffee intake showed minimal effects, suggesting further research is needed to understand its relationship with hepatobiliary health.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102450"},"PeriodicalIF":2.6,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016513","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":"Alkaline phosphatase and liver fibrosis at diagnosis are associated with deep response to ursodeoxycholic acid in primary biliary cholangitis","authors":"Guilherme Grossi Lopes Cançado ,&nbsp;Patrícia da Silva Fucuta ,&nbsp;Nathalia Mota de Faria Gomes ,&nbsp;Cláudia Alves Couto ,&nbsp;Eduardo Luiz Rachid Cançado ,&nbsp;Debora Raquel Benedita Terrabuio ,&nbsp;Cristiane Alves Villela‑Nogueira ,&nbsp;Michelle Harriz Braga ,&nbsp;Mateus Jorge Nardelli ,&nbsp;Luciana Costa Faria ,&nbsp;Elze Maria Gomes Oliveira ,&nbsp;Vivian Rotman ,&nbsp;Maria Beatriz Oliveira ,&nbsp;Simone Muniz Carvalho Fernandes da Cunha ,&nbsp;Marlone Cunha da Silva ,&nbsp;Liliana Sampaio Costa Mendes ,&nbsp;Claudia Alexandra Pontes Ivantes ,&nbsp;Liana Codes ,&nbsp;Valéria Ferreira de Almeida e Borges ,&nbsp;Fabio Heleno de Lima Pace ,&nbsp;Maria Lucia Gomes Ferraz","doi":"10.1016/j.clinre.2024.102453","DOIUrl":"10.1016/j.clinre.2024.102453","url":null,"abstract":"<div><h3>Objective</h3><p>Primary biliary cholangitis is a chronic and progressive autoimmune liver disease, whose prognosis can be improved by normalizing alkaline phosphatase and bilirubin. While ursodeoxycholic acid (UDCA) is first line standard of care, approximately 40 % of patients exhibit incomplete response. We aimed to identify prognostic markers for deep response to UDCA therapy at presentation.</p></div><div><h3>Patient and methods</h3><p>Data from the Brazilian Cholestasis Study Group cohort were analyzed retrospectively. Patients were assessed for deep response, defined as normal alkaline phosphatase and bilirubin, after 1 year of UDCA treatment. Additionally, the performance of the UDCA response score in predicting deep response was evaluated.</p></div><div><h3>Results</h3><p>A total of 297 patients were analyzed, with 57.2 % achieving an adequate response according to the Toronto criteria, while 22.9 % reached deep response. Cirrhosis (OR 0.460; 95 % CI 0.225–0.942; <em>p</em> = 0.034) and elevated baseline alkaline phosphatase levels (OR 0.629; 95 % CI 0.513–0.770; <em>p</em> &lt; 0.001) were associated with reduced odds of deep response. The UDCA response score exhibited moderate discrimination power (AUROC = 0.769) but lacked calibration.</p></div><div><h3>Conclusions</h3><p>Baseline ALP and liver fibrosis emerge as the most important prognostic factors to predict normalization of alkaline phosphatase and bilirubin after UDCA. The UDCA response score was inadequate for predicting deep response in the Brazilian PBC population.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102453"},"PeriodicalIF":2.6,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035407","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":"FXR contributes to obstructive jaundice-induced vascular hyporeactivity in mesenteric arteries by reconstituting BKCa channels","authors":"Jin-ping Li ,&nbsp;Bing-lu Ye ,&nbsp;Qiang Li ,&nbsp;Le-le Zhang ,&nbsp;Lei Zhuang ,&nbsp;Ya-wei Yuan","doi":"10.1016/j.clinre.2024.102448","DOIUrl":"10.1016/j.clinre.2024.102448","url":null,"abstract":"<div><h3>Objective</h3><p>Vascular hyporeactivity increases with the incidence of obstructive jaundice (OJ). Evidence suggests that OJ activates the farnesoid X receptor (FXR) as well as the large-conductance Ca²⁺-activated <em>K</em>⁺ (BK_Ca or MaxiK) channel. This study was designed to explore the role of the FXR in vascular hyporesponsiveness induced by cholestasis.</p></div><div><h3>Methods</h3><p>The OJ model rats were constructed by bile duct ligation (BDL) and treated with an FXR agonist or antagonist. Vasoconstriction of the mesenteric arteries (MAs) was assessed <em>in vitro</em>. Whole-cell patch clamp recordings were used to investigate BK_Ca channel function. Real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot were used to detect mRNA and protein levels.