European Journal of Clinical Microbiology & Infectious Diseases最新文献

{"title":"A rare case of long-standing lupus vulgaris with psoriasiform manifestations diagnosed by mNGS: a case report.","authors":"Qiang Li, Xiaoyang Yang, Huanlin Zhu, Shuhui Yang, Guangwen Yin","doi":"10.1007/s10096-026-05532-2","DOIUrl":"https://doi.org/10.1007/s10096-026-05532-2","url":null,"abstract":"<p><p>This report describes a rare case of lupus vulgaris mimicking psoriasis, undiagnosed for over 40 years. Conventional diagnostics, including histopathology and mycobacterial culture, failed to yield a definitive diagnosis. Ultimately, metagenomic next-generation sequencing (mNGS) of the skin tissue detected the Mycobacterium tuberculosis complex, confirming the infection. The patient showed marked clinical improvement following two months of dual-drug anti-tuberculosis therapy. This case highlights the clinical utility of mNGS for diagnosing atypical, long-standing cutaneous tuberculosis when conventional methods are negative, thereby preventing prolonged misdiagnosis and ensuring timely treatment.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835315","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":"Occurrence of healthcare-associated infections caused by the zoonotic bacterium Pasteurella multocida subsp. gallicida in patients with severe motor and intellectual disabilities in Japan.","authors":"Takahiro Harada, Tatsuya Negishi, Mizuho Imanishi, Toshiro Suzuki, Munetane Ueda, Kenji Kurata, Takafumi Nishimura, Masashi Kitahara, Akinori Nakamura, Yo-Ichi Takei, Yukiko Nagano, Noriyuki Nagano","doi":"10.1007/s10096-026-05528-y","DOIUrl":"https://doi.org/10.1007/s10096-026-05528-y","url":null,"abstract":"<p><strong>Purpose: </strong>Pasteurella multocida is an important zoonotic pathogen that can cause human infections, exhibiting a wide clinical spectrum ranging from localised bite-wound infections to invasive infections, particularly in immunocompromised patients. The detection of P. multocida isolates from three patients with severe motor and intellectual disabilities (SMID) led to an investigation into the genomic relationship to explore nosocomial transmission.</p><p><strong>Methods: </strong>Three P. multocida strains were isolated from transtracheal aspirate cultures taken from three different inpatients in the SMID ward between January and February 2025. All strains were identified by phenotypic tests and MALDI-TOF MS. Whole-genome sequencing was performed to identify subspecies, analyze virulence genes, and explore phylogenetic relatedness.</p><p><strong>Results: </strong>Three strains were identified as P. multocida subsp. gallicida, based on dDDH values of 89.6% and ANIm values of ≥98.89%. They belonged to novel sequence types multihost ST371 and RIRDC ST585, the capsular genotype of closest to type A, predominantly found in human respiratory pathogens, and the lipopolysaccharide genotypes of L1. They shared virulence genes encoding outer membrane proteins, adhesion factors, superoxide dismutases and hyaluronidases. The number of SNP differences between the three strains was found to be one or less, indicating that these strains are almost genetically indistinguishable.</p><p><strong>Conclusions: </strong>A noteworthy aspect of the present study is that it is the first to report intra-hospital transmission of P. multocida subsp. gallicida, as demonstrated through genome-level analysis. It is crucial to recognise that healthcare-associated infection caused by P. multocida can occur in specialised medical settings, such as wards for patients with SMID.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835336","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":"β-lactamase genes in clinical isolates of Capnocytophaga canimorsus and description of a novel class D β-lactamase, OXA-1422.","authors":"Zoja Germuskova, Eleonora Pronzini, Fanny Wegner, Tim Roloff, Tianyan Song, Miroslava Barancekova, Alois Cizek, Michael Addidle, Murray Robinson, Marc Dieu, Chaitanya Tellapragada, Christian G Giske, Kirstine Kobberøe Søgaard, Els M Broens, Francesco Renzi, Adrian Egli","doi":"10.1007/s10096-026-05526-0","DOIUrl":"https://doi.org/10.1007/s10096-026-05526-0","url":null,"abstract":"<p><strong>Background: </strong>Capnocytophaga canimorsus (C. canimorsus) is a zoonotic pathogen transmitted by dogs and cats that can cause severe infections in humans. Antimicrobial susceptibility data remain limited, but increasing genomic evidence suggests that functional β-lactamase genes may be more widespread than previously recognized.