Digestion最新文献

{"title":"Timing and Predictors for Vonoprazan Dose Escalation in Refractory Gastroesophageal Reflux Disease: A Long-Term Observational Study.","authors":"Satoshi Shinozaki, Hirotsugu Sakamoto, Hiroyuki Osawa, Tomonori Yano, Nikolaos Lazaridis, Hironori Yamamoto","doi":"10.1159/000546992","DOIUrl":"https://doi.org/10.1159/000546992","url":null,"abstract":"<p><strong>Background: </strong>Vonoprazan (VPZ) therapy has become one of the standard treatments for gastroesophageal reflux disease (GERD). When GERD symptoms persist despite the maintenance dose therapy (10 mg daily), dose escalation to 20 mg daily is generally recommended. This study aims to clarify the proper timing and predictors for dose escalation of VPZ therapy in patients with refractory GERD treated with the maintenance dose.</p><p><strong>Methods: </strong>This retrospective observational study included 257 patients with symptomatic GERD. Data from medical records, including endoscopic findings and Izumo scale scores, were analyzed.</p><p><strong>Results: </strong>The mean follow-up period was 3.3 years. Throughout the follow-up period, VPZ dose escalation (from 10 to 20 mg daily) was required in 56 of 257 patients (22%). Kaplan-Meier analysis showed cumulative dose-escalation-free rates at 6 months, 1 year, and 2 years were 87%, 81%, and 78%, respectively. Predictive factors for VPZ dose escalation were analyzed using a Cox proportional hazards regression model. Multivariate analysis revealed that pre-existing epigastric pain was a significant positive predictor for dose escalation, whereas pre-existing constipation was identified as a significant negative predictor. Kaplan-Meier analysis indicated that the one-year dose-escalation-free rates were 69% in patients with epigastric pain compared to 88% in those without (p=0.001). GERD symptom scores showed a significant improvement one month after dose escalation.</p><p><strong>Conclusion: </strong>The incidence of refractory GERD requiring VPZ dose escalation is relatively low. Epigastric pain prior to VPZ initiation independently predicts the need for dose escalation. VPZ dose escalation effectively improves GERD symptoms.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-17"},"PeriodicalIF":3.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316172","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":"Texture and Colour Enhancement Imaging (TXI) versus White Light Endoscopy for Detection of Dysplasia Within Barrett's Esophagus: a Pilot Study.","authors":"Edward Young, Hamish Philpott, Rajvinder Singh","doi":"10.1159/000546637","DOIUrl":"https://doi.org/10.1159/000546637","url":null,"abstract":"<p><strong>Introduction: </strong>Esophageal cancer is a leading global health issue, with increasing prevalence of esophageal adenocarcinoma and its precursor lesion, Barrett's esophagus (BE). Despite the opportunity to treat dysplasia prior to adenocarcinoma development, rates of missed advanced dysplasia at BE surveillance remain high. This pilot study aimed to assess whether Texture and Colour Enhancement Imaging (TXI), a new advanced mucosal imaging modality, improves dysplasia detection during BE surveillance compared to white light endoscopy (WLE).</p><p><strong>Methods: </strong>Patients undergoing endoscopy for BE assessment or surveillance at a single centre were included for analysis. Patients were randomized in a 1:1 ratio to examination with WLE then TXI or vice versa, followed by Narrow-Band Imaging (NBI). Targeted biopsies were taken from any suspicious areas and 4-quadrant surveillance biopsies were taken at 1cm intervals in the entire BE segment.</p><p><strong>Results: </strong>A total of 50 patients were included in the study, with 27 suspicious lesions seen in 22 patients. 93.3% (n=14/15) of high-grade dysplasia or early adenocarcinoma was detected as endoscopically visible lesions on TXI and NBI. However, 4 such lesions were not detected on WLE. On per-patient analysis, the sensitivity and NPV of TXI in combination with magnified NBI were both 100% with specificity of 84.6%, surpassing all PIVI thresholds for dysplasia diagnosis in BE.</p><p><strong>Conclusion: </strong>This pilot study demonstrates the feasibility of TXI as a potential addition to the armamentarium of advanced mucosal imaging available to proceduralists surveilling Barrett's Esophagus. Further large multi-centre studies would be required to make statistical comparisons with existing imaging modalities.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-21"},"PeriodicalIF":3.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309642","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":"Role of endoscopy in achalasia.","authors":"Noriyuki Kawami, Yoshimasa Hoshikawa, Eri Momma, Shintaro Hoshino, Katsuhiko Iwakiri","doi":"10.1159/000546952","DOIUrl":"https://doi.org/10.1159/000546952","url":null,"abstract":"<p><strong>Background: </strong>Esophagogastroduodenoscopy is often performed as an initial examination in patients with symptoms such as dysphagia or chest pain, which may suggest esophageal motility disorders. However, its current role is largely limited to ruling out organic diseases.