Clinical Rheumatology最新文献

{"title":"Syringomyelia Charcot-arthropathy involving the joints of both hands.","authors":"Jiaojiao Cao, Di Zhang, Jianguo Yang, Bing Fan","doi":"10.1007/s10067-025-07436-6","DOIUrl":"https://doi.org/10.1007/s10067-025-07436-6","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interaction of nutritional and inflammatory levels on all-cause mortality among individuals with rheumatoid arthritis: a prospective cohort study.","authors":"Zhuang Ma, Shixin Wu, Lin-En Xiong, Juncheng Zhong, Baiwen Lin, Liangkai Chen, Ting Xiong, Yuanjue Wu","doi":"10.1007/s10067-025-07458-0","DOIUrl":"https://doi.org/10.1007/s10067-025-07458-0","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition and systemic inflammation are frequently prevalent in individuals with rheumatoid arthritis (RA). However, limited studies have explored the combined impacts of nutritional and inflammatory levels on all-cause mortality among RA. This study is aimed at investigating these potential associations.</p><p><strong>Methods: </strong>We involved 2213 RA patients from the National Health and Nutrition Examination Survey (2001-2018). Nutritional risk index (NRI) and systemic inflammatory response index (SIRI) were used to evaluate the nutritional and inflammatory status of participants, respectively. Weight-based Kaplan-Meier survival curves and COX proportional hazard models were employed to ascertain the independent and joint association.</p><p><strong>Results: </strong>Over a median follow-up of 7.98 years, 544 deaths occurred. Following the adjustment for confounding factors, we found that individuals with moderate/severe malnutrition (HR, 2.13; 95%CI, 1.50-3.03) or high SIRI (HR, 1.49; 95%CI, 1.07-2.07) were independently associated with an increased risk of all-cause mortality. Furthermore, the simultaneous moderate/severe malnutrition and high SIRI further elevated the mortality risk (HR, 2.34; 95%CI, 1.53-3.56). An additive interaction was observed between malnutrition and high SIRI, yielding an excess risk of 0.34 (95%CI 0.06-0.62, P = 0.014), and the attributable proportion for the interaction was 20.9% (95%CI 7.6-34.2%).</p><p><strong>Conclusions: </strong>This research indicated that malnutrition and high systemic inflammation levels were independent risk factors for the prognosis of RA patients, and co-occurrence can further deteriorate the prognosis. Our findings highlight the importance of maintaining nutrition and anti-inflammation in patients with RA, providing new insights into the prognosis of RA patients.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SLAM receptors regulate immune checkpoints via SAP and EAT- 2 in rheumatoid arthritis: association with disease activity.","authors":"Mohammad Malekan, Armin Dozandeh-Jouybari, Najmeh Sadeghian, Mohsen Soltanshahi, Hossein Azadeh, Abolghasem Ajami, Hossein Asgarian-Omran, Saeid Taghiloo","doi":"10.1007/s10067-025-07461-5","DOIUrl":"https://doi.org/10.1007/s10067-025-07461-5","url":null,"abstract":"<p><strong>Objective: </strong>Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and immune dysregulation. This study aimed to investigate the role of SLAM family receptors (SLAMF1 and SLAMF7), immune checkpoint molecules (PD- 1 and TIGIT), and SH2-containing adaptor proteins (SAP and EAT- 2) in rheumatoid arthritis (RA) and their association with disease activity.</p><p><strong>Methods: </strong>A total of 50 RA patients (30 inactive, 20 active) and 20 healthy controls were enrolled. Real-time ​polymerase chain reaction (PCR) was used to assess the expression of target genes in peripheral blood mononuclear cells (PBMCs). Gene expression profiling datasets (GSE77298, GSE206848, GSE236924, GSE15573) were analyzed to identify differentially expressed genes (DEGs). Correlation of gene expression with Disease Activity Score 28-joint count (DAS28) was evaluated.</p><p><strong>Results: </strong>SLAMF1, SLAMF7, SAP, and EAT- 2 expression levels were significantly elevated in RA patients compared to controls. SLAMF1 and SAP expression correlated positively with DAS28 (r = 0.319, p = 0.02; r = 0.460, p = 0.0008, respectively). PD- 1 expression was higher in RA patients but showed no correlation with DAS28, while TIGIT expression was not significantly different. Bioinformatics analysis revealed significant upregulation of SLAMF7 and TIGIT in synovial tissues from RA patients.