Clinical Medicine最新文献

{"title":"'So it's real': Fibromyalgia, diagnostic injustice, and the case for a shared system response.","authors":"Surabhi Wig","doi":"10.1016/j.clinme.2026.100646","DOIUrl":"10.1016/j.clinme.2026.100646","url":null,"abstract":"<p><p>Fibromyalgia affects 2-4.5% of the UK population, yet remains among the most poorly recognised and inequitably managed conditions in primary and secondary care. Diagnostic delay averages six years with direct clinical and economic consequences, compounded by persistent stigma rooted in historical scepticism of patients' symptomatology. Recent guidance from the RCP, BSR, GIRFT, and NICE has sought to improve diagnostic clarity and management pathways, yet implementation remains inconsistent and fragmented across England. Current referral arrangements and service provision create institutional barriers that fall disproportionately on patients in deprived areas. This paper examines these systemic failures and argues for a coordinated, multi-level response spanning diagnostic confidence in primary care, specialist consultation as a clinical intervention, equitable access to pain services, and workforce training reform. The goal is not specialist ownership, but integrated contribution from every part of the healthcare pathway.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100646"},"PeriodicalIF":3.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988447","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":"Investigation of suspected pulmonary embolus - Imaging frequency and diagnostic yield over 10 years in a major UK teaching hospital.","authors":"Filipa M Mendes, Robert J B Goudie, Sarah L Cowan","doi":"10.1016/j.clinme.2026.100641","DOIUrl":"10.1016/j.clinme.2026.100641","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) is a condition with significant morbidity and mortality. Diagnostic imaging aims to identify patients with a PE so that they can receive anticoagulation. There is evidence, predominantly from the USA, that the number of diagnostic scans for PE has increased over time and the diagnostic yield (the percentage of positive scans) has decreased. There is limited evidence on whether this is also true in the UK.</p><p><strong>Aim: </strong>To describe the pattern of diagnostic imaging for acute PE and investigate whether there has been a change in the diagnostic yield over the last 10 years.</p><p><strong>Methods: </strong>All adult patients who underwent either computed tomography pulmonary angiogram (CTPA) or ventilation-perfusion (V/Q) scan as an investigation for acute PE at Cambridge University Hospitals NHS Foundation Trust (CUH) between 2015 and 2024 were included. This was a retrospective study using data extracted from the hospital electronic health record (EHR) system.</p><p><strong>Results: </strong>25,672 scans were included, comprising 23,908 CTPA and 1,764 V/Q scans. The annual number of scans increased slightly over the time period, with an average increase of 1.2% per year (p < 0.05). The overall diagnostic yield was 17.0%, with no clear trend over time. There was also no clear trend in the proportion of subsegmental PE detected over time.</p><p><strong>Conclusions: </strong>The overall number of scans performed and diagnostic yield for PE have remained relatively stable over the last decade. This is the largest study of its kind in the UK and, uniquely, also covers the entire timeline of the COVID-19 pandemic and its aftermath.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100641"},"PeriodicalIF":3.9,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896383","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":"Promoting clinical academic careers and medical research skills through a dedicated research training programme: Outcomes from the MEDICORE programme.","authors":"Ranya V Kumar, Jacob Vincent, Caleb Cole, Prakrit R Kumar, Nicholas R Evans","doi":"10.1016/j.clinme.2026.100640","DOIUrl":"10.1016/j.clinme.2026.100640","url":null,"abstract":"<p><strong>Study objective: </strong>Interest in medical research and clinical academic careers amongst medical students is concerningly low, posing a threat to the long-term sustainability of the clinical researcher workforce. A likely contributing factor is a lack of knowledge and teaching about medical research. To address this, we developed and evaluated the MEDICORE teaching programme; a dedicated clinical academia training programme designed to address these gaps.</p><p><strong>Design: </strong>The MEDICORE programme consisted of six biweekly in-person sessions from January to March 2024, targeting UK medical students. The learning outcomes addressed educational gaps about research identified by a prior national survey and the GMC Outcomes for Graduates.</p><p><strong>Main outcome measures: </strong>Pre- and post-session assessments measured students' improvement in knowledge and attitudes towards medical research and clinical academic careers.