Clinical Microbiology and Infection最新文献

{"title":"Funguria with severe complications in diabetic patients receiving SGLT2 inhibitors.","authors":"Jochem B Buil, Rosalie B T M Sterenborg, Paul E Verweij, Puck Oude Elferink, Wouter A van der Heijden, Frank L van de Veerdonk, Roger J Brüggemann","doi":"10.1016/j.cmi.2026.04.019","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.019","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764621","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":"Position Statement: Integrating Planetary Health into Infection Prevention and Control in Healthcare Settings - Toward a Balanced and Evidence-Based Approach.","authors":"Ermira Tartari, Emine Alp Meşe, Andre N H Bulabula, Stephanie J Dancer, Daniele Roberto Giacobbe, Manuel Krone, Claire Kilpatrick, Aleksandra Marek, Nicola Petrosillo, Elisabeth Presterl, Manish Ranjan, Juliëtte A Severin, Giacomo Stroffolini, Alma Tostmann, Margreet C Vos, Andreas F Widmer, Walter Zingg","doi":"10.1016/j.cmi.2026.04.017","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.017","url":null,"abstract":"<p><strong>Background: </strong>Infection prevention and control (IPC) is fundamental for patient safety. Effective IPC generates direct ecological benefits by preventing healthcare-associated infections (HAIs), thereby reducing prolonged hospitalisation, antibiotic use, and resource consumption. Paradoxically, IPC measures: single-use materials, chemical disinfectants, and resource-intensive waste streams, contribute to healthcare's greenhouse-gas emissions and environmental burden. As climate change and environmental degradation threaten human and ecosystem health, there is growing urgency to evaluate IPC measures through a planetary health lens, ensuring sustainability considerations complement rather than compromise infection prevention outcomes.</p><p><strong>Aims: </strong>This position paper by the ESCMID Study Group for Nosocomial Infections (ESGNI) examines intersections between IPC practice and planetary health. Drawing on a synthesis of current evidence and expert consensus, it identifies opportunities to reduce the environmental footprint of IPC where evidence supports equivalent or superior IPC outcomes, and outlines research and policy priorities where evidence remains insufficient.</p><p><strong>Content: </strong>The paper analyses five key domains at the IPC-planetary health interface: 1) single-use versus reusable, 2) biocides and environmental contamination, 3) healthcare waste, 4) AMR: IPC priorities within a One Health framework, and 5) IPC and planetary health in low- and middle-income countries. Cross-cutting themes, including circular economy principles, life-cycle assessment, regulatory barriers, and climate-related risks are explored, with implications for regulation, procurement, infrastructure, and workforce competencies.</p><p><strong>Implications: </strong>Sustainability considerations in IPC must function as a complement to, not a substitute for, infection prevention outcomes. Where evidence supports equivalent safety with a reduced environmental footprint, change is justified and should be pursued through evidence-based, risk-stratified, and context-specific approaches. Achieving this requires regulatory reform, interdisciplinary collaboration, and targeted investment in research, education, and capacity building. Positioning IPC as a partner in sustainable healthcare offers a pathway to reduce avoidable environmental harm while strengthening resilience against infectious threats - with patient safety as the primary and non-negotiable objective.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764575","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":"Beyond sensitivity and specificity: designing outcome-driven evidence for infectious disease in vitro diagnostics.","authors":"Benjamin Hommel","doi":"10.1016/j.cmi.2026.04.016","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.016","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764585","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":"Cessation of amoxicillin-clavulanate selective reporting and association with antibiotic prescribing and C. difficile infection in Ontario, Canada, 2017-2024: An ecological study.","authors":"Michelle K Wong, Nick Daneman, Bradley J Langford, Valerie Leung, Kevin L Schwartz, Huda Almohri, Lee W Goneau, Kevin A Brown","doi":"10.1016/j.cmi.2026.04.015","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.015","url":null,"abstract":"<p><strong>Objectives: </strong>To discourage unnecessary use of amoxicillin-clavulanate (a broader-spectrum antibiotic with high Clostridioides difficile infection (CDI) risk), selective reporting is used to suppress susceptibility results when the isolate is susceptible to narrower-spectrum antibiotics like amoxicillin. In Ontario, Canada, surveillance data revealed a rapid increase in amoxicillin-clavulanate susceptibility reporting in December 2021, consistent with a cessation of selective reporting in some community laboratories. Our objective was to examine whether increased amoxicillin-clavulanate susceptibility reporting among amoxicillin-susceptible urinary isolates was associated with increased prescribing of amoxicillin-clavulanate and community-associated CDI (CA-CDI) at a population level.