Endocrine Practice最新文献

{"title":"Comparative effectiveness of GLP-1 receptor agonists in patients with heart failure with preserved or minimally reduced ejection fraction: a comprehensive Bayesian network meta-analysis and network meta-regression.","authors":"Ibrahim Khalil, M Rafiqul Islam, A B M Kamrul-Hasan, Lakshmi Nagendra, Sunjida Amin Promi, Md Abu Sayed, Mohd Turzo Rahman, Nowrin Sultana, Noshin Anjum Tasmi, Manisha Das, Salsabil Tarannum, Rajendronath Dey, Deep Dutta","doi":"10.1016/j.eprac.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.06.005","url":null,"abstract":"<p><strong>Objectives: </strong>GLP-1 receptor agonists (GLP-1 RAs) have shown beneficial effects on clinical outcomes in patients with heart failure (HF) with preserved ejection fraction (HFpEF) or minimally reduced ejection fraction (HFmrEF). This network meta-analysis (NMA) aimed to consolidate evidence from RCTs assessing the effects of GLP-1 RAs in HFpEF and HFrEF.</p><p><strong>Methods: </strong>Several databases were searched comprehensively for relevant RCTs. A Bayesian NMA was conducted using R, and meta-regression was employed to investigate potential sources of heterogeneity. Statistical significance was evaluated using 95% Credible Intervals (CrI) and SUCRA to rank treatment effectiveness. The primary outcome was hospitalization for HF (HHF).</p><p><strong>Results: </strong>Eight reports from six Phase 3 RCTs (N=24,099), mostly with low risks of bias, were included. Compared to placebo, semaglutide reduced the risk of HHF (HR 0.52, 95% CrI [0.25, 0.87]), while tirzepatide (HR 0.51, 95% CrI [0.16, 1.24]) and exenatide (HR 0.82, 95% CrI [0.33, 1.73]) demonstrated no effect. Semaglutide and exenatide, but not tirzepatide, reduced the risk of all-cause mortality. None affected cardiovascular mortality. Semaglutide decreased the risk of worsening of HF events; tirzepatide did not. Tirzepatide and semaglutide enabled weight loss; however, only semaglutide notably enhanced the 6-minute walk distance. According to the SUCRA values, tirzepatide ranked highest for reducing HHF and body weight, semaglutide for decreasing cardiovascular mortality and worsening of HF events and improving the 6-minute walk distance, and exenatide for reducing all-cause mortality.</p><p><strong>Conclusion: </strong>GLP-1 RAs provide significant benefits for patients with HFpEF or HFmrEF, with semaglutide offering more advantages than tirzepatide and exenatide.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483666","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":"Consensus Thyroid Nodule Radiofrequency Ablation Reporting Guidelines Established Using a Delphi Approach.","authors":"Kendyl Carlisle, Rebecca Kowalski, Qing Lina Hu-Bianco, Sophie Y Dream, Jonathon O Russell, Steven P Hodak, Jennifer H Kuo, Yinin Hu","doi":"10.1016/j.eprac.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.06.006","url":null,"abstract":"<p><strong>Objectives: </strong>Radiofrequency ablation (RFA) has become increasingly utilized for thyroid nodules. However, best practice recommendations on data collection and outcomes reporting are lacking. The objective of this study was to generate consensus guidelines for thyroid RFA data collection for purposes of quality assurance and collaborative research.</p><p><strong>Methods: </strong>We recruited a multidisciplinary panel of experienced RFA practitioners through the North American Society for Interventional Thyroidology. Using a modified Delphi process, experts created and iteratively revised a data collection form encompassing items from the pre-, intra-, and post-procedural phases. Emphasis was placed on parameters that are readily available to both community and academic-based practitioners. Items with >70% (strongly-agree) or 100% (agree) consensus for inclusion were retained. The Delphi process and the final reporting instrument were built on REDCap.</p><p><strong>Results: </strong>Ten panelists from 9 institutions performing a median of 22.5 cases/year completed five Delphi rounds. All panelists voted strongly-agree for retention on 63% (n=37) of included items. The final instrument was divided into three forms: 1. Pre-procedure (n= 18 items), 2. Immediate post-procedure (n=9 items), and 3. Follow-up (n=10 items).</p><p><strong>Conclusions: </strong>Adoption of these three new thyroid RFA data collection forms by new and established interventionalists may facilitate collaboration, standardized outcomes reporting, and clinical trial design.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324816","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":"Risk of pituitary immune-related adverse events caused by immune checkpoint inhibitors:a systematic review and meta-analysis.","authors":"Zhe Li, Ziang Liu, Hongxia Wei, Shuqing Jin, Yuchen Sun, Yi Zhang, Yunfeng Liu","doi":"10.1016/j.eprac.