Digestive Diseases and Sciences最新文献

{"title":"Combination of Frailty and Sarcopenia Predicts Peri-operative Outcomes in Patients Undergoing Liver Transplantation: Analysis of the National Inpatient Sample.","authors":"Aalam Sohal, Sheena Bhushan, Jay Patel, Isha Kohli, Srinivasan Dasarathy, Kris V Kowdley","doi":"10.1007/s10620-025-09255-w","DOIUrl":"https://doi.org/10.1007/s10620-025-09255-w","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcopenia and frailty contribute to adverse clinical outcomes in patients with cirrhosis awaiting and after liver transplantation (LT). However, the impact of sarcopenia/physical frailty on perioperative LT outcomes has not been reported. The effect of physical frailty and sarcopenia on hospitalization outcomes in patients undergoing liver transplantation was evaluated in a nationwide dataset.</p><p><strong>Methods: </strong>Adult patients undergoing liver transplantation from 2016 to 2020 in the National Inpatient Sample database without/with frailty (defined by the hospital frailty risk score) and/or sarcopenia (defined by muscle-loss phenotype) were analyzed. Patients were stratified into those without sarcopenia or frailty (sarcopenia/frailty), with either sarcopenia/frailty, and those with both sarcopenia and frailty. Univariate and multivariate logistic/linear regression analyses were performed to compare in-hospital mortality, perioperative organ system complications, length of stay, and costs during the LT hospitalization in patients without/with frailty and/or sarcopenia. Adjustments were made for patient demographics, hospital characteristics, modified Charlson comorbidity index, etiology, and decompensation of liver disease.</p><p><strong>Results: </strong>Among the 34,405 LT recipients, there was a high prevalence of frailty alone (35%), sarcopenia alone (7.6%), or both sarcopenia/frailty (29.2%). Patients with both frailty and sarcopenia had higher in-hospital mortality (4.6%), periprocedural complications (79.4%), and non-routine discharge (71.4%) than patients with frailty, sarcopenia alone or neither sarcopenia nor frailty. Combined frailty and sarcopenia was associated with higher odds of in-hospital mortality, compared to patients with neither sarcopenia or frailty (aOR 4.06, p < 0.001).</p><p><strong>Conclusions: </strong>Combined frailty and sarcopenia are associated with an increased risk of mortality in hospitalized patients undergoing LT. Increased awareness and interventions to improve these risk factors should be emphasized before LT.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopy in End-Stage Renal Disease: Timing Matters.","authors":"Nirmaljeet Singh Malhi, Neeraj Singla","doi":"10.1007/s10620-025-09288-1","DOIUrl":"https://doi.org/10.1007/s10620-025-09288-1","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Metabolomics and Aptamer-Based Proteomics to Determine Pathophysiologic Differences in Decompensated Cirrhosis Patients Hospitalized with Acute Kidney Injury.","authors":"Giuseppe Cullaro, Andrew S Allegretti, Kavish R Patidar, Elizabeth C Verna, Jennifer C Lai","doi":"10.1007/s10620-025-09223-4","DOIUrl":"https://doi.org/10.1007/s10620-025-09223-4","url":null,"abstract":"<p><strong>Introduction: </strong>Limited understanding of kidney dysfunction types and acute kidney injury (AKI) recovery exists due to biopsy risks in decompensated cirrhosis patients. To inform this, we analyzed aptamer-based proteomics and metabolomics to differentiate by AKI diagnosis and recovery.</p><p><strong>Methods: </strong>A case-control study of 97 patients hospitalized at our institution. We performed aptamer-based proteomics and metabolomics on serum biospecimens obtained within 72 h of admission. We compared the proteome and metabolome by the AKI phenotype (i.e., HRS-AKI, ATN) and by AKI recovery (decrease in sCr within 0.3 mg/dL of baseline) using ANCOVA analyses adjusting for demographics and clinical characteristics. We completed Random Forest (RF) analyses to identify metabolites and proteins associated with AKI phenotype and recovery. Lasso regression models were developed to highlight metabolites and proteins that could improve diagnostic accuracy.</p><p><strong>Results: </strong>ANCOVA analyses showed no metabolomic or proteomic differences by AKI phenotype while identifying differences by AKI recovery status. Our RF and Lasso analyses showed that metabolomics can improve the diagnostic accuracy of both AKI diagnosis and recovery, and aptamer-based proteomics can enhance the diagnostic accuracy of AKI recovery.