</p><p><strong>Methods: </strong>Three C. canimorsus isolates harboring class D β-lactamase genes were selected by genomic screening from a larger collection of the Global Capnocytophaga Consortium for detailed characterization: two isolates from human clinical infections from Sweden and New Zealand, and a commensal canine isolate from the Czech Republic. We used hybrid Illumina-Nanopore genome assemblies, phylogenetic analysis, and structural modeling to characterize the genomic context and the predicted protein features of the β-lactamase genes. The functional impact of the β-lactamases on antibiotic activity was assessed by minimum inhibitory concentration (MIC) testing and confirmed through recombinant expression in the β-lactamase-negative reference strain C. canimorsus 5 (Cc5).</p><p><strong>Results: </strong>We detected bla_OXA-347 in a canine isolate and, for the first time, in a clinical C. canimorsus isolate from human infection. Additionally, we identified a previously uncharacterized allele, newly designated bla_OXA-1422, in another clinical isolate. Both β-lactamases were chromosomally encoded without clear mobile genetic elements and were part of a distinct phylogenetic cluster within the OXA family. Structural modeling showed conserved class D β-lactamase architecture. Strains carrying either gene had elevated MICs for multiple β-lactams, and expression of each gene in Cc5 recapitulated these effects.</p><p><strong>Conclusions: </strong>The identification and phenotypic characterization of OXA-type β-lactamases in clinical C. canimorsus isolates refine our understanding of β-lactamase diversity in this species and underscore the need for systematic investigations of β‑lactamase prevalence in this zoonotic pathogen.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835346","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":"Ceftazidime-avibactam as monotherapy or in combination for targeted treatment of KPC-producing Klebsiella pneumoniae infections in ICUs: a comparative analysis through counterfactual framework and desirability of outcome ranking.","authors":"Andrea Marino, Alberto Enrico Maraolo, Maria Mazzitelli, Alessandra Oliva, Nicholas Geremia, Andrea De Vito, Federica Cosentino, Chiara Gullotta, Vincenzo Scaglione, Eleonora Vania, Sara Lo Menzo, Paolo Navalesi, Lorenzo Volpicelli, Andrea Fiori, Pamela Prestifilippo, Annamaria Cattelan, Claudio Maria Mastroianni, Giordano Madeddu, Bruno Cacopardo, Giuseppe Nunnari","doi":"10.1007/s10096-026-05529-x","DOIUrl":"https://doi.org/10.1007/s10096-026-05529-x","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the causal effect of ceftazidime/avibactam (C/A) combination therapy versus monotherapy on mortality and clinical success in patients with KPC-producing Klebsiella pneumoniae (KPC-Kp) infections in intensive care unit.</p><p><strong>Methods: </strong>This multi-centre, retrospective observational study (2021-2023) included adults with KPC-Kp bloodstream infections or pneumonia treated with C/A-based regimens. We employed a counterfactual framework using inverse probability of treatment weighting (IPTW) to estimate the average treatment effect on 30-day mortality. Clinical success was further assessed using Desirability of Outcome Ranking (DOOR) analysis and partial credit scoring based on patient-perspective scenarios.</p><p><strong>Results: </strong>Among 123 included patients, 77 (62.6%) received monotherapy and 46 (37.4%) received combination therapy. The combination group presented with significantly higher baseline severity, including higher APACHE II scores and rates of septic shock. In the IPTW-adjusted analysis, 30-day survival was 73.8% (95% CI: 56-92%) with combination therapy compared with 60.8% (95% CI: 46.8-77%) with monotherapy. The survival probability ratio was 1.21 (95% CI: 0.80-1.45), indicating no statistically significant survival benefit. The DOOR analysis showed a 54.7% (95% CI: 48.9%-60.4%) probability of a more favourable outcome with combination therapy, which was not statistically significant. Mean partial credit scores did not differ significantly across scenarios prioritizing survival or adverse event avoidance.</p><p><strong>Conclusions: </strong>In this cohort, C/A-based combination therapy did not provide a significant survival advantage or an improved clinical desirability ranking compared with monotherapy, after adjusting for confounding factors.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835318","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":"Evolution of cefoperazone-sulbactam consumption in Romania between 2011 and 2024.","authors":"Carmen-Cristina Vasile, Liviu-Iulian Rotaru, Roxana Ioana Șerban, Gabriel Adrian Popescu","doi":"10.1007/s10096-026-05494-5","DOIUrl":"https://doi.org/10.1007/s10096-026-05494-5","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study is to describe the evolution of cefoperazone-sulbactam consumption in Romania between 2011 and 2024. The use of this fixed-dose combination is not recommended by the World Health Organisation as it may result in selection of antimicrobial resistance.