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.06.008","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) induced hypophysitis is one of the common endocrine immune-related adverse events (irAEs). Our goal is to evaluate the risk of pituitary irAEs caused by ICIs. The relevant literatures were retrieved from PubMed, Embase and Cochrane Library from inception to October 31, 2024.References were screened according to inclusion and exclusion criteria and study data were extracted. Meta-analysis was performed using Revman5.3 and Stata18.0 software. A total of 21 prospective single-arm trials and 17 randomized controlled trials (RCTs) were included. In single-arm trials, the incidence of hypophysitis (4.00%) and hypopituitarism (3.84%) caused by CTLA-4 was the highest in monotherapy, and the incidence of hypophysitis caused by PD-1 plus CTLA-4 was the highest in ICIs combination therapy (9.36%). In RCTs, the risk of pituitary irAEs caused by ICIs was higher than that of the control group (RR=10.09, 95%CI 6.90-14.75). Compared with monotherapy, ICIs combination therapy has a higher risk of pituitary irAEs (RR=5.42, 95%CI 3.36-8.73). In monotherapy, CTLA-4 caused the highest incidence of hypophysitis and hypopituitarism, reaching 16.17% and 1.75% respectively. Furthermore, the severity of adverse pituitary irAEs caused by CTLA-4 was also the highest (in single-arm trials 5.12%, in RCTs 16.35%). The results showed that ICIs is associated with a significantly higher risk of pituitary irAEs, and ICIs combination may further increase the risk. In monotherapy, CTLA-4 caused the highest incidence and severity of pituitary irAEs, while PD-L1 caused the lowest. In combination therapy, PD-1 combined with CTLA-4 resulted in a higher incidence of hypophysitis.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324817","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 Future of Automated Insulin Delivery Systems.","authors":"Michael S Hughes, Carol J Levy","doi":"10.1016/j.eprac.2025.05.752","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.05.752","url":null,"abstract":"<p><p>Automated insulin delivery (AID) systems have revolutionized diabetes care by integrating continuous glucose monitoring (CGM), insulin pumps, and advanced algorithms to improve glycemic outcomes and reduce user burden. Early commercial AID systems were developed with a conservative approach, prioritizing safety and regulatory approval over full automation or extensive customization. While these systems significantly improved diabetes management, they still face limitations, including incomplete automation, accessibility barriers, and the need for better adaptation to diverse user needs and lifestyles. These challenges are catalyzing development of next-generation AID technologies with a focus on achieving full automation, greater personalization, and broader accessibility. This review examines key limitations of current AID systems and explores future directions, including fully closed-loop control, novel insulin formulations, multi-hormonal systems, advanced sensor technologies, and integration of wearable and artificial intelligence (AI) tools. By addressing these challenges, future AID systems have the potential to deliver better effectiveness and equity in diabetes care for all individuals requiring insulin therapy.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324818","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":"CGM-Guided Insulin Infusion in Critically Ill Patients Promotes Safety, Improves Time Efficiency, and Enhances Provider Satisfaction.","authors":"Erin R Giovannetti, Rachael O Lee, Robert L Thomas, Tamar Wolinsky, Adrianne V Talbot, Rabia S Ali, Tricia Santos Cavaiola, Kristen Kulasa, Schafer C Boeder","doi":"10.1016/j.eprac.2025.05.751","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.05.751","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate the integration of real-time continuous glucose monitoring (rtCGM) into an insulin infusion computer calculator (IICC) to improve glycemic control, time efficiency, safety, and clinician workflow in the intensive care unit (ICU).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 35 critically ill adult patients requiring insulin infusion in the surgical and medical ICUs. Dexcom G7 rtCGM values were integrated into an institution-developed IICC using an ongoing validation protocol, allowing for non-adjunctive CGM use. The accuracy of rtCGM was assessed by comparing matched CGM and POC glucose values using mean absolute relative difference (MARD), Surveillance Error Grid, and Parkes Error Grid analyses. CGM time-in-range (TIR) metrics, clinician turnaround time (TAT) for glucose monitoring, and nurse satisfaction were also evaluated.