</p><p><strong>Conclusion: </strong>SLAMF1 and SLAMF7 appear to contribute to RA pathogenesis by modulating immune cell activity and cytokine production. Elevated PD- 1 levels suggest a role in immune dysregulation. The interplay between SLAM receptors, immune checkpoints, and adaptor proteins may exacerbate T cell overactivity and chronic inflammation, offering potential therapeutic targets. Key Points •RA patients showed significantly higher expression of SLAMF1, SLAMF7, PD- 1, SAP, and EAT- 2 compared to healthy controls. •SLAMF1 and SAP expression correlated with disease activity, with SLAMF1 levels higher in active RA cases. •PD- 1 overexpression suggested immune dysregulation, while TIGIT showed no significant difference in RA patients. •The interplay between SLAM receptors, immune checkpoints, and adaptor proteins may contribute to RA pathogenesis and serve as potential therapeutic targets.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAR-T cell therapy in rheumatic diseases: a review article.","authors":"Harshwardhan Patil, Rajath K Bharadwaj, Nilanjana Dutta, Ramaswamy Subramanian, Shiva Prasad, Mahabaleshwar Mamadapur","doi":"10.1007/s10067-025-07451-7","DOIUrl":"https://doi.org/10.1007/s10067-025-07451-7","url":null,"abstract":"<p><p>CAR-T cell therapy, a pioneering immune-modulating treatment that was initially designed for hematologic malignancies, is now being considered a potential treatment for autoimmune and rheumatic diseases. This method involves genetically engineering T cells to express chimeric antigen receptors (CARs), allowing them to target specific antigens associated with pathogenic immune cells. The review covers the possibility of CAR-T therapy in the treatment of autoimmune diseases like systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc). The therapy's ability to maintain remission by targeting autoreactive B cells in the course of disease has been an important aspect of studies involving SLE. In refractory RA, CAR-T cells also demonstrate a potential therapeutic modality in selectively killing immune cells driving the disease process. For SSc, CAR-T therapy may represent a novel therapeutic approach because it targets the dysregulated activity of B cells as well as the fibrotic processes that drive the disease pathology. Emerging evidence suggests potential applications in conditions such as Sjögren's syndrome and dermatomyositis. While CAR-T therapy promises accuracy, persistence, and the potential for long-term remission, many problems remain, including the risk of cytokine release syndrome, immune toxicity, and treatment affordability. The development of CAR-Tregs and advanced gene-editing techniques may increase the specificity and safety of therapy. In addition, clinical trials and long-term studies should be conducted to establish the efficacy, safety, and economic feasibility of this innovative approach. This review underscores the transformative potential of CAR-T therapy in the management of rheumatic diseases, particularly in refractory cases. Offering targeted immunomodulation with a minimum of systemic immune suppression, CAR-T therapy could redefine therapeutic paradigms and offer hope for improved outcomes in autoimmune diseases.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual roles of LncRNA RNA143598: a biomarker for rheumatoid arthritis and its implications in cancer.","authors":"Qiuhua Wu, Xiaoxia Zhang, Meiyun Qin, Danfei Shi, Yong Li","doi":"10.1007/s10067-025-07448-2","DOIUrl":"https://doi.org/10.1007/s10067-025-07448-2","url":null,"abstract":"<p><strong>Objective: </strong>Rheumatoid arthritis (RA) is a chronic autoimmune disease with complex pathological mechanisms, including immune system dysregulation and chronic inflammation. Recent studies indicate that long non-coding RNAs (LncRNAs) play key roles in immune regulation and have been implicated in the pathogenesis of multiple diseases, including RA and various types of cancer. Understanding the involvement of LncRNAs in RA and their potential transcriptional effects in cancer could provide novel insights into disease mechanisms and therapeutic targets.</p><p><strong>Methods: </strong>Using the GSE94519 dataset, we analyzed serum LncRNA profiles from RA patients and healthy controls. Differential expression genes (DEGs) were identified using GEO2R, and findings were validated via quantitative polymerase chain reaction (qPCR) in 39 RA and 53 healthy samples. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic performance. A pan-cancer analysis of MTRNR2L1 was conducted using TCGA data, with immune infiltration assessed via ssGSEA.</p><p><strong>Results: </strong>RNA143598 was significantly upregulated in RA patients, and qPCR confirmed its diagnostic potential (AUC = 0.77). Pan cancer analysis shows that MTRNR2L1 is highly expressed in glioblastoma (GBM) and lowly expressed in head and neck squamous cell carcinoma (HNSC), with high GBM expression linked to poor prognosis. Immune infiltration analysis showed MTRNR2L1 correlated with CD8 + T cells, macrophages, and dendritic cells in GBM.