</p><p><strong>Methods: </strong>We conducted an ecological longitudinal study of Ontario residents from January 2017 to June 2024, using monthly province-wide aggregated data. The primary exposure was monthly percentage of amoxicillin-clavulanate reporting among amoxicillin-susceptible Escherichia coli and Proteus mirabilis isolates. Outcomes included monthly amoxicillin-clavulanate prescribing rates and CA-CDI incidence, while prescribing of amoxicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, ciprofloxacin, and first-generation cephalosporins served as comparators. Analyses used negative binomial regression stratified by age and sex, adjusted for respiratory virus activity.</p><p><strong>Results: </strong>Following an increase in amoxicillin-clavulanate susceptibility reporting from 4.1% (Jan 2017 - Nov 2021) to 56.7% (Dec 2021 - Jun 2024) among amoxicillin-susceptible isolates, amoxicillin-clavulanate prescribing increased (Incidence Rate Ratio (IRR): 1.29, 95%CI: 1.17-1.43), while comparator antibiotic prescribing remained stable (amoxicillin IRR: 0.97, 95%CI: 0.87-1.09). Compared to amoxicillin, amoxicillin-clavulanate prescribing increased by 36% (IRR: 1.36, 95%CI: 1.23-1.51). The change in reporting was associated with 459 (95%CI: 336-585) modelled excess cases of CA-CDI from Dec 2021-Jun 2024, compared with the projected CA-CDI incidence if there had been no change in amoxicillin-clavulanate reporting.</p><p><strong>Conclusion: </strong>Our study suggests that reporting amoxicillin-clavulanate susceptibility among amoxicillin-susceptible urinary isolates is associated with increased amoxicillin-clavulanate prescribing and higher CA-CDI rates based on model-derived estimates, highlighting the impact of selective antibiotic susceptibility reporting by microbiology laboratories on patient outcomes.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764594","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":"Antibiotic resistance signature from war zones: MDRO colonization in pediatric refugees from Gaza and Ukraine compared with an Italian cohort.","authors":"Elio Castagnola, Roberto Bandettini, Giuseppe Spiga, Andrea Moscatelli, Anna Maria Crudo, Alessio Fantera, Raffaele Spiazzi","doi":"10.1016/j.cmi.2026.04.014","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.014","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764492","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":"Nudging in MicroBiology Laboratory Evaluation (NiMBLE): A systematic review and meta-analysis.","authors":"Bradley J Langford, Elizabeth Leung, Esther Jeong, Kevin A Brown, Glyneva Bradley-Ridout, Vaishnav Sivakumar, Linda R Taggart, Jenna Wong, Aaron Scherer, Larissa M Matukas","doi":"10.1016/j.cmi.2026.04.008","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.008","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial stewardship programs (ASP) include collaborating with clinical microbiology laboratories to improve antimicrobial use. Several ASP guidelines recommend selective or cascade reporting of antimicrobial susceptibility results - a behavioural nudge which entails modifying choice architecture to guide prescribing without removing clinician autonomy.</p><p><strong>Objectives: </strong>We conducted a systematic review and meta-analysis to evaluate the impact of nudging in microbiology reports on antimicrobial use and clinical outcomes.</p><p><strong>Methods: </strong>Data Sources: Following our PROSPERO-registered protocol (CRD42024568670), a search was conducted across four databases.</p><p><strong>Study eligibility criteria: </strong>All studies that evaluated clinical microbiology report nudges and prescribing and/or clinical outcomes were eligible.</p><p><strong>Participants: </strong>Studies in humans conducted in all healthcare settings were included.</p><p><strong>Interventions: </strong>Selective, framing and eye-level nudging strategies in microbiology reports.</p><p><strong>Assessment of risk of bias: </strong>Risk of bias was assessed using standard tools for each study design.</p><p><strong>Methods of data synthesis: </strong>Primary outcomes included prescribing appropriateness and antimicrobial utilisation. Secondary clinical outcomes included C. difficile infection rates, length of stay and mortality. Reported outcomes were pooled using random-effects meta-analysis.