</p><p><strong>Results: </strong>A total of 1,291 matched glucose pairs were analyzed. The rtCGM system demonstrated a MARD of 12.5%, with 99.6% of values falling within clinically acceptable error zones (A+B) on the Parkes Error Grid. Patients in the rtCGM-IICC protocol had mean glucose 141.9 mg/dL, with mean TIR (70-180 mg/dL) 82.8%, time above range (>180 mg/dL) 14.5%, and time below range (<70 mg/dL) 0.5%. Clinician time efficiency improved significantly, with POC testing requiring a mean TAT of nearly 5 minutes compared to 3-second CGM retrieval. All surveyed nurses (n=20) reported rtCGM increased efficiency and improved safety, and preferred rtCGM with POC over POC testing alone.</p><p><strong>Conclusions: </strong>Integrating rtCGM with an IICC protocol in the ICU enhances glycemic control, improves workflow efficiency, and reduces clinician workload while maintaining high accuracy.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495230","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":"Dental Implant Failure and Medication-Related Osteonecrosis of the Jaw Related to Dental Implants in Patients Taking Antiresorptive Therapy for Osteoporosis: A Systematic Review and Meta-Analysis.","authors":"Reza Mirza, Mohamed El Rabbany, Dalal S Ali, Sotirios Tetradis, Archibald Morrison, Salvatore Ruggiero, Rasha Alnajimi, Aliya A Khan, Gordon Guyatt","doi":"10.1016/j.eprac.2025.06.003","DOIUrl":"10.1016/j.eprac.2025.06.003","url":null,"abstract":"<p><strong>Objectives: </strong>To inform the 2024 International Task Force on Osteonecrosis of the Jaw update, we conducted a systematic review and meta-analysis evaluating dental implant failure and medication-related osteonecrosis of the jaw (MRONJ) related to antiresorptive therapy for osteoporosis.</p><p><strong>Methods: </strong>We searched 5 databases (1946-2024) for interventional and noninterventional studies reporting rates of dental implant failure or osteonecrosis in those with osteoporosis or osteopenia. Two reviewers independently screened all titles, abstracts, and full texts. Risk of bias was assessed using the modified Ottawa-Newcastle scale, and the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation.</p><p><strong>Results: </strong>We found 793 unique citations. Nine studies (n = 655) were included in the implant failure analysis. Random-effects meta-analysis revealed wide confidence intervals (CIs) for implant failure among those exposed to antiresorptives (relative risk, 0.82; 95% CI, 0.52-1.28; P = .38, very low certainty). Sensitivity analysis at the level of implant suggested that antiresorptives reduce implant failure (relative risk, 0.53; 95% CI, 0.34-0.81; P = .003, very low certainty). We identified 186 cases of MRONJ in implant recipients. The pooled rate of MRONJ following implantation in those exposed to antiresorptive therapy was 0.5% pooled from 21 cohorts. A single report of risk-adjusted MRONJ found that bisphosphonates increased MRONJ by 3 cases per 1000 patients (adjusted hazard ratio, 4.09; 95% CI, 2.75-6.09; P < .001, moderate certainty).</p><p><strong>Conclusions: </strong>The low-certainty evidence suggests that antiresorptive therapy for osteoporosis reduces dental implant failure. Bisphosphonates are associated with MRONJ in patients with osteoporosis receiving dental implants with moderate certainty.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283020","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 Evolution of Our Understanding of the Nuances of Pathologic Cortisol Secretion.","authors":"Lewis S Blevins","doi":"10.1016/j.eprac.2025.06.002","DOIUrl":"10.1016/j.eprac.2025.06.002","url":null,"abstract":"<p><p>Over a century has passed since Harvey Cushing reported and described the findings in his patient that led to his name being ascribed to the clinical syndrome we call Cushing syndrome. Decades of study have led to a greater understanding of the nuances of cortisol secretion associated with the various conditions that result in either relative or overt hypercortisolism. Referencing \"Cushing syndrome,\" and failing to recognize the subtle presentations of disordered cortisol secretion, leads to delays in diagnosis and treatment and excess morbidity in affected patients.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283021","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":"A Review of Real-World Evidence About the Use of Automated Insulin Delivery Systems in People with Type 1 Diabetes.","authors":"Sonia Gera, Jaisree Iyer, Seema Meighan, Christine A March, Brynn E Marks","doi":"10.1016/j.eprac.