</p><p><strong>Conclusion: </strong>RNA143598 is a promising RA biomarker, and its transcription gene MTRNR2L1 demonstrates potential in cancer prognosis and immune regulation. These findings provide a foundation for future research on targeted therapies for RA and cancer. Key Points • RNA143598 is identified as a significant biomarker for diagnosing rheumatoid arthritis (RA), showing promise for clinical application. • Quantitative PCR validation demonstrates the diagnostic potential of RNA143598, with an area under the curve (AUC) of 0.77. • MTRNR2L1, which is RNA143598 transcribed gene, exhibits differential expression in different cancer types, with high levels associated with poor prognosis in glioblastoma (GBM). • Immune infiltration analysis links MTRNR2L1 expression to the presence of CD8 + T cells, macrophages, and dendritic cells, suggesting its role in immune regulation in GBM.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal lupus erythematosus presenting with congenital heart block: clinical characteristics and follow-up.","authors":"Murad Gezer, Halise Hande Gezer","doi":"10.1007/s10067-025-07453-5","DOIUrl":"https://doi.org/10.1007/s10067-025-07453-5","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of ChatGPT's adherence to EULAR diagnostic criteria and therapeutic protocols for rheumatoid arthritis at two distinct time points, 14 days apart, utilizing binary and multiple-choice inquiries.","authors":"Neşe Çabuk Çelik, Elif Altunel Kılınç","doi":"10.1007/s10067-025-07417-9","DOIUrl":"https://doi.org/10.1007/s10067-025-07417-9","url":null,"abstract":"<p><strong>Objectives: </strong>Artificial intelligence (AI) possesses considerable promise in healthcare to offer decision help in particular domains, including rheumatoid arthritis (RA). This study assesses the adherence of the advanced AI model ChatGPT-v4 to the European League Against Rheumatism (EULAR) recommendations.</p><p><strong>Methods: </strong>The research employed a 100-item questionnaire consisting of true/false and multiple-choice formats, accompanied with real-world clinical scenarios developed concurrently with EULAR in the therapy of RA. Inquiries addressed diagnostic criteria, therapeutic alternatives, and follow-up procedures. Two rheumatologists assessed the ChatGPT for accuracy, consistency, and comprehensiveness utilizing a 6-point Likert scale.</p><p><strong>Results: </strong>Evaluation occurred at baseline and on day 14. AI rectified the majority of errors at baseline in the paired questions. It did not advance on specific responses. One of the two previously incongruent responses remained unaltered, while the other was rectified. The 48 originally congruent responses rose to 49 on day 14. In binary questions, AI exhibited greater coherence than in multiple-choice questions. At baseline, 43 (86%) of the multiple-choice items were answered correctly. Upon reevaluation, 42 (84%) were found to be accurate. One response was erroneous on day 14. Three of the seven initially erroneous responses remained unaltered. Four erroneous responses were later rectified.</p><p><strong>Conclusion: </strong>ChatGPT demonstrated efficacy in addressing binary and multiple-choice questions formulated according to EULAR guidelines for RA. The findings validated that AI can serve as a clinical support instrument in RA. It demonstrated that AI can be enhanced. AI attained accuracy in objective information and promptly rectified the error. Key Points • AI in healthcare: The integration of artificial intelligence, specifically ChatGPT-v4, in clinical practice aims to enhance decision-making in RA by adhering to EULAR recommendations for diagnosis, treatment, and follow-up. • Inter-rater reliability: High agreement levels were noted among the evaluators, with Cohen's kappa coefficients of 0.92 for binary questions and 0.94 for multiple-choice questions. • AI learning dynamics: The study reveals that ChatGPT showed improvement in understanding and answering more complex questions over time, unlike findings in previous studies where AI struggled with consistency. • Implications for clinical practice: The findings support the growing role of AI as a reliable tool in rheumatology, suggesting potential for personalized, evidence-based patient care.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The VITACORA- 19 and PsAID questionnaires are equally valid for assessing the impact of psoriatic arthritis on patients' quality of life.","authors":"Ignacio Braña, Marta Loredo, Juan Carlos Torre-Alonso, Rubén Queiro","doi":"10.1007/s10067-025-07446-4","DOIUrl":"https://doi.org/10.1007/s10067-025-07446-4","url":null,"abstract":"<p><strong>Background and aims: </strong>Health-related quality of life (HRQoL) is an often-underestimated aspect in psoriatic arthritis (PsA). We aimed to compare the VITACORA-19 and PsAID (Psoriatic Arthritis Impact of Disease) questionnaires to assess QoL in routine PsA management.