</p><p><strong>Summary: </strong>High-resolution manometry (the gold standard for diagnosing primary esophageal motility disorders such as achalasia) along with esophagography is extremely useful for diagnosis. In recent years, however, several new endoscopic findings-esophageal rosette, gingko leaf sign, champagne glass sign, corona appearance, and pinstripe pattern-have been reported, making it increasingly possible to strongly suspect achalasia through endoscopy. Additionally, the presence of multiple annular contractions, spiral (corkscrew) contractions, or narrowing (poor distensibility) in the esophageal body during endoscopy may suggest abnormal motility of the esophageal body.</p><p><strong>Key messages: </strong>When performing endoscopic examinations in patients with symptoms such as dysphagia or chest pain, it is important to consider the possibility of esophageal motility disorders. Careful endoscopic observation may allow for the suspicion of such disorders during the examination itself.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309641","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":"Esophageal hypervigilance and visceral anxiety are involved in esophageal symptom perception in patients with systemic sclerosis.","authors":"Yoshimasa Hoshikawa, Mikito Suzuki, Eri Momma, Shintaro Hoshino, Noriyuki Kawami, Masataka Kuwana, Katsuhiko Iwakiri, Masanori Atsukawa","doi":"10.1159/000546892","DOIUrl":"https://doi.org/10.1159/000546892","url":null,"abstract":"<p><p>[Background] Systemic sclerosis (SSc) causes esophageal motility disorders. However, esophageal symptom severity often does not correlate with the physiological findings of high-resolution manometry (HRM) in patients with SSc. Esophageal hypervigilance and visceral anxiety play a relevant role in symptom perception in patients with gastroesophageal reflux disease and esophageal motility disorders. Therefore, the present study examined the effects of anxiety and hypervigilance, along with HRM findings, on esophageal symptom severity in patients with SSc. [Methods] We reviewed the clinical data of consecutive patients with SSc who underwent HRM and were assessed using the esophageal hypervigilance and anxiety scale (EHAS) at our hospital between January 2022 and February 2025. Predictors for the Eckardt symptom score (ESS) and gastroesophageal reflux disease questionnaire (GerdQ) were investigated. [Results] This study included 51 patients with SSc. Significant differences were observed in EHAS scores between patients with ESS >3 and those with ESS ≤3 (34.0 [24.0-42.0] vs. 13.0 [1.0-24.0], p=0.003), but not in HRM findings. The EHAS score accounted for 38.2% of variance in the ESS score. Significant differences were also observed in the EHAS score between patients with GerdQ ≥8 and those with GerdQ <8 (26.0 [14.3-32.5] vs. 13.0 [0-22.0], p=0.011). The combined factors of the EHAS score and absent contractility accounted for 17.3% of variance in the GerdQ score. [Conclusion] Esophageal hypervigilance and anxiety may be involved in esophageal symptom severity, particularly dysphagia severity, in patients with SSc. Further studies involving interventions targeting these conditions, such as cognitive behavioral therapy, are warranted.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-16"},"PeriodicalIF":3.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301362","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":"Cost-effective Endoscopic Screening Strategies for Asymptomatic Gastric Cancer.","authors":"Fumiaki Ishibashi, Kosuke Okusa","doi":"10.1159/000546835","DOIUrl":"https://doi.org/10.1159/000546835","url":null,"abstract":"<p><strong>Background: </strong>In Japan, biennial esophagogastroduodenoscopy (EGD) screening for gastric cancer (GC) has been implemented for adults aged ≥50 years as part of a population-based screening program. This approach has facilitated early GC detection and demonstrated individual-level benefits. However, due to a generational decline in Helicobacter pylori infection, a reduction in the long-term effectiveness of this strategy is anticipated. Given the allocation of national resources, a cost-effectiveness evaluation is essential.</p><p><strong>Summary: </strong>As GC prevalence declines in the target population, the cost-effectiveness of existing screening practices may diminish. Mathematical simulation models are commonly employed to assess the comparative effectiveness and cost-effectiveness of various cancer screening strategies. Microsimulation models, which track individual-level outcomes, are utilized to evaluate person-level effects. By contrast, macrosimulation models-such as Markov and decision tree models-are used to assess population-level outcomes.</p><p><strong>Key messages: </strong>Nine studies have compared different EGD screening strategies. These studies support the effectiveness of biennial screening in high-risk countries. In low- to intermediate-risk countries-and among lower-risk populations within high-risk countries-extending the screening interval to ≥3 years appears reasonable. Additionally, strategies incorporating risk stratification using alternative modalities, such as serological tests, are more cost-effective. Continued discussion is necessary to optimize the EGD screening approach.