</p><p><strong>Results: </strong>534 student responses were collected overall, with on average 89 participants attending each session. Seven UK universities were represented, with 83.3% from one institution. Students reported that the MEDICORE programme addressed a curriculum gap in research training (81.5%). There was a significant increase in the number of students who felt confident completing a full research project and disseminating research through publications or presentations. Post-MEDICORE, students felt more confident in the structure of clinical academic training (mean Likert scale increase 1.45 ± 1.44, p < 0.0001). The number of students interested in pursuing a clinical academic career increased from 39.1% to 85.8% (p < 0.0001).</p><p><strong>Conclusion: </strong>MEDICORE demonstrates that dedicated research teaching is an effective intervention to promote research skills and the pursuit of future academic careers amongst medical students. Such efforts may help address predicted shortages in the clinical academic workforce.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100640"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872810","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":"Sink or swim: Making sense of the NICE intravenous fluid guidelines as a Foundation Year Doctor.","authors":"Talia Patel, Calum R A Heslop, Milap Rajpara, Shivaali Karelia, Rakesh Patel","doi":"10.1016/j.clinme.2026.100639","DOIUrl":"10.1016/j.clinme.2026.100639","url":null,"abstract":"<p><p>Foundation Year (FY) doctors consistently report feeling underprepared when applying intravenous fluid (IVF) guidelines due to inadequate training, resources and an underemphasis of evidence-based bedside assessment techniques. Given IVFs are the most commonly prescribed substance in the NHS, especially by FY doctors, inappropriate patient assessments and written prescriptions are a patient safety threat. Whilst the NICE IVF guideline exists, it is not without nuance and there remain challenges in delivering effective IVF education and sustainable learning interventions over time. From a FY doctor perspective discussed, senior clinicians demonstrating use of guidelines more explicitly may help address the gap between guidelines and clinical practice. Ultimately, given the widespread use of IVF, there is a need for improved education to develop FY doctors' clinical reasoning and ensure patient safety.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100639"},"PeriodicalIF":3.9,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860513","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":"The economic imperative for an AI Productivity Index in healthcare: Beyond clinical promise to fiscal accountability.","authors":"Yazan A Al-Ajlouni, Basile Njei","doi":"10.1016/j.clinme.2026.100638","DOIUrl":"10.1016/j.clinme.2026.100638","url":null,"abstract":"<p><p>Artificial intelligence (AI) is increasingly embedded in healthcare delivery, yet its evaluation remains dominated by technical performance metrics that inadequately capture real-world system value. Clinical accuracy is necessary but insufficient to justify adoption in resource-constrained health systems facing workforce shortages and rising demand. AI technologies compete for limited financial, technical and cognitive resources, but there is no standardised framework to assess their effects on productivity, workflow, downstream utilisation or equity. This article argues that treating clinical validity as a proxy for value risks misallocating scarce resources and undermining trust in digital transformation. We propose an AI Productivity Index to complement existing safety, efficacy and economic assessments by evaluating operational impact, implementation burden, opportunity costs and post-deployment consequences. Embedding productivity measurement into procurement and governance processes could help align AI innovation with fiscal accountability, equitable access and sustainable healthcare delivery.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100638"},"PeriodicalIF":3.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789206","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":"Prevalence and predictive factors of chronic kidney disease among individuals with cardiometabolic risk factors: A multicenter cross-sectional study, North East Ethiopia.","authors":"Getachew Bizuneh Aydagnuhm, Ermiyas Endewunet Melaku","doi":"10.1016/j.clinme.2026.100613","DOIUrl":"10.1016/j.clinme.2026.100613","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a major global public health concern, affecting more than 9% of adults worldwide and contributing to rising morbidity, mortality, and healthcare costs. The burden is disproportionately higher in low-resource settings such as Sub-Saharan Africa, where limited diagnostic capacity leads to delayed detection and accelerated progression to kidney failure. In Ethiopia, existing evidence is largely confined to diabetic populations, with minimal data on other high-risk groups. This study aimed to determine the prevalence of CKD and its associated risk factors among individuals with cardio-metabolic risk factors.