</p></div><div><h3>Results</h3><p>A significant increase in vascular tone and responsiveness to norepinephrine (NE) was observed after the MaxiK channel blocker (IbTX) was administered. This effect was pronounced in BDL animals and can be mimicked by the FXR agonist GW4064 and inhibited by the FXR antagonist Z-guggulsterone (Z-Gu). GW4064 has a similar effect as cholestasis in promoting MaxiK currents in isolated arterial smooth muscle cells (ASMCs), while Z-Gu blunted this effect. The mRNA and protein expression of FXR and MaxiK-β1, but not MaxiK-α, were significantly increased in the BDL group in comparison to the sham. Furthermore, activation or inhibition of FXR promoted or inhibited the mRNA and protein expression of the MaxiK-β1 subunit, respectively.</p></div><div><h3>Conclusion</h3><p>Activation of FXR enhances the capability of the MaxiK channel to regulate vascular tone and leads to vascular hyporesponsiveness in the MAs of BDL rats, which may be mediated by the nonparallel upregulation of MaxiK-α and MaxiK-β1 subunit expression.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102448"},"PeriodicalIF":2.6,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003773","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":"Reply to comments on “Dependent functional status is an independent risk factor for 30-day mortality and morbidities following colectomy for volvulus: An ACS- NSQIP study from the United States”","authors":"Renxi Li","doi":"10.1016/j.clinre.2024.102449","DOIUrl":"10.1016/j.clinre.2024.102449","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102449"},"PeriodicalIF":2.6,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003774","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":"ARHGEF39 targeted by E2F1 fosters hepatocellular carcinoma metastasis by mediating fatty acid metabolism","authors":"Yao Huang ,&nbsp;Jianxing Zeng ,&nbsp;Teng Liu ,&nbsp;Qingyi Xu ,&nbsp;Xianglin Song ,&nbsp;Jinhua Zeng","doi":"10.1016/j.clinre.2024.102446","DOIUrl":"10.1016/j.clinre.2024.102446","url":null,"abstract":"<div><h3>Background</h3><p>Hepatocellular carcinoma (HCC) stands as the prevailing manifestation of primary liver cancer. Previous studies have implicated ARHGEF39 in various cancer progression processes, but its impact on HCC metastasis remains unclear.</p></div><div><h3>Methods</h3><p>Bioinformatics analysis and qRT-PCR were employed to test ARHGEF39 expression in HCC tissues and cells, identified enriched pathways associated with ARHGEF39, and investigated its regulatory relationship with E2F1. The impact of ARHGEF39 overexpression or knockdown on cellular phenotypes in HCC was assessed through the implementation of CCK-8 and Transwell assays. Accumulation of neutral lipids was determined by BODIPY 493/503 staining, while levels of triglycerides and phospholipids were measured using specific assay kits. Expression of E-cadherin, Vimentin, MMP-2, MMP-9, and FASN were analyzed by Western blot. The interaction between ARHGEF39 and E2F1 was validated through ChIP and dual-luciferase reporter assays.</p></div><div><h3>Results</h3><p>Our study demonstrated upregulated expression of both ARHGEF39 and E2F1 in HCC, with ARHGEF39 being associated with fatty acid metabolism (FAM) pathways. Additionally, ARHGEF39 was identified as a downstream target gene of E2F1. Cell-based experiments unmasked that high expression of ARHGEF39 mediated the promotion of HCC cell viability, migration, and invasion via enhanced FAM. Moreover, rescue assays demonstrated that the promotion of HCC cell metastasis by high ARHGEF39 expression was attenuated upon treatment with Orlistat. Conversely, the knockdown of E2F1 suppressed HCC cell metastasis and FAM, while the upregulation of ARHGEF39 counteracted the repressive effects of E2F1 downregulation on the metastatic potential of HCC cells.