Clinics and research in hepatology and gastroenterology最新文献

{"title":"Effect of different modalities of exercise on Fatty Liver Index in patients with metabolic syndrome: The RESOLVE randomized trial","authors":"","doi":"10.1016/j.clinre.2024.102461","DOIUrl":"10.1016/j.clinre.2024.102461","url":null,"abstract":"<div><h3>Introduction</h3><p>Metabolic associated liver disease (MASLD) is the most common liver disease in the world especially in people with metabolic syndrome. First-line treatments mainly consist in lifestyle modifications for these populations. The main objective of this study is to assess the effect of a short intervention program with different exercise modalities on Fatty Liver Index (FLI) in patients with metabolic syndrome.</p></div><div><h3>Methods</h3><p>85 patients (40 men, 45 women) with metabolic syndrome and liver steatosis were randomized in 3 groups for a 3 weeks residential program: <em>Re group</em>—high-resistance-moderate-endurance; <em>rE group</em>—moderate-resistance with high-endurance and <em>re group</em>—moderate-resistance with moderate-endurance. Patients also followed a negative energy balance of 500 kcal/day. Then, a follow-up of 1 year with interviews with dieticians and exercise physicians to maintain lifestyle modification was performed. Anthropometric, cardiometabolic and hepatic outcomes were performed at baseline, at the end of the 3-week residential program, 3 months, 6 months and 12 months after baseline.</p></div><div><h3>Results</h3><p>This study demonstrated that all three training programs significantly improve FLI and that this effect was lasting among the follow-up (<em>p</em> &lt; 0.001). More specifically, the <em>Re</em> group exhibited a more pronounced decrease in FLI compared with re (<em>p</em> &lt; 0.05). Finally, the decrease in FLI was associated with improvement in anthropometric and cardiometabolic outcomes at 3-weeks (<em>p</em> &lt; 0.001) and 3-months (<em>p</em> &lt; 0.01).</p></div><div><h3>Conclusion</h3><p>Short duration program is effective to improve FLI and cardiometabolic parameters in MASLD patients. Encourage to increase physical activity even for a short duration is relevant in this population.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232730","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":"Camrelizumab combined with transcatheter arterial chemoembolization for intermediate or advanced hepatocellular carcinoma: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.clinre.2024.102465","DOIUrl":"10.1016/j.clinre.2024.102465","url":null,"abstract":"<div><h3>Objective</h3><div>This review assesses the efficacy and safety of the combination of transarterial chemoembolization (TACE) and camrelizumab for treating advanced hepatocellular carcinoma (HCC) and is to provide a goal, evidence-based medical foundation for effectively guiding clinical practice.</div></div><div><h3>Methods</h3><div>We conducted a computerized search of six electronic databases to identify studies pertinent to the combination of TACE and camrelizumab for treating advanced HCC. For further analysis of clinical indicators and adverse events data, we utilized random or fixed-effect models to account for heterogeneity between studies.</div></div><div><h3>Results</h3><div>As of May 30, 2023, 12 articles were included for Meta-analysis, encompassing 1123 patients with advanced HCC. The results indicated that the combined objective response rate (ORR) and disease control rate (DCR) were 51.1 % and 86.8 %, respectively. Regarding survival indicators, the combined overall survival (OS) and progression-free survival (PFS) were 24.26 months and 11.84 months, respectively. Among the adverse events observed, the highest incidence rates for TACE combined with camrelizumab were fever (all grade: 46.5 %, ≥grade III: 5.0 %), hypertension (all grade: 32.2 %, ≥grade III: 8.5 %), transaminase elevation (all grade: 34.7 %, ≥grade III: 13.4 %), and nausea and vomiting (all grade: 43.9 %, ≥grade III: 2.5 %).</div></div><div><h3>Conclusions</h3><div>This study demonstrated the efficacy and safety of combining TACE with camrelizumab in treating patients with advanced HCC, providing valuable evidence for its prospective clinical application. However, due to the limited availability of clinical data, it is essential to design larger-scale and multi-center clinical randomized controlled trials in the future to validate and confirm these findings definitively.