</p><p><strong>Methods: </strong>A facility-based cross-sectional study was conducted from 1 March to 30 September 2025. A total of 510 adults with at least one of the cardiometabolic risk factors were enroled to the study. Data were collected through structured interviews, clinical examination, laboratory testing, and abdominal ultrasonography. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI 2021). Logistic regression was used to identify predictors of CKD.</p><p><strong>Results: </strong>The mean age of study participants was 61.7 years and 22.35% of them were found to have chronic kidney disease. CKD Stages 3, 4, and 5 were present in 13.92%, 5.69%, and 2.75% of the study participants, respectively. Chronic kidney disease was associated with abnormal waist circumference (P = 0.040), hepatitis B infection (P = 0.021), type 2 diabetes (p = 0.001), hypertension (p = 0.021), and previous acute kidney injury (p = 0.0001).</p><p><strong>Conclusion and recommendations: </strong>The study demonstrated a substantial burden of CKD with more than one-fifth of adults found to have moderate to severe kidney function impairment. Early screening of high-risk individuals and targeted management should be strengthened. Urine albumin-to-creatinine ratio (UACR) testing, which is relatively simple method of CKD screening, should be made available to improve the early screening and detection of kidney disease.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100613"},"PeriodicalIF":3.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381821","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":"What is new in tuberculosis?","authors":"Ye Myat, Maddalena Cerrone, Onn Min Kon","doi":"10.1016/j.clinme.2026.100634","DOIUrl":"10.1016/j.clinme.2026.100634","url":null,"abstract":"<p><p>Tuberculosis (TB) is the deadliest leading infectious disease globally. Approximately 10.7 million people worldwide were estimated to have developed TB in 2024. TB rates have increased in the UK over the last three years. Vigilance in acute care settings and across medical subspecialties is essential to ensure early recognition and control of TB particularly given the significant proportion of extrapulmonary presentations. Advances in diagnostic tools have significantly improved detection, with rapid PCR now becoming the standard for timely case identification. Whole genome sequencing (WGS) is now routinely in place to identify drug resistance, track transmission and guide public health responses. In parallel, treatment strategies are evolving, with shorter and more effective regimens available for latent TB, active disease, and multidrug-resistant TB. This review provides an overview of the epidemiology, clinical presentation, diagnosis, and management of TB, with a focus on recent advances relevant to clinical practice in the UK.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100634"},"PeriodicalIF":3.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705862","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":"Association between dietary magnesium intake and all-cause mortality in patients with chronic kidney disease: Insights from NHANES 1999-2018.","authors":"Zi-Yan Xu, Jing Zou, Li-Jun Xie, Ying Ye, Kai-Ying He, Juan Zhu, Xiao-Lan Wang, Ruo-Li Wang, Yi-Jia Luo, Jian-Hui Zhang, Qian Chen, Dan-Dan Ruan, Yan-Feng Zhou, Mei-Zhu Gao, Li Zhang, Yun-Fei Li, Zhu-Ting Fang, Fang-Meng Huang, Bin Hu, Jie-Wei Luo, Zhi-Hai Zheng, Li Chen","doi":"10.1016/j.clinme.2026.100633","DOIUrl":"10.1016/j.clinme.2026.100633","url":null,"abstract":"<p><strong>Background: </strong>We investigated the association between food-derived dietary magnesium intake and all-cause mortality among adults with chronic kidney disease.</p><p><strong>Methods: </strong>We analysed data from adults aged ≥20 years with CKD who participated in the National Health and Nutrition Examination Survey between 1999 and 2018. Mortality status was ascertained through linkage to the National Death Index through 31 December 2019. Multivariable Cox proportional hazards models were used to evaluate the association between dietary magnesium intake and all-cause mortality. Restricted cubic spline analysis, Kaplan-Meier survival analysis, subgroup analyses, and sensitivity analyses were also performed.</p><p><strong>Results: </strong>A total of 8,104 CKD patients were included in this cohort study with a median follow-up of 85 months, during which 3,134 (38.7%) died from all causes. In the fully adjusted Cox model, each 100 mg/day increase in dietary magnesium intake was associated with a 7.5% lower risk of all-cause mortality (HR = 0.925, 95% CI 0.881-0.971; P = 0.002). Compared with the lowest quartile, adjusted hazard ratios were 0.978 (95% CI 0.883-1.083) for Q2, 0.904 (95% CI 0.804-1.016) for Q3, and 0.866 (95% CI 0.744-1.007) for Q4, with a significant trend across quartiles (P for trend = 0.036). RCS analysis demonstrated a significant overall association with no evidence of nonlinearity (P for overall association = 0.009; P for nonlinearity = 0.472). Kaplan-Meier analysis showed higher survival probabilities among participants with higher dietary magnesium intake.