</p><p><strong>Discussion: </strong>Our analyses provide novel insight into pathophysiologic pathways, highlighting the metabolomic and proteomic similarities between patients with cirrhosis with HRS-AKI and ATN while also identifying differences between those with and without AKI recovery.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of Bowel Bubbles During Colonoscopy Following Bowel Preparation with Oral Sulfate Solution or 2 L Polyethylene Glycol-Electrolyte Solution with Ascorbic Acid.","authors":"Wiqas Ahmad, Naohisa Yoshida, Lucas Cardoso, Sher Rehman, Reo Kobayashi, Naoto Iwai, Ken Inoue, Osamu Dohi, Hideyuki Konishi, Ryohei Hirose, Yoshikazu Inagaki, Yoshito Itoh","doi":"10.1007/s10620-025-09277-4","DOIUrl":"https://doi.org/10.1007/s10620-025-09277-4","url":null,"abstract":"<p><strong>Introduction: </strong>Bowel bubbles are one of the key factors influencing the quality of colonoscopy. We aimed to evaluate the density of luminal bubbles in colonoscopy and compared oral sulfate solution (OSS) with 2L polyethylene glycol and electrolyte solution with ascorbic acid (PEG) in a same-day preparation.</p><p><strong>Methods: </strong>This was a retrospective multicenter study. A total of 162 patients (45 OSS and 117 PEG) who underwent colonoscopy with bubble assessment between June and September 2024 were analyzed. The rate of bubbles by location and the risk factors for severe bubbles in the proximal colon were examined. Additionally, the comparisons of bubbles and polyp detection in OSS and PEG after propensity-score matching were performed using an original score named as bowel bubble score of colonoscopy (BBS-C; score 0: none-score 3: severe).</p><p><strong>Results: </strong>Among 162 cases, the rates of severe bubbles were 16.0% in the proximal colon and 9.9% in the distal colon (p = 0.098). In the multivariate analysis of risk factors for severe bubbles in the proximal colon, good preparation was positively associated with severe bubbles (OR: 4.878; 95% CI 1.33-20.0; p = 0.017), with poor preparation as the reference. After matching, the rates of severe bubbles in the proximal colon between the OSS and PEG groups were 11.1% vs. 6.7% (p = 0.470).</p><p><strong>Conclusion: </strong>The rates of bubbles in each segment were examined by BBS-C, and good bowel preparation was a risk factor for proximal severe bubbles. There was no significant difference regarding severe bubbles between OSS and PEG.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining Best Practices and Content for Foundational Ambulatory GI and Hepatology Teaching During GI Fellowship.","authors":"Amy G Ogurick, Kay Chen, Zain Sobani, David N Assis, Donna Windish","doi":"10.1007/s10620-025-09294-3","DOIUrl":"https://doi.org/10.1007/s10620-025-09294-3","url":null,"abstract":"<p><p>Less than 10% of adult gastroenterology (GI) fellowship is required to occur in the ambulatory, office-based, setting according to the Accreditation Council for Graduate Medical Education (ACGME). However, most GI fellowship graduates will spend a significant portion of their career in this setting. Training programs outside of GI have utilized multiple interventions to help bridge this educational training gap between inpatient-heavy training and outpatient-focused practice. For example, specialties such as internal medicine, pediatrics, and pulmonary and critical care have developed adaptable and widely available foundational ambulatory curricula. However, no such curriculum currently exists for GI training programs. To address this unmet need, commonly used curricular resources for GI fellowship from a variety of organizations (ABIM, ACGME, etc.) were reviewed to define a set of 32 core topics. This effort represents the first step of a needs assessment to determine the content and structure of a foundational ambulatory curriculum for GI fellowship and serves as an example of a structured and scholarly approach to advancing medical education research.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-obstructive Perforation: A Rare Disaster Following Successful Duodenal Bezoar Fragmentation.","authors":"Chunfei Wang, Yongshuai Liu, Lei Zong, Shanming Sun","doi":"10.1007/s10620-025-09292-5","DOIUrl":"https://doi.org/10.1007/s10620-025-09292-5","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Limitations of Duodenal Endoscopic Submucosal Dissection in the United States.","authors":"Mai A Khalaf, Fares Ayoub, Tara Keihanian, Allan Zhang, Christina Zelt, Salmaan Jawaid, Neil Sharma, Mohamed O Othman","doi":"10.1007/s10620-025-09238-x","DOIUrl":"https://doi.org/10.1007/s10620-025-09238-x","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic submucosal dissection (ESD) of duodenal tumors is challenging due to its unique anatomy and high risk of adverse events. Its use is limited in the United States due to procedural complexity. Our study highlights the feasibility of ESD for managing duodenal tumors in the US.