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281411","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":"Predictors and inpatient outcomes of aspiration pneumonia in patients with percutaneous endoscopic gastrostomy tube: An analysis of national inpatient sample","authors":"","doi":"10.1016/j.clinre.2024.102463","DOIUrl":"10.1016/j.clinre.2024.102463","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous endoscopic gastrostomy (PEG) tubes are commonly inserted to provide a route for enteral feeding in patients who are unlikely to have adequate oral intake for prolonged periods of time. This study aims to determine the incidence of aspiration pneumonia among PEG tube patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of NIS database records (October 2015 to December 2020) for patients with PEG. Primary and secondary outcomes were assessed using ICD-10-CM/PCS codes.</div></div><div><h3>Results</h3><div>We identified a total of 2,053,560 weighted hospitalizations involving patients with PEG tube. Those with aspiration pneumonia were older (mean age 67.01 vs. 63.85, <em>p</em> &lt; 0.01) and were predominantly male. At baseline, the aspiration pneumonia group had higher rates of dementia (AOR 1.22, 95 % CI: 1.19–1.24), malnutrition (AOR 1.13, 95 % CI: 1.11–1.15), cerebrovascular disease (AOR 1.29, 95 % CI 1.25–1.33), cardiac arrhythmias (AOR 1.05, 95 % CI 1.03–1.08), congestive heart failure (AOR 1.20, 95 % CI 1.17–1.24), COPD (AOR 1.18, 95 % CI 1.15–1.20), paralysis (AOR 1.06, 95 % CI 1.03–1.09), alcohol abuse (AOR 1.12, 95 % CI 1.07–1.17), and psychoses (AOR 1.07, 95 % CI 1.02–1.13). Those with aspiration pneumonia exhibited increased mortality (<em>p</em> &lt; 0.01, AOR 1.59, 95 % CI 1.54–1.65), higher incidence of severe sepsis (AOR 2.03, 95 % CI 1.98–2.07) and longer hospital stays, and accrued greater hospital charges (<em>p</em> &lt; 0.01). Notably, while GERD is typically considered a risk factor for AP, our findings indicated that GERD was associated with a decreased risk of AP in this patient population.</div></div><div><h3>Conclusion</h3><div>Patients with a PEG tube who develop aspiration pneumonia experience increased mortality rates, extended hospitalizations, a higher frequency of septic shock, and augmented healthcare consumption. Notably, old male, congestive heart failure, cerebrovascular disease, dementia, and COPD play a pivotal role in predicting these outcomes.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281410","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":"Comparing baseline VAF in circulating tumor DNA and tumor tissues predicting prognosis of patients with colorectal cancer liver metastases after curative resection.","authors":"Ke-Min Jin, Quan Bao, Ting-Ting Zhao, Hong-Wei Wang, Long-Fei Huang, Kun Wang, Bao-Cai Xing","doi":"10.1016/j.clinre.2024.102464","DOIUrl":"10.1016/j.clinre.2024.102464","url":null,"abstract":"<p><strong>Introduction: </strong>The prognostic value of baseline variant allele frequency (VAF) in circulating tumor DNA (ctDNA) of colorectal cancer liver metastases (CRLM) patients after curative resection was rarely investigated.</p><p><strong>Methods: </strong>A single-center prospective study was performed to investigate the prognostic impact of baseline VAF in ctDNA and matched tumor tissues of CRLM patients after curative resection between May 2019 and May 2021 by the Illumina NovoSeq 6000 platform. The relationship of the tumor burden score (TBS) and the VAF in ctDNA and matched tumor tissues was evaluated by the Pearson correlation method. The survival curves of recurrence-free survival (RFS) and overall survival (OS) were plotted. Factors associated with RFS were calculated using Cox regression analysis, and an integrated prognostic model using significant baseline variables was proposed.</p><p><strong>Results: </strong>There were 121 patients with baseline ctDNA and matched tumor tissues enrolled in the study. A total of 417 mutations spanning 20 genes were identified in baseline tumor tissues of 119/121 (98.3 %) cases. The overall mutations in tumor tissues were completely covered by ctDNA in 52 of 121(43.0 %) patients. Baseline VAF in ctDNA but not in tumor tissues was significantly correlated to TBS of CRLM (R = 0.36, p < 0.001). Significantly longer RFS but not OS was observed in patients with lower VAF in ctDNA compared to those with higher one (p < 0.001 and p = 0.33 respectively). Multivariate Cox regression analysis showed higher VAF in baseline ctDNA was an independent risk factor for RFS. An integrated prognostic model including baseline metastasis location and VAF in ctDNA outperformed the traditional CRS model in predicting RFS.</p><p><strong>Conclusion: </strong>Baseline VAF in ctDNA but not in tumor tissues influenced RFS of CRLM patients after curative resection.