European Journal of Clinical Microbiology & Infectious Diseases最新文献

{"title":"The feasibility of antimicrobial lead time as process and quality indicator for hospitals.","authors":"R I Helou, H van der Sijs, D Rizopoulos, M Vogel, N J Verkaik, A Verbon","doi":"10.1007/s10096-025-05085-w","DOIUrl":"https://doi.org/10.1007/s10096-025-05085-w","url":null,"abstract":"<p><strong>Purpose: </strong>Antimicrobial lead time (ALT) is the time from antimicrobial order to administration, an understudied parameter. This study aims to determine feasibility of retrieving ALT, differences in ALT for different infectious diseases and the association of ALT with length of stay (LoS) in order to establish the value of this parameter as potential new process or quality indicator (QI).</p><p><strong>Methods: </strong>In a retrospective study in a tertiary care hospital in the Netherlands, adult hospitalized patients treated for an infection were included over a 20-month period. ALT was calculated with data from the electronic health record system with computerized provider order entry.</p><p><strong>Results: </strong>Thousand patients (56.1% men, median age 61 years) were included. The median ALT was 1.05 h and significantly shorter in septic patients (n = 65) than in patients with other infections (n = 935; 0.27 h, interquartile range (IQR) 0.07-0.67 vs. 1.18 h, IQR 0.37-3.15; p < 0.001). If blood cultures were obtained median ALT was shorter (0.85 h vs. 1.77 h; p < 0.001). ALT was not shorter in patients with positive compared to negative blood cultures (0.63 h vs. 0.94 h; p = 0.053). Antimicrobials ordered in the emergency room had a shorter median ALT than in medical wards (0.43 h vs. 1.57 h; p < 0.001). After correcting for indication, we found no association between ALT and LoS (p = 0.34).</p><p><strong>Conclusions: </strong>ALT is an easily measurable QI for sepsis. More studies are needed to establish whether ALT is a feasible QI for meningitis and community-acquired pneumonia. For all infections, ALT can be used as process indicator for drug administration.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572543","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":"Beta-lactam combination treatment overcomes rifampicin resistance in Mycobacterium tuberculosis.","authors":"Diana H Quan, Trixie Wang, Elena Martinez, Hanna Y Kim, Vitali Sintchenko, Warwick J Britton, James A Triccas, Jan-Willem Alffenaar","doi":"10.1007/s10096-025-05062-3","DOIUrl":"https://doi.org/10.1007/s10096-025-05062-3","url":null,"abstract":"<p><p>The significant global impact of tuberculosis (TB) on human health is exacerbated by the increasing prevalence of multi-drug resistant tuberculosis (MDR-TB) and the challenges of novel drug discovery for the treatment of drug-susceptible and drug-resistant strains of M. tuberculosis. Rifampicin is a key first-line TB drug and rifampicin resistance is a major obstacle to treating MDR-TB. Utilising existing antimicrobial drugs to supplement combination therapy and overcome rifampicin resistance is a promising solution due to their widespread availability and proven clinical safety profile. Therefore, this study aimed to explore the feasibility of using beta-lactam/beta-lactamase inhibitor combinations with rifampicin to inhibit the growth of multidrug-resistant M. tuberculosis. Based on inhibitory concentration (IC), oral bioavailability, pricing, commercial availability, five beta-lactams and the beta-lactamase inhibitor, clavulanate, were selected for testing. These were combined with rifampicin for in vitro testing against Mycobacterium tuberculosis H37Rv. Resazurin assays and colony forming unit (CFU) enumeration were used to quantify drug efficacy, Chou-Talalay calculations were performed to identify drug synergy and Chou-Martin calculations were performed to quantify drug dose reduction index (DRI). The combination of tebipenem-clavulanate/rifampicin and cephradine-clavulanate/rifampicin were found to be synergistic and highly effective against clinical isolates of MDR-TB, overcoming rifampicin resistance in vitro. Beta-lactam synergy may provide viable combination therapies with rifampicin to address the issue of drug resistance in TB.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565960","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":"Extensively drug-resistant Haemophilus influenzae isolated in Geneva, Switzerland.","authors":"Abdessalam Cherkaoui, Patrice Francois, Nadia Gaia, Gesuele Renzi, Adrien Fischer, Jacques Schrenzel","doi":"10.1007/s10096-025-05093-w","DOIUrl":"https://doi.org/10.1007/s10096-025-05093-w","url":null,"abstract":"<p><p>The emergence of multi-drug resistant (MDR) and even extensively drug-resistant (XDR) strains among H. influenzae was observed in some Asian countries. Herein, we reported the first XDR H. influenzae isolated in Geneva, Switzerland. This strain was isolated in a good-quality sputum sample from a 63 year-old male patient. There was no respiratory infection diagnosed at that time. The strain was non-typeable and pan-β-lactam resistant. According to whole genome sequencing analysis it belongs to sequence type 159 and the ST-107 clonal complex. It was classified into group III + regarding the amino acid substitutions identified in the transpeptidase domain of PBP3.