</p><p><strong>Methods: </strong>This retrospective cohort included duodenal ESD lesions at two tertiary US medical centers from 2017 to 2024. The primary outcomes included technical success, en bloc, R0, and curative resection rates. Secondary outcomes were adverse events and recurrence rates.</p><p><strong>Results: </strong>Seventy-four duodenal lesions in 70 patients were resected by three endoscopists with variable levels of experience in ESD. Most lesions (56%) were located in the duodenal bulb. Technical success was 100%, with en bloc and R0 resection rates of 78.3% and 51.4%, respectively. Mean procedure time was 85.9 ± 50.4 min. Neuroendocrine tumors had higher en bloc (90% vs. 62.5%) but lower R0 resection rates (43.8% vs. 53.1%) than adenomas. Adenomas had more positive lateral margins (50% vs. 18.3%). Larger lesions (> 30 mm) had lower en bloc resection rates than smaller ones (≤ 30 mm). The overall adverse event rate was 25.7%. Intraprocedural deep muscle injury and bleeding were more common in lesions > 3 cm (18.2% and 6%) than in smaller lesions (7.3% and 2.4%).</p><p><strong>Conclusions: </strong>Duodenal ESD has lower en-bloc and R0 resection rates, but higher risk of adverse events compared to other sites. An individualized approach and careful discussion of endoscopic versus non-endoscopic options with every patient is warranted.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vonoprazan Versus Lansoprazole in the Healing and Maintenance Phase of Erosive Esophagitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.","authors":"Syed Hasham Ali, Sushil Rayamajhi, Hareesha Rishab Bharadwaj, Aditya Gaur, Muhtasim Fuad, Arkadeep Dhali, Dushyant Singh Dahiya, Matan Bone, Babu Mohan, Sushovan Guha","doi":"10.1007/s10620-025-09290-7","DOIUrl":"https://doi.org/10.1007/s10620-025-09290-7","url":null,"abstract":"<p><strong>Background: </strong>Vonoprazan (VPZ), a potassium-competitive acid blocker, has emerged as an alternative to traditional proton-pump inhibitors like Lansoprazole (LPZ) for the treatment of erosive esophagitis (EE). Vonoprazan provides stronger acid suppression compared to PPIs; however, evidence regarding its effectiveness and safety in treating EE remains limited. We conducted a systematic review and meta-analysis to evaluate the comparative effectiveness and safety of VPZ versus LPZ in the healing and maintenance phases of EE.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across PubMed, Embase and Cochrane Library to identify eligible randomized controlled trials (RCTs) published till 12 December 2024 that evaluated efficacy and safety of VPZ and LPZ in patients with EE. Outcomes included endoscopic healing rates, recurrence rates, and treatment-emergent adverse events (TEAEs). Pairwise meta-analyses and network meta-analyses (NMA) were performed using Review Manager 5.4.1 and Bayesian models.</p><p><strong>Results: </strong>This meta-analysis included 7 RCTs with 4,903 patients. In the healing phase, VPZ showed significantly higher endoscopic healing rates than LPZ at Week 2 (RR: 1.09; 95% CI: 1.04-1.13; p < 0.0001, I² = 0%) and among patients with severe EE (LA classification C/D) at both Week 2 (RR: 1.26; 95% CI: 1.15-1.38; p < 0.00001, I² = 0%) and Week 8 (RR: 1.13; 95% CI: 1.03-1.24; p = 0.007, I² = 67%). No significant differences were observed in TEAEs, severe adverse events, or treatment discontinuation. In the maintenance phase, VPZ 20 mg reduced recurrence rates compared to LPZ 15 mg (RR: 0.41; 95% CI: 0.17-0.85) without differences in TEAEs.</p><p><strong>Conclusions: </strong>VPZ demonstrates greater efficacy in healing and maintaining remission in EE, particularly in severe cases, with a safety profile comparable to LPZ. These findings support VPZ as an effective alternative to PPIs. However, long-term studies are warranted.