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281409","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":"Baylor College of Medicine (BCM) model predicts recurrence after mucosectomy of colorectal lateral spreading tumors in European cohorts","authors":"","doi":"10.1016/j.clinre.2024.102460","DOIUrl":"10.1016/j.clinre.2024.102460","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167610","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":"Gut microbiota–NLRP3 inflammasome crosstalk in metabolic dysfunction-associated steatotic liver disease","authors":"","doi":"10.1016/j.clinre.2024.102458","DOIUrl":"10.1016/j.clinre.2024.102458","url":null,"abstract":"<div><p>Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with metabolic dysfunction, ranging from hepatic steatosis with or without mild inflammation to nonalcoholic steatohepatitis, which can rapidly progress to liver fibrosis and even liver cancer. In 2023, after several rounds of Delphi surveys, a new consensus recommended renaming NAFLD as metabolic dysfunction-associated steatotic liver disease (MASLD). Ninety-nine percent of NAFLD patients meet the new MASLD criteria related to metabolic cardiovascular risk factors under the \"multiple parallel hits\" of lipotoxicity, insulin resistance (IR), a proinflammatory diet, and an intestinal microbiota disorder, and previous research on NAFLD remains valid. The NLRP3 inflammasome, a well-known member of the pattern recognition receptor (PRR) family, can be activated by danger signals transmitted by pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs), as well as cytokines involved in immune and inflammatory responses. The activation of the NLRP3 inflammasome pathway by MASLD triggers the production of the inflammatory cytokines IL-1β and IL-18. In MASLD, while changes in the composition and metabolites of the intestinal microbiota occur, the disrupted intestinal microbiota can also generate the inflammatory cytokines IL-1β and IL-18 by damaging the intestinal barrier, negatively regulating the liver on the gut–liver axis, and further aggravating MASLD. Therefore, modulating the gut–microbiota–liver axis through the NLRP3 inflammasome may emerge as a novel therapeutic approach for MASLD patients. In this article, we review the evidence regarding the functions of the NLRP3 inflammasome and the intestinal microbiota in MASLD, as well as their interactions in this disease.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2210740124001797/pdfft?md5=ecdf2be5d876b10bdf05a4018b786fb3&pid=1-s2.0-S2210740124001797-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132047","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 spleen stiffness measurement by 100‐Hz vibration‐controlled transient elastography, liver stiffness, APRI score and their combination for predicting oesophageal varices in liver cirrhosis","authors":"","doi":"10.1016/j.clinre.2024.102456","DOIUrl":"10.1016/j.clinre.2024.102456","url":null,"abstract":"<div><h3>Background</h3><p>Oesophageal varices (EV) rupture remains one of the most severe complications of cirrhosis. As the gold standard to predict this accident, esophagogastroduodenoscopy (EGD) itself also has a weakness. Not all patients are convenient with this modality in clinical practice apart from the risk and cost burden. Hence, the search for other non-invasive modalities with high accuracy is still noteworthy. Among them, spleen stiffness measurement (SSM) with 100 Hz probe, liver stiffness measurement (LSM), and the aspartate amino transferase to platelet ratio index (APRI) score became popular and intensively studied with good accuracy, but the results remain conflicting. This study aims to investigate the performance of SSM, LSM, APRI score, and their combination especially as a screening tool for predicting EV in liver cirrhosis patients.</p></div><div><h3>Methods</h3><p>In this cross-sectional study, we included 141 patients with liver cirrhosis who had undergone endoscopy, SSM, LSM, and APRI score calculation between January and March 2023 were enrolled. Diagnostic accuracy was assessed by the area under the receiver-operator curve (AUC). Transient elastography (TE) measurement was performed using a spleen-dedicated FibroScan with a 100-Hz probe.</p></div><div><h3>Results</h3><p>Of the 141 patients, the most common aetiology was hepatitis B in 71 patients (50.4 %). EV were found in 116 patients. Using the AUC, SSM at a cutoff of 40 kPa had the best performance with an AUC of 0.892 (CI 95 %: 0.814–0.969, <em>p</em> &lt;0.0001), with sensitivity 88.79 % and specificity 80 %). Meanwhile, LSM and APRI score had an AUC of 0.832 (CI 95 %: 0.742–0.922, <em>p</em> &lt;0.0001) and 0.780 (CI 95 %: 0.660–0.900, <em>p</em> &lt;0.0001), respectively. The combination of all measurement tools did not show better performance than SSM alone with an AUC of 0.892 (CI 95 %: 0.802–0.982, <em>P</em> &lt;0.0001)</p></div><div><h3>Conclusion</h3><p>SSM provides better performance than LSM and APRI scores for predicting EV. Performance of SSM alone is non-inferior compare to multiple diagnostic tools combined.