</p></div><div><h3>Conclusion</h3><p>Our findings confirmed the critical role of ARHGEF39 in HCC metastasis and unmasked potential molecular mechanisms through which ARHGEF39 fostered HCC metastasis via FAM, providing a theoretical basis for exploring novel molecular markers and preventive strategies for HCC metastasis.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102446"},"PeriodicalIF":2.6,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916202","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":"Familial NTCPD presenting with persistent hypercholanemia and co-existing with a series of novel heterozygous mutations","authors":"Meifen Wang ,&nbsp;Lin Zhou ,&nbsp;Qian Zhang ,&nbsp;Juan Li ,&nbsp;Junchao Peng ,&nbsp;Rui Chen ,&nbsp;Qi Shao ,&nbsp;Zhongrui Bi ,&nbsp;Mingying Wang ,&nbsp;Jiwei Li","doi":"10.1016/j.clinre.2024.102444","DOIUrl":"10.1016/j.clinre.2024.102444","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102444"},"PeriodicalIF":2.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901146","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 congenital hepatic fibrosis and Caroli's syndrome: Two illustrative cases","authors":"Meifen Wang ,&nbsp;Xiaomei Liu ,&nbsp;Chuanfu Qiao ,&nbsp;Rui Chen ,&nbsp;Jintao Duan ,&nbsp;Rong Zeng ,&nbsp;Jiwei Li","doi":"10.1016/j.clinre.2024.102443","DOIUrl":"10.1016/j.clinre.2024.102443","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102443"},"PeriodicalIF":2.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901145","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":"Thirty-day outcomes of non-emergent colectomy for inflammatory bowel disease in patients with chronic obstructive pulmonary disease","authors":"Renxi Li","doi":"10.1016/j.clinre.2024.102445","DOIUrl":"10.1016/j.clinre.2024.102445","url":null,"abstract":"<div><h3>Background</h3><p>Inflammatory bowel disease (IBD) can have significant colonic involvement and carries a long-term risk of surgical resection. Chronic obstructive pulmonary disease (COPD) and IBD share multiple inflammatory pathways, suggesting a bidirectional relationship through proposed pulmonary-intestinal cross-talk. This study aimed to examine the association between COPD and 30-day outcomes following non-emergent colectomies for IBD.</p></div><div><h3>Methods</h3><p>Patients with IBD as the primary indication for colectomy were selected from National Surgical Quality Improvement Program (NSQIP) colectomy database 2012–2022. Emergency colectomy cases were excluded. A 1:3 propensity-score matching was used to balance the preoperative characteristics of COPD and non-COPD patients. Thirty-day postoperative outcomes were compared.</p></div><div><h3>Results</h3><p>Among 25,285 patients who underwent colectomy for IBD, 365 (1.44 %) had COPD. Patients with COPD were older and had more comorbidities. After propensity-score matching, all COPD patients were matched to 1,095 patients without COPD. COPD and non-COPD patients had comparable 30-day mortality (3.29 % vs 2.19 %, <em>p</em> = 0.25). However, COPD patients had higher pulmonary complications (14.79 % vs 7.21 %, <em>p</em> &lt; 0.01) attributed to pneumonia (10.14 % vs 4.02 %, <em>p</em> &lt; 0.01), sepsis (12.88 % vs 8.68 %, <em>p</em> = 0.02), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (28.22 % vs 22.10 %, <em>p</em> = 0.02), discharge not to home (40.28 % vs 34.02 %, <em>p</em> = 0.04), and longer length of stay (<em>p</em> = 0.01).</p></div><div><h3>Conclusion</h3><p>Therefore, given their mortality rates, colectomy is an effective treatment for IBD patients with concurrent COPD, while their postoperative care should include close monitoring of pulmonary symptoms and timely interventions to prevent further complications. Future research should explore the long-term prognosis of COPD patients after colectomy for IBD.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 8","pages":"Article 102445"},"PeriodicalIF":2.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901148","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}