</p><p><strong>Conclusions: </strong>Higher dietary magnesium intake was independently associated with a lower risk of all-cause mortality among adults with CKD. These findings suggest that adequate dietary magnesium intake may represent an important nutritional factor associated with prognosis in CKD. Further prospective studies and randomised clinical trials are warranted to determine whether increasing dietary magnesium intake can improve clinical outcomes.</p><p><strong>Summary statement: </strong>Higher dietary magnesium intake was independently associated with lower all-cause mortality among patients with chronic kidney disease in NHANES 1999-2018. These findings highlight the potential protective role of adequate magnesium intake in improving long-term survival in this population.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100633"},"PeriodicalIF":3.9,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697167","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":"Risk factors of clonal hematopoiesis of indeterminate potential.","authors":"Qiaoxue Liu, Fen Yang, Hans-Olov Adami, Yingsuo Zhao, Tove Wästerlid, Fang Fang, Qianwei Liu","doi":"10.1016/j.clinme.2026.100635","DOIUrl":"10.1016/j.clinme.2026.100635","url":null,"abstract":"<p><strong>Background: </strong>Accumulating evidence demonstrates associations between clonal hematopoiesis of indeterminate potential (CHIP) and increased risks of haematological and non-haematological health outcomes. Although adverse health consequences of CHIP have become well-documented, large knowledge gaps exist regarding the aetiology of CHIP.</p><p><strong>Objective: </strong>To investigate risk factors for CHIP using large-scale phenotypic data and Mendelian randomisation analysis.</p><p><strong>Methods: </strong>We utilised rich phenotypic and genomic data from the UK Biobank (UKB) to perform a cross-sectional study to systematically investigate risk factors of CHIP, including around 460,000 participants recruited from 2006 to 2010. We used Logistic regression to estimate odds ratios (ORs) of CHIP in relation to risk factors (sociodemographic factors, lifestyle factors, history of diseases, blood cell count, blood biochemistry parameters, proteomics biomarkers and metabolomics biomarkers). In addition, we conducted Mendelian Randomisation (MR) analyses to assess causality between the studied risk factors and CHIP, using publicly available summary statistics of genome-wide association studies (GWAS).</p><p><strong>Results: </strong>We found that advanced age, smoking, history of several diseases (including breast cancer and leiomyoma of uterus), as well as several serum biomarkers (monocyte count, proteins LY75, SIGLEC6, SIRPB1 and CYB5R2) were associated with CHIP.</p><p><strong>Conclusion: </strong>Our findings expanded existing knowledge base by demonstrating novel risk factors of CHIP, especially history of several diseases and serum biomarkers. These findings advance understanding of the aetiology of CHIP.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100635"},"PeriodicalIF":3.9,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697258","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":"Finerenone exposure and ischaemic stroke in patients with type 2 diabetes and chronic kidney disease: A propensity score-matched cohort study.","authors":"Wu-Lung Chuang, Ruey-Hwang Chou, Yuan-Hung Wang, I-Ju Tsai, Cheng-Li Lin, Der-Yang Cho, Kuang-Hsi Chang","doi":"10.1016/j.clinme.2026.100617","DOIUrl":"10.1016/j.clinme.2026.100617","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) commonly coexist and are associated with an increased risk of ischaemic stroke. Finerenone has demonstrated benefits on composite renal and cardiovascular outcomes in randomised trials; however, ischaemic stroke has generally been evaluated as part of composite endpoints, and real-world evidence focusing on this outcome remains limited.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX Global Research Network to evaluate the association between finerenone use and incident ischaemic stroke among adults with newly diagnosed T2DM who subsequently developed CKD. Finerenone users were compared with non-users. Propensity score matching was applied to balance demographic characteristics and baseline comorbidities. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 125,086 eligible patients were identified before matching, including 1,990 finerenone users. After 1:1 propensity score matching, 1,990 finerenone users were matched with 1,990 non-users with adequate covariate balance. Finerenone use was associated with a lower observed hazard of ischaemic stroke both before matching (adjusted HR, 0.30; 95% CI, 0.24-0.36) and after matching (adjusted HR, 0.33; 95% CI, 0.26-0.42).</p><p><strong>Conclusions: </strong>In this real-world cohort of patients with T2DM and CKD, finerenone use was associated with a lower observed hazard of ischaemic stroke.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100617"},"PeriodicalIF":3.9,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381815","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}