</p><p><strong>Methods: </strong>This retrospective study analyzed the data on antibiotic consumption collected by the National Center for Surveillance and Control of Communicable Diseases which is based on data provided by the National Health Insurance Fund and the IQVIA-Multinational Integrated Data Analysis System. Antibiotic sales were converted into defined daily doses (DDDs) per 1,000 inhabitants per day.</p><p><strong>Results: </strong>The consumption of cefoperazone-sulbactam in Romania between 2011 and 2024 ranged from 0.016 to 0.021 DDD per 1000 inhabitants per day, with an average of 0.019 DDD per 1000 inhabitants per day. When adjusted for population, the RO1 macroregion registered the highest average consumption (0.033 DDDs per 1000 inhabitants per day). One-way ANOVA on DDD per 1,000 inhabitants per day data suggested that there were no statistically significant differences between macroregions (F = 2.78, p = 0.054). Although differences are observed in the mean values, they can be explained by counties with abnormally high consumption.</p><p><strong>Conclusion: </strong>Educational and training activities focused on the outlier counties are necessary to raise awareness about the risk of increased selection of antimicrobial resistance. In line with the rejection of the reclassification proposal of cefoperazone-sulbactam in the updated 2025 WHO AWaRe classification of antibiotics, new government policies to ensure the discontinuation of cefoperazone-sulbactam use in Romania are needed.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835249","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":"Management of community-acquired brain abscess and intracranial empyema: a survey of UK neurosurgical centres.","authors":"Carmen Thompson Perea, Holly Roy, James Hatcher, Sophia de Saram, Jacob Bodilsen, Peter Whitfield, William Singleton, Jack Wildman, Michelle M Kameda-Smith, Eliza Gil","doi":"10.1007/s10096-026-05522-4","DOIUrl":"https://doi.org/10.1007/s10096-026-05522-4","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to describe current perceptions and attitudes to management of of brain abscess (BA) or sub-/extra-dural empyema (SDE/EDE) in the United Kingdom (UK) to compare this to the 2024 European Society of Clinical Microbiology and Infectious Diseases BA guidelines.</p><p><strong>Methods: </strong>We conducted a web-based survey of infection specialists (IS) and neurosurgeons (NS) at neurosurgical centres across the UK.</p><p><strong>Results: </strong>IS from 27/39 (69%) and NS from 18/39 (46%) UK neurosurgical centres participated. All IS reported use of a third-generation cephalosporin as empirical antibiotic therapy, 57/61 (93%) alongside metronidazole, 19/57 (33%) preferring oral metronidazole throughout treatment. Most IS (46/60, 76.7%) consider switching to oral antibiotics prior to completing 6 weeks intravenous (IV) therapy, with 33/46 (71.7%) considering a 1-2 week minimum IV duration if there has been neurosurgical intervention. Most NS (22/25, 88%) agreed that neurosurgical intervention is indicated for any BA ≥ 2.5 cm diameter, most (21/25, 84%) favouring burr hole aspiration. For SDE/EDE only 12/25 (48%) of NS would surgically intervene in all circumstances. Most IS and NS (72/76, 94.7%) would consider intrathecal antibiotics in ruptured BA with ventriculitis; only 11/74 (14%) reported experience with intracavitary antimicrobials. 44/74 (59%) reported using steroids in BA, while 20/74 (27%) reported avoiding steroids. Reimaging was favoured at 2-3 weeks by NS, IS favoured 4-8 weeks, or not reimaging.</p><p><strong>Conclusion: </strong>There are areas of marked variation in the management of BA and SDE/EDE in the UK, particularly early switch from IV to oral antibiotics, SDE surgery, repeat brain imaging and use of steroids.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812604","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":"Bacteriophage-induced outer membrane protein remodelling drives the phenotypic switching and antibiotic re-sensitization in Klebsiella pneumoniae.","authors":"Yadav Ranu, Srajana Nayak, Pallavi Bhat Ajakkala, Juliet Roshini Mohan Raj, Vijaya Kumar Deekshit, Biswajit Maiti","doi":"10.1007/s10096-026-05519-z","DOIUrl":"https://doi.org/10.1007/s10096-026-05519-z","url":null,"abstract":"<p><strong>Aim: </strong>Bacteriophages are the most common biological agents that target bacteria, offering a potential alternative to antibiotics for treating multidrug-resistant pathogens, such as Klebsiella pneumoniae. The onset of bacteriophage resistance remains a significant obstacle. This study highlights the role of outer membrane proteins (OMPs) in the development of bacteriophage resistance in K. pneumoniae.