</p><p><strong>Methods: </strong>Cross-sectional analysis of a randomly selected PsA population. Disease activity was estimated using the DAPSA (Disease Activity score for PsA) index and HRQoL using the VITACORA-19 and PsAID. The construct validity of VITACORA-19 was analysed (Pearson correlation and ROC curves).</p><p><strong>Results: </strong>Forty-five patients were included, 24 men and 21 women, mean age 55 ± 13 years, mean disease duration 8.2 ± 6.1 years. Most patients showed adequate disease control, median DAPSA 11.3 (IQR: 8.0-19.3), median PsAID 2.7 (IQR: 1.1-5.0). VITACORA-19 scores ranged from 6 to 94. The correlation between VITACORA-19 and PsAID was high, r: -0.7 (95%CI: -0.84 to -0.46), p < 0.0001. A VITACORA-19 score in the range of 6-29 corresponded to high DAPSA disease activity, a range of 30-44 corresponded to moderate DAPSA activity and a range of 45-95 corresponded to low DAPSA activity. The cut-off for an acceptable symptomatic state (PsAID < 4) corresponded to a VITACORA-19 score ≥ 66 with an area under the ROC curve of 0.85 (95%CI: 0.71-0.98).</p><p><strong>Conclusions: </strong>This is the first study comparing the VITACORA-19 and PsAID questionnaires. Either of the two questionnaires could be used to assess HRQoL in PsA. For the first time, VITACORA-19 thresholds are defined that identify the different DAPSA activity categories. A VITACORA-19 score ≥ 66 could be an appropriate treatment target. Key Points • Health-related quality of life (HRQoL) is an often-underestimated aspect in psoriatic arthritis (PsA). • The PsAID and VITACORA-19 questionnaires offer similar performance for assessing HRQoL in PsA. • A VITACORA-19 ≥ 66 identifies the low disease impact state according to the PsAID. • VITACORA-19 thresholds identifying DAPSA categories are reported.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author's response to letter to editor.","authors":"Linlin Huang, Chen Chen, Yi Cheng, Lingbiao Wang, Wenjing Ye, Haihua Yang, Wanqin Wu, Sen Yang, Weiguo Wan, Xiaoxia Zhu, Yu Xue, Yiyun Yu, Xiangjun Chen, Hejian Zou, Minrui Liang","doi":"10.1007/s10067-025-07430-y","DOIUrl":"https://doi.org/10.1007/s10067-025-07430-y","url":null,"abstract":"<p><p>Authors' Response to Letter to Editor from Yan Shen and Xianxian Fu.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune/immune rheumatic diseases in family members of children with enthesitis related arthritis and other categories of juvenile idiopathic arthritis: a study from India.","authors":"Lekshmi Minikumari Rahulan, Able Lawrence, Amita Aggarwal","doi":"10.1007/s10067-025-07444-6","DOIUrl":"https://doi.org/10.1007/s10067-025-07444-6","url":null,"abstract":"<p><strong>Background: </strong>Familial aggregation of autoimmune/inflammatory rheumatic diseases suggests a shared genetic basis for autoimmunity. Data on familial autoimmune/inflammatory rheumatic diseases is limited in JIA.</p><p><strong>Methods: </strong>Accompanying family members of all consecutive patients with JIA attending the clinic during March 2023-May 2024 were asked to participate in the study. Those consenting were interviewed about the history of autoimmune/immune rheumatic diseases among the first- and second-degree relatives, with the help of a questionnaire (validated with medical records or telephonic interviews with relatives). In addition, family members of 71 healthy children served as controls.</p><p><strong>Results: </strong>8244 relatives of 361 patients with JIA and 1033 relatives of 71 healthy controls were included in the study. Among 361 JIA patients (267 ERA, 24 systemic onset, 44 polyarticular, 12 oligoarticular and 14 psoriatic arthritis) 144 (39.8%) had at least one family member with autoimmune/immune rhematic diseases. In families of children with ERA, Spondyloarthropathy & JIA were the common disease in family while in non-ERA JIA, hypothyroidism and RA were common. First degree relatives had higher prevalence as compared to second degree relatives of patients (130/1639 versus 97/4421; p < 0.05). 2.5% maternal relatives of patients had disease as opposed to 1.9% paternal relatives of patients (p < 0.001). The risk ratio among relatives of JIA patients was 1.22, while the sibling risk ratio was 5.91.</p><p><strong>Conclusion: </strong>Nearly 40% of JIA patients had familial autoimmune/immune rhematic diseases. While in ERA there was paternal parent of origin effect for SpA in non-ERA there was maternal parent of origin for autoimmune diseases.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}