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-16"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233423","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":"Regulation of colonic motility by cystathionine-γ-lyase neuron remodeling.","authors":"Shiwei Liang, Haicheng Fang, Guoqiang Jia, Ying Liu","doi":"10.1159/000546390","DOIUrl":"https://doi.org/10.1159/000546390","url":null,"abstract":"<p><p>Colitis is a colonic inflammatory reaction induced by various factors, such as pathogenic microorganisms, physical and chemical factors and food allergens. At present, the mechanism of colonic motility disorder in colitis remains unclear. The aim of the present study was to investigate the relationship between the expression of cystathionine-γ-lyase (CSE) in neurons from colonic tissue and colonic motility disorders in colitis. A model of colitis was established in rats. The disease activity index (DAI) was determined in the colitis model and control rats, and the number of fecal droppings was recorded for 7 days. Organ bath recordings, immunohistochemistry, immunocytochemistry and western blotting were performed on rat colonic samples and in neurons of the myenteric plexus of the enteric nervous system (ENS) in order to investigate the relationship between the expression of CSE and colonic motility disorder in colitis. The results demonstrated that, in the colitis model, colonic motility and the number of fecal droppings were reduced. In addition, treatment with acetylcholine increased the contractile activity of colonic strips in both groups. Treatment with inhibitors of H2S-producing enzymes significantly increased the area under the curve of longitudinal muscle strips in the colitis group. CSE was expressed in the mucosa, submucosa, circular muscle, longitudinal muscle cells and myenteric plexus. The expression of CSE in neurons of the myenteric plexus of the ENS was upregulated in the colitis group. These findings suggest that upregulation of endogenous H2S synthetase and increased H2S production may account for decreased colonic motility.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-16"},"PeriodicalIF":3.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198529","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":"Endoscopic treatment of achalasia.","authors":"Gonzalo Latorre, Robert Bechara","doi":"10.1159/000546490","DOIUrl":"https://doi.org/10.1159/000546490","url":null,"abstract":"<p><strong>Background: </strong>Achalasia is the most common major esophageal motility disorder, characterized by impaired lower esophageal sphincter (LES) relaxation and absent or ineffective peristalsis. Peroral endoscopic myotomy (POEM), pneumatic dilation (PD), and botulinum toxin injection (BTI) are the main endoscopic therapies available. This review highlights recent advances, technical variations, and updated evidence on the efficacy and safety of POEM.</p><p><strong>Summary: </strong>POEM has emerged as a highly effective and minimally invasive treatment for achalasia, with randomized controlled trials demonstrating excellent long-term clinical success and durability. Its safety profile and capacity for a tailored myotomy offer distinct advantages over alternative therapies. However, gastroesophageal reflux disease (GERD) remains a key concern. Ongoing efforts are focused on optimizing procedural techniques, including myotomy length and orientation, sling fiber preservation, and the addition of fundoplication. Additionally, training protocols, patient selection criteria, and strategies to prevent and predict GERD are critical areas of development. Future research should aim to refine follow-up strategies and define objective measures of success to enhance the safety, efficacy, and accessibility of POEM.</p><p><strong>Key messages: </strong>Endoscopic treatments of achalasia, particularly POEM, offer effective and durable outcomes. Optimizing technique, refining training, and managing GERD are essential for improving safety and long-term success.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-25"},"PeriodicalIF":3.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173017","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":"Steatotic Liver Disease Subtypes and their Association with Colorectal Cancer Risk in Korea: A Nationwide Population-Based Study.","authors":"Sang Yi Moon, Minkook Son, Jong Yoon Lee, Yeo Wool Kang, Myeongseok Koh","doi":"10.1159/000546376","DOIUrl":"https://doi.org/10.1159/000546376","url":null,"abstract":"<p><strong>Background: </strong>A recent Delphi consensus proposed a new classification system for steatotic liver disease (SLD), replacing the previous terminology, non-alcoholic fatty liver disease (NAFLD). This study aimed to examine the association between SLD subtypes and the risk of developing colorectal cancer (CRC).</p><p><strong>Methods: </strong>We used the Korean National Health Insurance Service database to identify participants who underwent health screenings in 2009 and 2010 and retrospectively analysed their data through to 2019. The participants were grouped into four categories: no SLD, metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-related liver disease (ALD). Hepatic steatosis was defined as a fatty liver index ≥30. The primary outcome was the occurrence of newly diagnosed CRC according to the SLD classification.