</p><p><strong>Method: </strong>The study examined the native OMP profiles of isolates that are sensitive and resistant to bacteriophages. K. pneumoniae isolates were treated with bacteriophages, and the survivors were subcultured to generate bacteriophage-tolerant strains. These strains were further characterised phenotypically, and OMP encoding gene expression was studied using quantitative real-time PCR.</p><p><strong>Results: </strong>OMP encoding genes were significantly upregulated, and OMPs were overexpressed in these tolerant strains. Bacteriophage-tolerant strains exhibited increased resistance to other phages, lower growth rates, enhanced biofilm-forming abilities, and reduced capsule production. The bacteriophage-tolerant strains also showed susceptibility to antibiotics to which the parent strains had earlier displayed resistance, particularly to carbapenems and macrolides.</p><p><strong>Conclusion: </strong>Understanding the mechanisms of phage emergence can help us prepare for and mitigate the threat of unprecedented phage resistance, which could pose a significant public health risk.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812596","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":"Clinical and molecular characteristics of Streptococcus agalactiae bacteremia in nonpregnant adults: a single-center analysis over 16 years in Hiroshima, Japan.","authors":"Hiroki Kitagawa, Satoshi Nakano, Kayoko Tadera, Yuta Kuhara, Keitaro Omori, Norifumi Shigemoto, Shota Koide, Shogo Otake, Kasumi Ishida-Kuroki, Yo Sugawara, Motoyuki Sugai, Hiroki Ohge","doi":"10.1007/s10096-026-05520-6","DOIUrl":"https://doi.org/10.1007/s10096-026-05520-6","url":null,"abstract":"<p><strong>Purpose: </strong>Molecular epidemiological data on Streptococcus agalactiae (Group B Streptococcus [GBS]) causing bacteremia in non-pregnant adults in Japan remain limited. This study elucidated the clinical characteristics and molecular epidemiology of GBS strains causing bacteremia in this population.</p><p><strong>Methods: </strong>Data on non-pregnant adults with GBS treated at Hiroshima University Hospital between 2008 and 2023 were retrospectively reviewed. Clinical data were collected, and strains were characterized for antimicrobial susceptibility by susceptibility testing and whole-genome sequencing.</p><p><strong>Results: </strong>A total of 73 adult patients with 74 episodes of GBS bacteremia were identified. The most common infection sites were skin and soft tissue (25.7%) and bacteremia with unknown focus (20.3%). Streptococcal toxic shock syndrome (STSS) was observed in 17 patients (23.0%), and the 30-day mortality rate was 25.7%. The predominant serotype/clonal complex (CC) lineages were Ib/CC12 (n = 14, 18.9%), V/CC1 (n = 12, 16.2%), and Ia/CC23 (n = 7, 9.5%). Notably, all seven Ia/CC23 strains and 10 (83.3%) V/CC1 strains were recovered after 2016. Single-nucleotide polymorphism-based analysis revealed the presence of strains within the ST17 and ST464 lineages circulating between pediatric and adult populations.</p><p><strong>Conclusions: </strong>This study demonstrates the emergence of the Ia/CC23 and V/CC1 lineages among invasive GBS strains causing bacteremia in non-pregnant adults in Japan over the past 10 years. Identifying the transmission pathways linking different age groups may help reduce the burden of invasive GBS infection in both pediatric and adult populations and develop effective public health and preventive strategies.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812536","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":"Antimicrobial strategies for ureteral stent removal after radical cystectomy: a comparative cohort study.","authors":"Maurin Helen Mangold, Jennifer Kazmierczak, Marlis Gerigk, Nicolas Carl, Luisa Vivienne Renner, Maren Juliane Wenk, Maurice Stephan Michel, Karl-Friedrich Kowalewski, Niklas Westhoff","doi":"10.1007/s10096-026-05514-4","DOIUrl":"https://doi.org/10.1007/s10096-026-05514-4","url":null,"abstract":"","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765971","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":"Clinical outcomes and therapeutic approaches in pediatric infections caused by metallo-β-lactamase-producing organisms: a five-year experience in a tertiary care hospital.","authors":"Costanza Tripiciano, Sarah Barni, Paola Bernaschi, Venere Cortazzo, Gianluca Vrenna, Lorenza Romani, Gabriella Bottari, Luigi Dei Giudici, Tiziana Fragasso, Francesca Tortora, Marta Luisa Ciofi Degli Atti, Laura Lancella, Maia De Luca","doi":"10.1007/s10096-026-05521-5","DOIUrl":"https://doi.org/10.1007/s10096-026-05521-5","url":null,"abstract":"","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766022","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}