Gynecological Endocrinology最新文献

{"title":"Effects of estradiol, tamoxifen, and raloxifene on human temporal lobe cortex astroglial cell spreading.","authors":"Ivaldo Silva, Frederick Nicholas Naftolin, Vinicius Oliveira Santana, Anne Williamson, Ahmed Fadiel, Dennis Spencer, Howard J Li","doi":"10.1080/09513590.2026.2618881","DOIUrl":"10.1080/09513590.2026.2618881","url":null,"abstract":"<p><strong>Background: </strong>Astrocytes, once regarded as passive support cells, are recognized as active regulators of synaptic organization and neuronal integration. Through extension or retraction of their processes, astrocytes influence synapse formation and elimination. Astrocytes express estrogen receptors, and animal studies have shown that estradiol modifies astrocytic morphology in relation to synaptic density.</p><p><strong>Objective: </strong>To examine the effects of estradiol and two clinically available selective estrogen receptor modulators (SERMs), tamoxifen, and raloxifene on astrocyte processes in human brain tissue.</p><p><strong>Methods: </strong>Human temporal lobe cortical slices were incubated for 60 min with estradiol (10 nM), tamoxifen (1.0 µM), or raloxifene (1.0 µM), and the results were compared with untreated control slices. Astrocytes were visualized by immunostaining for the glial cytoskeletal marker glial fibrillary acidic protein (GFAP). Light microscopy image analysis was used to quantify astrocytic process thickness and branching, using Neurolucida® software.</p><p><strong>Results: </strong>Control slices exhibited astrocytic branch extension and thinning during the incubation period. Similar morphological changes were observed in the tamoxifen-treated slices. In contrast, raloxifene treatment was associated with a significant reduction in astrocyte branching and thinning compared with controls (<i>p</i> = 0.01 for primary processes). Estradiol treatment resulted in intermediate reductions in astroglial process measures that did not reach statistical significance.</p><p><strong>Conclusions: </strong>Estradiol, tamoxifen, and raloxifene - widely used hormonal agents - were associated with distinct effects on astrocyte morphology in human cortical tissue. These findings support a role for estrogen receptor modulation in astroglial structural regulation and suggest a potential cellular mechanism contributing to central nervous system symptoms reported in clinical settings.</p>","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2618881"},"PeriodicalIF":3.0,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018269","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":"Transdermal versus oral hormone replacement therapy and bone mass density in Turner syndrome patients: a pilot study.","authors":"Katalin Widmann, Marlene Hager, Lisa-Maria Windischbauer, Robert Krysiak, Johannes Ott","doi":"10.1080/09513590.2026.2692740","DOIUrl":"10.1080/09513590.2026.2692740","url":null,"abstract":"<p><strong>Objective: </strong>Women with Turner syndrome (TS) are at increased risk of reduced bone mineral density (BMD) due to primary ovarian insufficiency. This study aimed to assess longitudinal changes in BMD in TS patients receiving oral or transdermal hormone replacement therapy (HRT) and to identify factors associated with bone density decline.</p><p><strong>Methods: </strong>This retrospective pilot study included 40 TS patients treated with oral or transdermal estradiol. The median age was 22 years in both the transdermal (20-30) and oral (20-27) groups. Median BMI was 23.1 (21.1-25.5) and 25.4 (22.1-29.1), respectively. Dual-energy X-ray absorptiometry (DEXA) of the lumbar spine and femoral neck was performed at baseline and follow-up. The primary outcome was the <i>t</i>-score at both sites. Univariable and multivariable logistic regression analyses were used to identify factors associated with declining <i>t</i>-scores.</p><p><strong>Results: </strong>At baseline, 38.3% of patients had osteopenia, and 3.3% had osteoporosis. During follow-up, a decline in <i>t</i>-scores at at-least one skeletal site was observed in 47.5% of patients. No significant differences were found between oral and transdermal estradiol therapy regarding absolute <i>t</i>-scores, <i>t</i>-score changes, or the proportion of patients with declining <i>t</i>-scores (all <i>p</i> > 0.05). In multivariable analysis, lower vitamin D levels at follow-up were independently associated with declining <i>t</i>-scores.</p><p><strong>Conclusions: </strong>In TS patients, the route of estradiol administration did not significantly affect long-term BMD outcomes. Despite HRT, a substantial proportion of patients experienced bone loss. Vitamin D status has emerged as the most relevant modifiable factor associated with declining BMD, highlighting the need for bone health management beyond HRT.