</p><p><strong>Results: </strong>This analysis included 242,275 participants. The adjusted hazard ratios for CRC incidence were 1.17 (95% confidence interval [CI]: 1.10-1.25) for MASLD, 1.45 (95% CI: 1.28-1.65) for MetALD, and 1.78 (95% CI: 1.48-2.14) for ALD, with no SLD as the reference group. All results were statistically significant (p < 0.001).</p><p><strong>Conclusion: </strong>Individuals in Korea with MASLD, MetALD, or ALD are at an increased risk of developing CRC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173033","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":"High-Fat Diet-Induced Gut Microbiota Disruption Promotes Colorectal Cancer Lymphatic Metastasis via Propionate/GPR41 Signaling.","authors":"Jialei Wang, Qingying Tan, Min Ni, Feng Chen, Junlong Yang, Guoliang Wang, Xiaoyong Zhao, Xiaoli Zhang, Sen Zhang","doi":"10.1159/000545843","DOIUrl":"https://doi.org/10.1159/000545843","url":null,"abstract":"<p><strong>Objective: </strong>High-fat diets (HFD) are known to affect the gut microbiome structure and potentially promote the development and metastasis of colorectal cancer (CRC). This study aims to elucidate the molecular mechanisms through which gut microbiome dysbiosis, mediated by the propionate/GPR41 signaling pathway, promotes lymphangiogenesis and lymph node (LN) metastasis in CRC, providing new insights for CRC treatment.</p><p><strong>Methods: </strong>Microbial diversity and composition in rectal cancer were compared between CRC patients and healthy controls using 16s rRNA sequencing. Key genes related to short-chain fatty acid metabolism, HFD, and gut microbiota were identified. In vitro assays assessed CRC cell proliferation, migration, invasion, and lymphangiogenesis. A CRC mouse model on an HFD was used to measure fecal propionate levels and analyze GPR41 expression in tumors. In vivo fluorescence imaging was employed to track cancer cell migration and lymph node metastasis.</p><p><strong>Results: </strong>HFD-induced microbial dysbiosis led to a significant reduction in SCFA-producing bacteria and an increase in pro-inflammatory species. This dysbiosis contributed to the suppression of propionate's protective effects. Propionate inhibited CRC cell proliferation, migration, and invasion under HFD conditions by activating the GPR41 pathway. Silencing GPR41 reversed these inhibitory effects, highlighting the key role of GPR41 in mediating propionate's anti-tumor effects. In vivo experiments further confirmed that propionate suppressed HFD-enhanced CRC lymphatic metastasis through the GPR41 signaling pathway, linking microbial dysbiosis with the modulation of cancer progression.</p><p><strong>Conclusion: </strong>This study reveals that HFD promotes CRC lymphangiogenesis and LN metastasis through gut microbiota dysbiosis and suppression of the propionate-activated GPR41 signaling pathway. These findings highlight the therapeutic potential of targeting the propionate/GPR41 axis , offering a promising strategy for developing novel anticancer therapies.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-27"},"PeriodicalIF":3.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173021","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":"Biodegradable stents for the treatment of refractory benign esophageal strictures: Systematic review and meta-analysis.","authors":"Daniel Tyč, Nina Vaněčková, Josef Hanuš, Iva Selke Krulichová","doi":"10.1159/000546377","DOIUrl":"https://doi.org/10.1159/000546377","url":null,"abstract":"<p><strong>Introduction: </strong>Refractory benign esophageal strictures (RBES) pose significant clinical challenges. Biodegradable (BD) stents have emerged as alternatives to traditional stenting methods, offering the possibility of reducing the need for multiple procedures. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of BD stents in the treatment of RBES.</p><p><strong>Methods: </strong>The PubMed, Web of Science, Scopus, Cochrane, and Science Direct databases were searched according to the PRISMA statement. Studies that focused on the clinical outcomes of BD stents used in adult patients with RBES were included. Data on technical success and complication rates were analyzed using random-effects models. Efficacy data were analyzed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>The review included 15 studies with 241 BD stent implantations. The technical success rates were consistently high in all studies. The median time to restenosis was 21 weeks, with survival rates of 38.4% at 26 weeks and 27.0% at 52 weeks. The rate of complications requiring intervention was relatively low, but significant hyperplasia and pain occurred in 16.4% and 8.8% of the cases, respectively. Significant heterogeneity was observed in hyperplasia-related outcomes, which required a detailed subgroup analysis to investigate the underlying causes.</p><p><strong>Conclusion: </strong>BD stents provide acceptable results in terms of efficacy and safety for the treatment of RBES. However, the evidence is limited owing to the lack of randomized controlled trials and comparative studies. Future research should focus on these areas to strengthen the clinical evidence regarding BD stents.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-23"},"PeriodicalIF":3.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157440","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}