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565990","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":"Diversity of Mycoplasma genitalium strains in Australia: relationship with sexual networks and antimicrobial resistance.","authors":"Teck-Phui Chua, Jennifer A Danielewski, Emma L Sweeney, Erica L Plummer, Catriona S Bradshaw, David M Whiley, Dorothy A Machalek, Suzanne M Garland, Gerald L Murray","doi":"10.1007/s10096-025-05081-0","DOIUrl":"https://doi.org/10.1007/s10096-025-05081-0","url":null,"abstract":"<p><strong>Purpose: </strong>Molecular typing can identify relationships between M. genitalium strains and antimicrobial resistance and demographic data. We examined the association of mgpB sequence types (STs) with sex/sexual orientation, antimicrobial resistance and geographical location for M. genitalium in Australia.</p><p><strong>Methods: </strong>Sequence data derived from previous studies in Victoria and Queensland were obtained from 170 M. genitalium samples for the mgpB, 23 S rRNA, and parC genes. An additional 55 M. genitalium samples from Victoria were sequenced for the same three genes in this study. A combined data set of 225 samples collected between 2017 and 2019 were examined for associations between mgpB ST and (i) sex/sexual orientation, (ii) macrolide and fluoroquinolone resistance, and (iii) geographical location using chi-square test.</p><p><strong>Results: </strong>Overall, 66 mgpB STs were identified; the most common were ST-7 (17.9%), ST-4 (11.6%), ST-105 (11.6%), and ST-2 (5.4%). There was a strong association between ST and sex/sexual orientation; ST-4 and ST-105 were most common among men-who-have-sex-with-men (p < 0.0001) while ST-7 among women (p < 0.0001). There was a strong association between ST and macrolide resistance (p = 0.0028). Fluoroquinolone resistance was less common (28.0%) and did not differ by STs (p = 0.20). There was no association between ST and geographic location (p = 0.056).</p><p><strong>Conclusion: </strong>In this Australian study, four mgpB STs were common and were strongly associated with sex/sexual orientation and macrolide resistance. This relationship was not seen for fluoroquinolone resistance nor geographic location. These findings highlight the sporadic nature of resistance, indicating a need for effective treatment approaches combined with routine antimicrobial resistance surveillance.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540634","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":"Genomic insights into drug resistance and virulence determinants in rare pyomelanin-producing clinical isolates of Acinetobacter baumannii.","authors":"Lipsa Panda, Krishnapriya Gk, Ajit Ramesh Sawant, Santosh Kumar Singh, Minakshi Gupta, Sheela Devi C, P Shashikala, K Prashanth","doi":"10.1007/s10096-024-05008-1","DOIUrl":"10.1007/s10096-024-05008-1","url":null,"abstract":"<p><strong>Purpose: </strong>Clinical isolates of multi-drug resistant Acinetobacter baumannii are a major cause of nosocomial infections, often attributed to the highly adaptable genome that helps it to thrive under environmental selection pressure. Here, we aim to provide genotypic-based surveys and comparative whole genome sequencing (WGS) analysis to explore the genomics of the rare pyomelanin-forming clinical isolates of A. baumannii from India.</p><p><strong>Methods: </strong>A total of 54 clinical isolates of A. baumannii obtained from two tertiary care hospitals were genotyped using repetitive sequence-based PCR (REP-PCR) for elucidating their molecular epidemiology, followed by their resistance profiling through the determination of minimum inhibitory concentration using the micro broth dilution method. The isolates' virulence and antibiotic-resistant determinants were detected by PCR screening, followed by biofilm quantification. Pyomelanin pigment produced by A. baumannii isolates was isolated and chemically characterized. Finally, WGS of three pigment-producing and one non-producing A. baumannii strains was performed to explore the factors contributing to their variability.