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125046","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":"Exploring the relationship between vitamin D and hepatic carcinoma in individuals diagnosed with hepatitis B virus infection","authors":"","doi":"10.1016/j.clinre.2024.102457","DOIUrl":"10.1016/j.clinre.2024.102457","url":null,"abstract":"<div><h3>Objective</h3><p>The primary objective of this study is to examine the distribution and prognostic implications of serum vitamin D levels among individuals diagnosed with primary hepatic carcinoma (PHC) attributable to hepatitis B virus (HBV) infection.</p></div><div><h3>Methods</h3><p>A total of 345 patients diagnosed with HBV infection were enrolled in our hospital between August 2014 and October 2020. Among these, 144 individuals were diagnosed with chronic hepatitis B (CHB), 66 individuals were diagnosed with HBV-related hepatic cirrhosis (HBV cirrhosis), and 135 individuals were diagnosed with HBV-related PHC (HBV-PHC). Peripheral serum levels of vitamin D were measured. Patients with cirrhosis underwent examination using the Child–Pugh grading system, and the mortality rates at 1-year and 3-year intervals for patients with HBV-PHC were analyzed.</p></div><div><h3>Results</h3><p>Vitamin D levels in peripheral serum in the CHB group, HBV cirrhosis group, and HBV-PHC group exhibited varying degrees of reduction compared to healthy individuals. Significant differences were observed between the three groups (<em>F</em> = 4.02, <em>P</em> = 0.019). No significant difference was observed in vitamin D levels between different Child–Pugh grades within the HBV cirrhosis group (<em>F</em> = 0.89, P = 0.417). However, significant differences were observed in vitamin D levels between different Child–Pugh grades within the HBV-PHC group (<em>F</em> = 4.84, P = 0.009). There was no significant difference in 1-year and 3-year mortality rates between patients diagnosed with HBV-PHC and with varying vitamin D levels (P &gt; 0.05).</p></div><div><h3>Conclusions</h3><p>Vitamin D levels decreased to varying degrees in patients diagnosed with CHB, HBV cirrhosis, and PHC. This decrease was well correlated with disease progression (HBV-PHC group &lt; HBV cirrhosis group &lt; CHB group). In cases where hepatic function was comparable, there was no discernible correlation between serum vitamin D level and mortality rates from PHC.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104956","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":"DRESS syndrome associated with a hemophagocytic lympho-histiocytosis: A rare presentation of DILI induced by a nutritional supplement","authors":"","doi":"10.1016/j.clinre.2024.102455","DOIUrl":"10.1016/j.clinre.2024.102455","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092475","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":"Risk factors of HBV reactivation in leukemia patients with resolved HBV infection after allogeneic hematopoietic stem cell transplantation","authors":"","doi":"10.1016/j.clinre.2024.102447","DOIUrl":"10.1016/j.clinre.2024.102447","url":null,"abstract":"<div><h3>Background</h3><p>The hepatitis B surface antigen (HBsAg)–negative and antibody to hepatitis B core antigen (anti-HBc)–positive patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk of HBV reactivation (HBVr).</p></div><div><h3>Methods</h3><p>To analyze the risk factors for HBVr, a total of 1,042 leukemia patients(≥18years of age), who underwent allo-HSCT from January 2016 to April 2022 in The First Affiliated Hospital of Soochow University, were enrolled in the study. Finally, 193 leukemia patients with resolved HBV infection were included into the study.</p></div><div><h3>Results</h3><p>HBVr occurred in 22 patients (11.39 %), and the median time to HBVr was 24 months (with a range of 11-51months). Hepatitis flares developed in 22.73 % of patients with HBVr, and hepatic failure occurred in 1 patient. During the follow-up period, only 1(1.3 %) patient experienced HBVr among 79 patients with antiviral prophylaxis. While 21(18.42 %) patients experienced HBVr among 114 patients without antiviral prophylaxis. The cumulative incidence of HBV reactivation at 3 years was 44.4. % for anti-HBs-negative donors/recipients with a low anti-HBs titer (&lt;100IU/L) and 7.1 % for anti-HBs-positive donors/recipients with a high anti-HBs titer (≥100IU/L) respectively. In addition, univariate and multivariate Cox regression analyses confirmed the use of rituximab as a risk factor for HBV reactivation.</p></div><div><h3>Conclusion</h3><p>The univariate and multivariate analyses confirmed that the anti-HBs titer in both recipients and donors are protective indicators to prevent incidence of HBVr. In addition, antiviral prophylaxis can significantly reduce the incidence of HBVr.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055128","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}