</p>","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2692740"},"PeriodicalIF":3.0,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328850","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":"Endometrial receptivity in polycystic ovary syndrome: altered biomarkers and underlying mechanisms.","authors":"Huihuang Chi, Jiexue Pan, Zuwei Yang, Hefeng Huang","doi":"10.1080/09513590.2025.2610550","DOIUrl":"https://doi.org/10.1080/09513590.2025.2610550","url":null,"abstract":"<p><p>Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by hyperandrogenism and ovulatory dysfunction. Women with PCOS are at an increased risk for adverse pregnancy outcomes, such as miscarriage and preterm birth. Endometrial receptivity plays a pivotal role in embryo implantation. However, there has been limited review or discussion regarding potential alterations in endometrial receptivity in PCOS patients, the nature of these changes, and their underlying mechanisms. In this review, we aim to summarize the alterations in endometrial receptivity associated with PCOS, highlight the impact of PCOS on endometrial receptivity, and explore the underlying mechanisms. Abnormal expression of key receptivity markers has been observed in both PCOS patients and animal models, which may contribute to reduced endometrial receptivity. The factors leading to impaired endometrial receptivity in PCOS are multifaceted, including hormonal imbalances, metabolic disturbances, chronic inflammation, and microbiota alterations. However, the intricate mechanisms behind PCOS-related endometrial dysfunction remain poorly understood. Further research is essential to unveil these complex mechanisms and improve fertility outcomes for women with PCOS.</p>","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2610550"},"PeriodicalIF":1.7,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900016","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":"Peripheral precocious puberty with unilateral ovarian agenesis in early childhood: a case report and review of literature.","authors":"Elene Asanidze, Alla Vash-Margita, Besik Asanidze, Mariam Kharaishvili, Maia Chiokadze, Ana Jibladze, Jenaro Kristesashvili","doi":"10.1080/09513590.2026.2695508","DOIUrl":"10.1080/09513590.2026.2695508","url":null,"abstract":"<p><p>Peripheral precocious puberty (PPP) is a rare condition in early childhood, particularly among girls under 3 years of age. One cause of PPP is functional ovarian cysts that secrete estrogen at levels sufficient to trigger the development of premature secondary sexual characteristics. Unilateral ovarian agenesis is an uncommon congenital anomaly. The coexistence of both conditions in a single patient is extremely rare and poses unique diagnostic and management challenges. We report the case of a 2-year and 10-month-old girl presenting with concurrent breast development, pubarche, and recurrent vaginal bleeding. Pelvic imaging revealed a cyst in the left ovary and agenesis of the right ovary. Laparoscopy confirmed absence of the right ovary and ipsilateral fallopian tube. Based on clinical, hormonal, and radiologic findings, a diagnosis of PPP due to a functional ovarian cyst was made. Given the rapid progression of symptoms, increase in cyst size, and concern for torsion, a short observation period of three months was followed by ovarian-preserving laparoscopic cystectomy. Histopathology confirmed a benign follicular cyst. Postoperatively, the patient experienced partial regression of pubertal signs and complete resolution of vaginal bleeding. This case highlights the importance of individualized decision-making in managing PPP,especially in the presence of congenital anomalies.</p>","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2695508"},"PeriodicalIF":3.0,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338563","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":"Great obstetrical syndromes: new insights into progesterone's role and clinical implications.","authors":"Gian Carlo Di Renzo, Valentina Tsibizova","doi":"10.1080/09513590.2026.2704987","DOIUrl":"https://doi.org/10.1080/09513590.2026.2704987","url":null,"abstract":"","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2704987"},"PeriodicalIF":3.0,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591282","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":"Variation in gestational outcomes among PCOS phenotypes in natural and art-conceived pregnancies.","authors":"Pooja Senthil, Natalie Piserchio, Krista Potter, Rebecca Ryznar","doi":"10.1080/09513590.2026.2676215","DOIUrl":"10.1080/09513590.2026.2676215","url":null,"abstract":"<p><strong>Objective: </strong>Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. While diagnostic criteria have historically varied, the Rotterdam criteria, established in 2003, are now the standard. This classification identifies four PCOS phenotypes based on the presence and/or absence of three key features: ovulatory dysfunction (OD), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). Despite phenotypic differences, current clinical guidelines treat PCOS as a homogeneous condition when assessing pregnancy risks. Therefore, this narrative review examines variations in gestational outcomes across PCOS phenotypes in both natural and assisted reproductive technology (ART)-conceived pregnancies.