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.06.004","url":null,"abstract":"<p><p>Automated insulin delivery systems (AID) have revolutionized type 1 diabetes (T1D) management. Guidelines support offering AID to all people with T1D and engaging in shared decision making when choosing among the available AID systems. In clinical trials, AID has been shown to improve glycemic control and reduce hypoglycemia while also improving quality of life. However, participants in clinical trials do not accurately reflect the entire T1D population and outcomes from these controlled may not generalize to clinical care. A growing body of real-world evidence seeks to understand the effect of AID systems on glycemia and person-reported outcome measures in real-world populations. These real-world studies highlight the effect of differences in engagement with AID, including time in automated mode and boluses per day, considerations about AID system selection, and approaches to educate people with T1D. In this review, we compare glycemic and person reported outcomes in clinical trials and the real-world studies, with consideration of the effects of different systems according to user characteristics. We also review the current state of device selection and education for people with diabetes, their caregivers, and clinicians. Lastly, we summarize key findings across AID systems and opportunities for further research.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283019","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":"Undetectable Serum Thyroglobulin in Patients With Differentiated Thyroid Cancer: Antithyroglobulin Antibodies, Assay Limitation, or Other?","authors":"Benjamin Andress, Sandra A Miller, Anthony D Maus, Jennifer V Kemp, Joshua A Bornhorst, Stefan K Grebe, Alicia Algeciras-Schimnich","doi":"10.1016/j.eprac.2025.06.001","DOIUrl":"10.1016/j.eprac.2025.06.001","url":null,"abstract":"<p><strong>Objective: </strong>To determine why some patients with differentiated thyroid cancer (DTC) lymph node (LN) metastases do not have detectable serum thyroglobulin (Tg).</p><p><strong>Methods: </strong>Fine needle aspiration biopsy (FNAB) washout fluid from patients with DTC LN metastases and undetectable serum Tg measurement by immunoassay (Tg-IA) were evaluated for the presence of Tg and anti-Tg antibodies (TgAbs). Spike-recovery experiments in serum were performed to assess the reason for undetectable Tg.</p><p><strong>Results: </strong>Of the 42 patients, 87% had detectable Tg in the FNAB washout fluid by Tg-IA, and 83% by Tg mass spectrometry (Tg-MS) measurement. Seventy-six percent of these patients had detectable serum TgAb, while 26% did not. Tg spike-recovery experiments performed on the TgAb+ (positive) serum samples showed decreased Tg recovery by Tg-IA but not by Tg-MS (Tg-IA mean, range: 50%, 12%-84%; Tg-MS 96%, 70%-117%). In TgAb- (negative) serum samples no interference was observed (>94% recoveries). No difference in FNAB washout fluid Tg recovery between TgAb- and TgAb+ patients was observed.</p><p><strong>Conclusion: </strong>Tg was detected by both Tg-IA and Tg-MS methods in the majority of FNAB washout fluid from patients with DTC LN metastases who exhibited undetectable serum Tg by Tg-IA and Tg-MS. The absence of serum Tg could not be completely explained by the presence of TgAb. These results suggest that, for a subset of patients with DTC LN metastases, the absence of detectable Tg in serum does not appear to be due to analytical limitations of current Tg assays or the presence of TgAb interference.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274461","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":"Moving Beyond Glycated Hemoglobin to Glucose Patterns: Newer Indications for Continuous Glucose Monitor Use.","authors":"Shubham Agarwal, Ron T Varghese, Renato Savian, Cecilia C Low Wang, Rodolfo J Galindo","doi":"10.1016/j.eprac.2025.05.749","DOIUrl":"10.1016/j.eprac.2025.05.749","url":null,"abstract":"<p><p>Glucose homeostasis is a constant process involving several physiological mechanisms. Estimation of glucose via continuous glucose monitor (CGM) sensors provides a 24-hour comprehensive evaluation of glycemic excursions, enabling a closer understanding of the underlying defective mechanisms beyond current biomarkers of glycemia, focusing on the impact of glucose exposure, and not on the constant changes. CGM use in type 2 diabetes has shown to have a beneficial effect in improving glycated hemoglobin and time spent in range of 70-180 mg/dL. Some studies have also shown a legacy effect of CGM use after its discontinuation. Use of CGM in various other conditions such as end stage kidney disease, obstructive sleep apnea, gastroparesis, postbariatric hypoglycemia, and insulinoma has been shown to fill the diagnostic and therapeutic void. The advent of new glycemic metrics with the coming of CGM also improves our pathophysiological understanding of such diseases in the context of more readily available glycemic data. As future studies continue to emerge demonstrating the benefits of CGM in conditions other than diabetes; a frameshift focus on the value of constant glucose assessment and not on point-in-time metrics is necessary. Understanding and changing our approach to glycemic excursion will be pivotal for use of CGM beyond traditional indications and improve patient outcomes and quality of life metrics.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247024","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}