</p><p><strong>Results: </strong>REP-PCR genotyping identified around 8 clusters, with all isolates being multidrug-resistant (MDR). Pyomelanin-producing isolates were strong biofilm formers, characterized by the concurrent presence of 'pgaB, BfmR, BfmS, ompA, and cusE' biofilm-related genes. These pigmented strains belonged to ST2^Pas and co-harbored bla_OXA-23, bla_ADC-25, aph (3')-VIa, armA, aph (6)-Id, tet(B) and msr(E) genes. Thirteen common IS elements and biosynthetic gene clusters of arylpolyene, NI-siderophore, and NRP-metallophore were identified. Notably, genomic islands containing aminoglycoside 3'-phosphotransferase, oxidative stress, two-component response regulators, efflux pump-related, toxin-antitoxin protein, and virulence-related genes were also mapped by WGS.</p><p><strong>Conclusion: </strong>The pyomelanin-forming isolates were MDR and virulent. The elucidation of WGS analysis provided critical insights for understanding the epidemiology, virulome, and mobilome of rare pigment-producing A. baumannii strains.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"533-547"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852966","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":"3-Hydroxybenzoic acid inhibits the virulence attributes and disrupts biofilm production in clinical isolates of Acinetobacter baumannii.","authors":"Naji Naseef Pathoor, Pitchaipillai Sankar Ganesh, Abdul R Anshad, Rajesh Kanna Gopal, Esaki Muthu Ponmalar, Suvaiyarasan Suvaithenamudhan, Parthiban Rudrapathy, Esaki M Shankar","doi":"10.1007/s10096-024-05009-0","DOIUrl":"10.1007/s10096-024-05009-0","url":null,"abstract":"<p><strong>Purpose: </strong>Acinetobacter baumannii (A. baumannii) is an emerging global public health threat owing to its ability to form biofilms. Here, we evaluated 3-hydroxybenzoic acid (3-HBA), a promising organic compound, for its ability to disrupt biofilm formation and virulence attributes in clinical isolates of A. baumannii.</p><p><strong>Materials and methods: </strong>The effect of 3-HBA on A. baumannii was assessed by determining the minimum inhibitory concentration (MIC) and certain other in vitro investigations viz., extracellular polymeric substance (EPS) estimation, crystal violet staining assay, motility assay, and the hydrogen peroxide (H₂O₂) assay to examine its impact on bacterial virulence. Biofilm formation was also evaluated at the air-liquid interface. In situ visualization investigations were employed to confirm biofilm dispersion at the lowest effective concentration. The cytotoxic effects of 3-HBA on MCF-7 cells were investigated using the MTT assay.</p><p><strong>Results: </strong>At a sub-inhibitory concentration of 0.078 mg/mL, 3-HBA reduced biofilm formation in A. baumannii LSAB-04 and A. baumannii LSAB-06 by 61.22% and 59.21%, respectively, and decreased EPS production by 64% in LSAB-04 and 58.31% in LSAB-06. Microscopic examination confirmed significant biofilm dispersion. 3-HBA also significantly impaired swarming motility and increased their sensitivity to H₂O₂. The MTT assay showed a dose-dependent decrease in MCF-7 cell viability (43.67%) at a concentration of 0.078 mg/mL.</p><p><strong>Conclusion: </strong>Our findings underscore the likely role of 3-HBA as a promising A. baumannii biofilm-disrupting agent. Further, by downplaying against the virulence factors of A. baumannii, 3-HBA could be a compelling alternative to conventional antibiotics that however requires to be investigated.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"653-669"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909403","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":"Chikungunya virus and armed forces: relevance and vaccine prospects.","authors":"Jonas Schmidt-Chanasit, Ralf Matthias Hagen, Hagen Frickmann","doi":"10.1007/s10096-024-05028-x","DOIUrl":"10.1007/s10096-024-05028-x","url":null,"abstract":"","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":"44 3","pages":"763-764"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in antimicrobial stewardship: a systematic review and meta-analysis of predictive performance and diagnostic accuracy.","authors":"Flavia Pennisi, Antonio Pinto, Giovanni Emanuele Ricciardi, Carlo Signorelli, Vincenza Gianfredi","doi":"10.1007/s10096-024-05027-y","DOIUrl":"10.1007/s10096-024-05027-y","url":null,"abstract":"<p><p>The increasing threat of antimicrobial resistance has prompted a need for more effective antimicrobial stewardship programs (AMS). Artificial intelligence (AI) and machine learning (ML) tools have emerged as potential solutions to enhance decision-making and improve patient outcomes in AMS. This systematic review and meta-analysis aims to evaluate the impact of AI in AMS and to assess its predictive performance and diagnostic accuracy. We conducted a comprehensive literature search across PubMed/MEDLINE, Scopus, EMBASE, and Web of Science to identify studies published up to July 2024. Studies