</p><p><strong>Results: </strong>We analysed 45 studies of the 36,339 records identified. Most studies were conducted among adult inpatient populations, in high-income countries, predominantly in North America. For prescribing appropriateness, nudging interventions were associated with a 143% increase (n=23 studies, OR = 2.43 [1.91 to 3.10]). Nudging reduced utilisation by 1.70 (n=7 studies, 95% CI 0.17 to 3.22) days of therapy. There was no evidence of increased harm; length of stay was 1.1 days longer without nudge (95% CI: -0.4 to 2.5); and no impact to mortality (OR 1.07, 95%CI: 0.65 to 1.76) or C. difficile infection rates (OR 1.08, 95%CI: 0.89 to 1.30).</p><p><strong>Conclusions: </strong>Nudging improved antimicrobial appropriateness and utilisation, supporting its addition to ASPs. Future research should employ prospective designs to mitigate potential biases, and evaluate clinical outcomes, sustainability and generalisability.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721836","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":"Pharmacokinetics, target attainment and outcomes of piperacillin/tazobactam in critically ill patients receiving continuous infusion with therapeutic drug monitoring: a retrospective analysis.","authors":"Ute Chiriac, Max Münchow, Anka C Röhr, Otto R Frey, Anna T Frey, Daniel Frisch, Maxime Gaasch, Markus A Weigand, Sebastian G Wicha, Alexander Brinkmann","doi":"10.1016/j.cmi.2026.04.010","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.010","url":null,"abstract":"<p><strong>Objectives: </strong>To provide real-world evidence on piperacillin exposure and outcomes in critically ill patients following the implementation of pharmacokinetic (PK)/pharmacodynamic (PD)-guided dosing in routine care.</p><p><strong>Methods: </strong>This retrospective observational study included critically ill adults who received continuous piperacillin/tazobactam infusion between 2011 and 2019. Empiric doses were individualized using dosing software based on renal function and subsequently adjusted according to therapeutic drug monitoring (TDM) results. Drug exposure was defined as subtherapeutic (<32 mg/L), therapeutic (32-64 mg/L), extended (64-96 mg/L), or supratherapeutic (>96 mg/L).</p><p><strong>Results: </strong>A total of 1538 critically ill patients with severe infections and sepsis of varying severity were included, and 3,089 piperacillin serum concentrations were analysed. Median daily piperacillin dose was 8 g (6-12 g; IQR), median steady-state concentration 55 mg/L (38-73 mg/L; IQR), and median clearance 6.25 L/h (4.0-9.8 L/h; IQR). At the first measurement, individualized empiric dosing resulted in 45.7% (704/1538)of patients being within the therapeutic range; after TDM-guided adjustment, target attainment increased to 62.4% (968/1551). Subtherapeutic and supratherapeutic concentrations were uncommon among all TDM samples collected during individualized dosing (<32 mg/L: 12.8%, 395/3089; <16 mg/L: 0.8%, 26/3089; >96 mg/L: 11%, 340/3089). 28-day mortality was 18.2% (131/718) in patients within the therapeutic range, 27.0% (107/396) in those within the extended range, and 40.9% (101/247) in those with supratherapeutic concentrations (p=0.05). Women were associated with 1.74-fold higher odds of supratherapeutic concentrations (OR 1.74, 95% CI 1.38-2.19, p<0.001; 176/2022 male vs 152/1067 female with concentrations >96 mg/L).</p><p><strong>Conclusions: </strong>A multimodal approach combining individualized empiric dosing, TDM, and continuous infusion ensured target attainment while reducing drug consumption. These findings support the integration of individualized, PK/PD-guided dosing into routine care for critically ill patients and warrant further exploration of sex-related differences in exposure.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716332","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":"Early versus late diagnosis in infectious encephalitis: A population-based cohort study.","authors":"Lærke Storgaard Duerlund, Lykke Larsen, Merete Storgaard, Helene Mens, Lothar Wiese, Micha Phill Grønholm Jepsen, Birgitte Rønde Hansen, Hans Rudolf Lüttichau, Christian Østergaard Andersen, Morten Blaabjerg, Arun Venkatesan, Henrik Nielsen, Jacob Bodilsen","doi":"10.1016/j.cmi.2026.04.009","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.009","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the clinical characteristics and outcomes of patients with early versus late diagnosis of infectious encephalitis in Denmark.</p><p><strong>Methods: </strong>Nationwide, prospective, population-based cohort study using the Danish Study Group for Infections of the Brain database to identify all adults hospitalized with infectious encephalitis from 2015-2023. Late diagnosis was defined as lumbar puncture or initiation of acyclovir treatment >6 hours after admission, and very late diagnosis >24 hours after admission. Unfavourable outcome was defined as Glasgow Outcome Scale<5. Relative risks (RR) with 95% confidence intervals (CI) for receiving a late diagnosis and the associated prognosis were assessed using modified multivariable Poisson regression.