</p><p><strong>Methods: </strong>A search of three databases (PubMed, Cochrane, and Google Scholar) using key terms identified 13 eligible retrospective and prospective studies reporting gestational outcomes in PCOS phenotypes.</p><p><strong>Results: </strong>Findings indicate that phenotypes characterized by HA (A, B, and C) are at higher risk for preeclampsia, gestational diabetes, and miscarriage in natural pregnancies. However, in ART-conceived pregnancies, Phenotypes A and D exhibited higher risks of adverse outcomes, while Phenotypes A and C showed significantly lower live birth and cumulative live birth rates.</p><p><strong>Conclusion: </strong>These results reveal inconsistencies in pregnancy risks across phenotypes and conception methods, suggesting differences in the underlying mechanisms. The findings challenge the one-size-fits-all approach to pregnancy counseling in PCOS. Incorporating phenotype-specific risk stratification into clinical guidelines could enhance maternal and neonatal outcomes, particularly for high-risk phenotypes. Further research is needed to refine pregnancy care strategies tailored to individual PCOS phenotypes.</p>","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2676215"},"PeriodicalIF":3.0,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987251","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":"C-reactive protein-triglyceride-glucose index as a novel biomarker for type 2 diabetes mellitus association in women with a history of gestational diabetes mellitus.","authors":"Qiu-Feng Xiao, Xiao-Hong Xie, Chong-Zhi Wen, Zhou-Lan Li","doi":"10.1080/09513590.2026.2690803","DOIUrl":"https://doi.org/10.1080/09513590.2026.2690803","url":null,"abstract":"<p><strong>Objective: </strong>To explore the relationship between the C-reactive protein-triglyceride-glucose index (CTI) and the risk of type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (GDM).</p><p><strong>Methods: </strong>Logistic regression and restricted cubic spline (RCS) analyses were used to explore the relationship between CTI and the risk of T2DM. Subgroup and interaction analyses were conducted to examine the sensitivity of CTI to T2DM risk and its interaction with confounding factors, respectively. Machine learning algorithms were employed to rank variable importance in T2DM. The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were employed to investigate the clinical value of CTI.</p><p><strong>Results: </strong>CTI showed a significant positive linear association with T2DM, influenced by hyperlipidemia and BMI. CTI was related to T2DM risk among individuals with low-density lipoprotein cholesterol (LDL-C) >130 mg/dL. CTI ranked as the top predictor of T2DM risk. The area under the curve (AUC) of CTI was 0.767 in predicting T2DM. CTI provided a clinical net benefit for predicting T2DM when the threshold probability ranged from 0.18 to 0.64.</p><p><strong>Conclusion: </strong>CTI is associated with future T2DM in women with prior GDM, showing a continuous dose-response relationship. Elevated LDL-C may enhance CTI's predictive power.</p>","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2690803"},"PeriodicalIF":3.0,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411508","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":"Short-term outcomes and tolerability of a hyaluronic acid-based vaginal gel in the management of genitourinary syndrome of menopause: a retrospective observational study.","authors":"Rachele Capasso, Maria Giovanna Vastarella, Alessandra Salzano, Pietro Fumiento, Martina Amabile, Feliciano Ciccarelli, Gorizio Pieretti, Mario Faenza, Felice Moccia","doi":"10.1080/09513590.2026.2644646","DOIUrl":"10.1080/09513590.2026.2644646","url":null,"abstract":"<p><strong>Background: </strong>Genitourinary syndrome of menopause (GSM) is characterized by vulvovaginal dryness, irritation, dyspareunia, and elevated vaginal pH due to estrogen deficiency-related changes of the lower genital tract. Non-hormonal therapies, including hyaluronic acid (HA)-based vaginal gels, are increasingly used to improve local tissue hydration and symptoms.</p><p><strong>Objective: </strong>To assess short-term clinical outcomes and local tolerability associated with a hyaluronic acid-based vaginal gel (Gynexelle Hyalo-Duo) in women with GSM.</p><p><strong>Methods: </strong>This retrospective, single-center observational study included 60 women aged 18-65 years (30 reproductive-age and 30 postmenopausal) managed at Studio Medico Capasso, Naples, Italy. The gel was applied daily for 7 days, followed by three applications per week for 3 weeks. Outcomes included the Vaginal Health Index (VHI), Vulvar Health Index (VuHI), Subjective Evaluation of Specific Symptoms (SESS), and vaginal pH, assessed at baseline (T₀), after 1 week (T₁), and after 4 weeks of treatment (T₂).