included were observational, cohort, or retrospective, focusing on the application of AI/ML in AMS. The outcomes assessed were the area under the curve (AUC), accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We calculated the mean pooled effect size (ES) and its 95% confidence interval (CI) using a random-effects model. The risk of bias was assessed using the QUADAS-AI tool, and the protocol was registered in PROSPERO. Out of 3,458 retrieved articles, 80 studies met the inclusion criteria. Our meta-analysis demonstrated that ML models exhibited strong predictive performance and diagnostic accuracy, with the following results: AUC [ES: 72.28 (70.42-74.14)], accuracy [ES: 74.97 (73.35-76.58)], sensitivity [ES: 76.89; (71.90-81.89)], specificity [ES: 73.77; (67.87-79.67)], NPV [ES:79.92 (76.54-83.31)], and PPV [ES: 69.41 (60.19-78.63)] across various AMS settings. AI and ML tools offer promising enhancements due to their strong predictive performance. The integration of AI into AMS could lead to more precise antimicrobial prescribing, reduced antimicrobial resistance, and better resource utilization.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"463-513"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930965","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":"First recorded food-borne outbreak of gastroenteritis caused by enteroinvasive Escherichia coli serotype O8:H19 in Thailand.","authors":"Kazuhisa Okada, Amonrattana Roobthaisong, Atchareeya Nakkarach, Suthida Muangnoicharoen Hearn, Adirek Saenharn, Lalada Naksen, Pawinee Doung-Ngern, Pilailuk Akkapaiboon Okada, Tetsuya Iida","doi":"10.1007/s10096-024-05024-1","DOIUrl":"10.1007/s10096-024-05024-1","url":null,"abstract":"<p><p>An enteroinvasive Escherichia coli (EIEC) outbreak affecting 154 individuals was identified among attendees at a wedding in Loei Province, Thailand. The median time to symptom onset was 18 h (range: 7-72 h). The epidemiological evidence suggested that larb-neua-dib (spicy minced raw beef salad) was the probable source of the outbreak. The O8:H19 isolates identified in this study closely resemble the O8:H19 strains from the United States and the United Kingdom, but not the O96:H19 strains from Europe. This is the first EIEC outbreak documented in Thailand. Complexities in identifying EIEC contribute to its underreporting.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"733-737"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genome-based development and clinical evaluation of a customized LAMP panel to rapidly detect, quantify, and determine antibiotic sensitivity of Escherichia coli in native urine samples from urological patients.","authors":"Moritz Fritzenwanker, Marcel O Grabitz, Vera Negwer, Oliver Schwengers, Borros Arneth, Trinad Chakraborty, Can Imirzalioglu, Florian Wagenlehner","doi":"10.1007/s10096-024-05030-3","DOIUrl":"10.1007/s10096-024-05030-3","url":null,"abstract":"<p><strong>Purpose: </strong>We designed and tested a point of care test panel to detect E.coli and antibiotic susceptibility in urine samples from patients at the point of care in the urological department. The aim of this approach is to facilitate choosing an appropriate antibiotic for urinary tract infections (UTI) at first presentation in the context of increasing antibiotic resistance in uropathogens worldwide.</p><p><strong>Methods: </strong>We analyzed 162 E.coli isolates from samples from a university urological department to determine phenotypic and genotypic resistance data. With this data we created customized LAMP (loop-mediated isothermal amplification) panels for a commercial machine with which to detect and possibly quantify E.coli and six antibiotic resistance determinants. In a second step we tested these panel(s) for diagnostic accuracy on 1596 urine samples and compared with routine microbiological culture.</p><p><strong>Results: </strong>E.coli was detected with 95.4% sensitivity and 96.1% specificity. Dynamics of the LAMP amplification could be used to gauge bacterial loads in the samples. Antibiotic sensitivity was detected with good negative (sensitive) predictive values: ampicillin 92.8%, ampicillin/sulbactam 96.4%, cefuroxime 92.8%, cefotaxime 97.8%, trimethoprim/sulfamethoxazole 96.5%, ciprofloxacin 96.8%.</p><p><strong>Conclusion: </strong>The LAMP panel provided E.coli detection and sensitivity information within one hour and thus could principally guide initial antibiotic therapy upon patients presenting with UTI. The panel helps to select initial adequate antibiotic therapy as well as providing diagnostic stewardship. Follow up investigations will expand the test system to other uropathogens.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"703-715"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}