</p><p><strong>Results: </strong>Infectious encephalitis was identified in 495 patients of whom 183/495 (37%) were categorized as early diagnosis and 312/495 (63%) as late diagnosis. Median time to diagnosis was 12 hours (interquartile range [IQR] 4-43). Patients with late diagnosis were older compared to those with early diagnosis (72 years, IQR 61-79 vs 65 years, IQR 43-75). A late diagnosis was less likely in patients presenting with GCS <12 (Adj. RR 0.61; 95%CI 0.42-0.89), VZV encephalitis (Adj. RR 0.69, 95%CI 0.55-0.86), or an unknown aetiology (Adj. RR 0. 72, 95%CI 0.57-0.91). In patients with early diagnosis, 30-day mortality was 8/183 (4%) compared with 32/312 (10%) in patients with late diagnosis. Multivariable analysis showed no association between late diagnosis and unfavourable outcome at 6-months. However, diagnosis >24 hours after admission was associated with increased mortality at 30 days (Adj. RR 2.20; 95% CI 1.16-4.19) and six months (Adj. RR 1.59 95%CI 1.06-2.39).</p><p><strong>Conclusion: </strong>Late diagnosis of infectious encephalitis remains common and is associated with older age and absence of altered mental status at admission. Receiving a diagnosis >24 hours after admission is associated with increased risk of 30-day and 6-month mortality.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716330","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":"Comparing large language models for antibiotic prescribing: an updated analysis using the same clinical benchmark.","authors":"Antonio Russo, Nicholas Geremia, Davide Fiore Bavaro, Susan K Seo, Justin Laracy, Maria Mazzitelli, Andrea Marino, Alberto Enrico Maraolo, Agnese Colpani, Michele Bartoletti, Anna Maria Cattelan, Cristina Mussini, Saverio Giuseppe Parisi, Luigi Angelo Vaira, Giuseppe Nunnari, Giordano Madeddu, Andrea De Vito","doi":"10.1016/j.cmi.2026.04.012","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.012","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716357","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":"Three Decades Shaping Infection Prevention and Control: A Narrative Review on Petra Gastmeier's achievements.","authors":"Luisa Denkel, Friederike Maechler, Seven Aghdassi, Michael Behnke, Sonja Hansen, Axel Kola, Brar Piening, Frank Schwab, Miriam Wiese-Posselt, Frauke Mattner, Elisabeth Meyer, Ralf-Peter Vonberg, Christine Geffers","doi":"10.1016/j.cmi.2026.04.011","DOIUrl":"https://doi.org/10.1016/j.cmi.2026.04.011","url":null,"abstract":"<p><strong>Background: </strong>This narrative review was written for the CMI series \"Standing on the shoulders of giants: heroes and heroic studies paving the way forward in clinical microbiology and infectious diseases\".</p><p><strong>Objectives: </strong>We aim to offer a narrative review on Petra Gastmeier's contributions to the field of infection prevention and control (IPC).</p><p><strong>Sources: </strong>This work relies on personal collection of relevant publications as well as on our personal experience.</p><p><strong>Content: </strong>This narrative review aims to summarize Petra Gastmeier's contributions to the field of infection prevention and control (IPC). She is regarded one of the key drivers behind modern and evidence-based IPC in Germany aiming at prevention of healthcare-associated infections (HAI), and contributed substantially to the development of the German Hospital Infection Surveillance System (KISS). Under her leadership, KISS developed from a few participating hospitals into a network of more than 1,000 hospitals. By conducting epidemiological studies on antimicrobial resistances (AMR), propagating hand hygiene, pioneering clinical trials on the effectiveness of IPC measures, she constantly improved hospital hygiene and patient safety in Germany and beyond. Evidence-based reasoning, focusing on things that really matter, being pragmatic, open-minded, flexible as well as prioritizing mentorship and building an atmosphere of trust for her team, accompanied Petra Gastmeier's long and outstanding career.</p><p><strong>Implications: </strong>Gastmeier's work underscores the importance of strategically developing data and professional networks to enhance measurability and support the evaluation and application of emerging methods for IPC. Furthermore, this review may serve as an inspiration for future leaders in infection control and beyond, in shaping their own career paths and defining the leadership style they aspire to adopt.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716413","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}