</p><p><strong>Results: </strong>At T₂, mean VHI increased from 12.7 ± 3.3 to 19.3 ± 4.0 (<i>p </i>< 0.001), VuHI decreased from 5.3 ± 3.8 to 2.5 ± 3.5 (<i>p </i>< 0.001), and SESS improved from 11.8 ± 3.3 to 2.4 ± 3.9 (<i>p </i>< 0.001). Vaginal pH decreased from 6.1 ± 1.0 to 4.7 ± 0.8 (<i>p </i>< 0.001). Improvements were observed in both reproductive-age and postmenopausal women. No adverse events were documented.</p><p><strong>Conclusion: </strong>Short-term use of a hyaluronic acid-based vaginal gel was associated with improvements in vulvovaginal symptoms and vaginal health parameters, with good local tolerability, in a real-world observational setting.</p>","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2644646"},"PeriodicalIF":3.0,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147467682","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":"Correlation of the estimated glucose disposal rate with self-reported endometrial cancer: a cross-sectional study from NHANES 1999-2018.","authors":"Rui Kong, Wei Xia, Chao Zhang, Bingjie Liu, Yidi Zheng, Zhiqi Wang","doi":"10.1080/09513590.2026.2720976","DOIUrl":"https://doi.org/10.1080/09513590.2026.2720976","url":null,"abstract":"<p><strong>Objective: </strong>Given accumulating data implicating insulin resistance (IR) in endometrial carcinogenesis, this study evaluated whether eGDR-a feasible non-invasive IR metric-is associated with self-reported endometrial cancer in a cross-sectional population-based sample.</p><p><strong>Methods: </strong>The analytical sample consisted of 31,666 female NHANES respondents (1999-2018), including 248 EC cases versus 31,418 cancer-free comparators. Propensity score matching (1:1) controlled for baseline imbalances.</p><p><strong>Results: </strong>The eGDR was significantly lower in the EC group (6.84 ± 2.76) than in the control group (7.51 ± 2.66) (<i>P</i> = 0.004). After adjusting for confounding variables, the odds ratio (OR) for eGDR as a inversely associated with self-reported EC was 0.906 (95% CI: 0.826-0.991, <i>P</i> = 0.0328). A significant decreasing trend in EC risk was observed across eGDR quartiles. After covariate adjustment, eGDR remained inversely associated with EC (Model 2: OR 0.917, 95% CI 0.849-0.988, <i>P</i> = 0.024; Model 3: OR 0.906, 95% CI 0.826-0.991, <i>P</i> = 0.0328). Additionally, the restricted cubic spline revealed a significant nonlinear correlation between eGDR and the risk of EC.</p><p><strong>Conclusions: </strong>In this large cross-sectional study, higher eGDR was associated with lower odds of prevalent self-reported EC. These findings suggest a link between insulin sensitivity and endometrial cancer that warrants prospective evaluation.</p>","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2720976"},"PeriodicalIF":3.0,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148827718","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":"Restoring ovulation in functional hypothalamic amenorrhea: impact of polycystic ovarian morphology on hormonal response to pulsatile GnRH.","authors":"Magdalena Boegl, Isabella Kasper, Didier Dewailly, Daniel Mayrhofer, Marlene Hager, Johannes Ott","doi":"10.1080/09513590.2026.2677994","DOIUrl":"10.1080/09513590.2026.2677994","url":null,"abstract":"<p><strong>Objective: </strong>Up to 50% of women with functional hypothalamic amenorrhea (FHA) exhibit polycystic ovarian morphology (PCOM) on ultrasound. We aimed to compare the hormonal response to ovulation induction with pulsatile GnRH therapy in FHA patients with and without PCOM.</p><p><strong>Methods: </strong>In this single-center observational study, 41 patients with FHA underwent 3 months of pulsatile GnRH therapy to induce ovulation. Patients were categorized into a PCOM group (<i>n</i> = 24) and a non-PCOM group (<i>n</i> = 17). Serum levels of Anti-Muellerian-hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, sex hormone-binding globulin (SHBG), testosterone, and thyroid-stimulating hormone (TSH) were assessed at baseline and after 3 months of treatment.</p><p><strong>Results: </strong>At baseline, median AMH levels were significantly higher in the PCOM group (6.21 ng/ml [IQR 4.03-8.87]) compared to the non-PCOM group (1.7 ng/ml [IQR 1.14-2.20]; <i>p</i> < 0.001). After 3 months of pulsatile GnRH therapy, AMH levels significantly increased in the non-PCOM group (1.94 [IQR 1.39-2.49], <i>p</i> < 0.001), whereas no significant change was observed in the PCOM group (<i>p</i> = 0.218). LH, FSH, and estradiol levels increased in both groups. Pulsatile GnRH therapy effectively induced ovulation (1 dominant follicle in each patient), irrespective of ovarian morphology.</p><p><strong>Conclusion: </strong>The significant AMH rise in women with FHA without PCOM likely reflects restored folliculogenesis. In contrast, the absence of an AMH rise in the PCOM group was expected, given their already elevated baseline levels. Importantly, these findings suggest that pulsatile GnRH therapy does not exacerbate AMH levels in most patients.</p>","PeriodicalId":12865,"journal":{"name":"Gynecological Endocrinology","volume":"42 1","pages":"2677994"},"PeriodicalIF":3.0,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005163","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}