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Endoscopic Gastrostomy with Jejunal Extension Versus Direct Percutaneous Endoscopic Jejunostomy for Post-pyloric Feeding: A Dual-Center Retrospective Study.","authors":"Matthew R Krafft, Soban Maan, Adam Scott, Katherine Shepherd, Rahul Karna, Emily Clemetson, Shailendra Singh, Shyam Thakkar, Stuart K Amateau","doi":"10.1007/s10620-025-09198-2","DOIUrl":"https://doi.org/10.1007/s10620-025-09198-2","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic procedures for post-pyloric feeding include percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) and direct percutaneous endoscopic jejunostomy (PEJ). We conducted the largest and only dual-center retrospective study comparing outcomes of patients receiving PEG-J vs. PEJ.</p><p><strong>Methods: </strong>A dual-center retrospective study was conducted of patients who underwent either PEG-J or PEJ for post-pyloric feeding ±  gastric decompression. Primary outcomes were technical success (TS) and reintervention for adverse event (rAE: ≥ 1 feeding tube exchange, conversion, and/or removal performed as needed for management of tube-related or stoma-related AE). Secondary outcomes were index procedure time, AE category (tube-related/stoma-related), and reintervention(s) prompted by each AE category.</p><p><strong>Results: </strong>TS was similar for both procedures (PEG-J: 71/75 [95%] vs. PEJ: 68/75 [91%], p = 0.533). The PEG-J cohort had more reinterventions for AEs (rAE: 33/75 [44%] vs. 20/75 [27%], p = 0.04) occurring closer to the index procedure (median time to rAE, 163 days vs. 307 days, log rank p = 0.018). Tube-related AEs (38/75 [51%] vs. 25/75 [33%], p = 0.047) and resultant reinterventions were more common after PEG-J, especially tube clog (p = 0.017) and retrograde J-tube migration (p = 0.0003). Stoma-related AEs (PEG-J: 3/75 [4%] vs. PEJ: 7/75 [9%], p = 0.327) and resultant reinterventions were similar in both cohorts.</p><p><strong>Conclusions: </strong>Technical success was comparable between PEG-J and PEJ; however, PEJ recipients had fewer tube-related AEs and resultant reinterventions. These findings favor PEJ as first-line for patients requiring prolonged post-pyloric feeding, especially if concomitant gastric decompression is not required.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Procedural Oxygen Mask Versus Conventional Nasal Cannula for Hypoxemia Prevention During Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial.","authors":"Bedirhan Gunel, Ayse Sencan, Zeynep Yasemin Tavsanoglu, Tunahan Cevik, Emine Atli, Zeki Islamoglu, Ahmet Yuksek, Mehmet Yilmaz","doi":"10.1007/s10620-025-09264-9","DOIUrl":"https://doi.org/10.1007/s10620-025-09264-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the effects of a conventional nasal cannula (NC) and a Procedural Oxygen Mask™ (POM™) on oxygenation and airway interventions during sedated endoscopic retrograde cholangiopancreatography (ERCP) in the semi-prone position.</p><p><strong>Methods: </strong>In this prospective, randomized, controlled trial, 150 patients undergoing ERCP were randomized to receive oxygen via either an NC or a POM™. The primary outcome was the incidence of hypoxemia and secondary outcomes included the incidence of severe and prolonged desaturation, the duration of hypoxemia, the number of hypoxemic episodes per patient, and the lowest recorded SpO₂, along with the incidence of airway interventions, the incidence of procedure-disrupting body motions, hemodynamic changes, and satisfaction scores from both gastroenterologists and patients.</p><p><strong>Results: </strong>Hypoxemia occurred in 14 patients (18.7%) in the NC group and in 4 patients (5.3%) in the POM™ group, with a significant difference between groups (p = 0.024). The lowest recorded SpO₂ was found to differ significantly between the two groups (p < 0.001). In the multiple logistic regression analysis, NC use (aOR = 9.675; 95% CI 2.263-41.372; p = 0.002), higher total propofol dose (aOR = 1.014; 95% CI 1.007-1.022; p < 0.001), lower preoperative hemoglobin levels (aOR = 0.635; 95% CI 0.455-0.886; p = 0.007), and elevated direct bilirubin levels (aOR = 1.296; 95% CI 1.078-1.559; p = 0.006) were independently associated with an increased risk of hypoxemia.</p><p><strong>Conclusions: </strong>The use of a POM™ during ERCP while the patient is in the semi-prone position under sedation significantly reduces the incidence of hypoxemia and may therefore contribute to improved oxygenation management. This finding suggests that a POM™ is a viable alternative to NC.</p><p><strong>Trial registration: </strong>The clinical trial was registered at https://www.</p><p><strong>Clinicaltrials: </strong>gov/ (NCT06681558) on October 31, 2024.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}