Hepatology International最新文献

{"title":"Clinical features and mortality outcomes of patients with MASLD only compared to those with MAFLD and MASLD.","authors":"Mingqian Jiang, Ziyan Pan, Jacob George, Mohammed Eslam","doi":"10.1007/s12072-024-10721-2","DOIUrl":"10.1007/s12072-024-10721-2","url":null,"abstract":"<p><strong>Background and aims: </strong>The applicability of the proposed metabolic dysfunction-associated steatotic liver disease (MASLD) definition has not been validated. We aimed to characterize the profiles and long-term survival of people meeting the criteria for MASLD, but not that of metabolic dysfunction-associated fatty liver disease (MAFLD), i.e. MASLD only.</p><p><strong>Methods: </strong>Using data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, 7791 adult participants were included and categorized into four distinct groups: no SLD, non-MAFLD MASLD, MASLD-MAFLD, and cryptogenic SLD (steatosis without metabolic dysfunction).</p><p><strong>Results: </strong>Participants in the MASLD-only group were younger and had better metabolic profiles and fibrosis degree compared to those with MASLD-MAFLD and those with no SLD. Their profiles were comparable to those with cryptogenic SLD. Similarly, the MASLD-only group tend to have lower cumulative incidence of all-cause and cardiovascular mortality. Clustering analysis showed that MASLD only clusters differently from individuals with MASLD-MAFLD.</p><p><strong>Conclusions: </strong>MASLD only is a distinct clinical group with substantial heterogeneity compared to those captured using the MAFLD criteria.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":"1731-1739"},"PeriodicalIF":5.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and treatment of severe immune-related hepatotoxicity based on clinical and pathological characteristics.","authors":"Nan Zhang, Zhaohui Li, Yutao Liu, Xiaohua Shi, Di Shi, Yue Li, Xiaoyan Si, Ziyu Xun, Jing Shao, Haitao Zhao, Hanping Wang","doi":"10.1007/s12072-024-10688-0","DOIUrl":"10.1007/s12072-024-10688-0","url":null,"abstract":"<p><strong>Background: </strong>The management of severe immune-related hepatotoxicity (irH) needs to be further optimized. This study aims to analyze the clinical characteristics of severe irH; improve the therapeutic strategy, especially salvage treatment in steroid-refractory irH; and determine the safety of immune checkpoint inhibitor (ICPi)-rechallenge.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients who developed severe irH and those without irH after immunotherapy between May 2019 and June 2023. Propensity score matching was used to match these two cohorts with similar baseline characteristics.</p><p><strong>Results: </strong>Among 5,326 patients receiving ICPis, 51 patients developed severe irH. irH occurred after a median duration of 36 days and a median of two doses after the first ICPi administration. Patients receiving PD-L1 inhibitors faced a lower risk of developing severe irH. A higher dose of glucocorticoids (GCS) was administered to grade 4 irH than grade 3 irH. For steroid-sensitive patients, grade 4 irH individuals received a higher dosage of GCS than those with grade 3 irH, with no difference in time to resolution. Meanwhile, a significantly higher dose of GCS plus immunosuppression was needed in the steroid-refractory group. Liver biopsy of the steroid-refractory patients exhibited heterogeneous histological features. Twelve patients were retreated with ICPi. No irH reoccurred after a median follow-up of 9.3 months.</p><p><strong>Conclusion: </strong>irH requires multidimensional evaluation. PD-L1 inhibitors correlated with a lower risk of severe irH. Grade 4 irH demands a higher dose of GCS than recommended. Pathology may guide the salvage treatment for steroid-refractory irH. ICPi rechallenge in severe irH is feasible and safe.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":"1770-1780"},"PeriodicalIF":5.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and managements of congenital hepatic hemangioma: a cohort study of 211 cases.","authors":"Xue Gong, Min Yang, Zixin Zhang, Tong Qiu, Jiangyuan Zhou, Wei Shan, Xuepeng Zhang, Yuru Lan, Pingqian Bao, Zilong Zhou, Congxia Yang, Yujia Zhang, Tianliang Li, Jing Guo, Jun Guo, Guoyan Lu, Feiteng Kong, Yongbo Zhang, Siyuan Chen, Yi Ji","doi":"10.1007/s12072-024-10756-5","DOIUrl":"https://doi.org/10.1007/s12072-024-10756-5","url":null,"abstract":"<p><strong>Background: </strong>Hepatic hemangiomas can be classified into three morphologic patterns: focal (congenital hepatic hemangiomas [CHHs]), multifocal, and diffuse. We aimed to identify the clinical characteristics of CHH and evaluate the changes in CHH management at our institution over the last 2 decades.</p><p><strong>Methods: </strong>This was a retrospective cohort study of children diagnosed with CHH who were managed at 8 investigation sites. The primary outcome was changes in CHH size in patients at the last follow-up. The primary exposure of interest was management modality in 2 study periods (2003-2012 versus 2013-2022).</p><p><strong>Results: </strong>Two hundred and eleven patients were analyzed. Four different subtypes of CHH were identified. Rapidly involuting CHH patients had complete involution/nearly complete involution, with a median age of 12.0 months. Noninvoluting CHH presented no change in CHH size. Partially involuting CHH patients presented with partial involution and had a stable tumor size at a median age of 16.0 months. Postnatally proliferating CHHs had an initial postnatal increase in CHH lesion size and underwent involution at a median age of 27.0 months. Further analysis revealed that management strategies for CHHs have shifted over time, with the proportion of patients receiving expectant management increasing from 35.4% before 2013 to 77.7% after 2013 (difference, 42.3%; 95% confidence interval 29.3-53.3%). The survival rate of patients with CHH was high (98.6%).</p><p><strong>Conclusions: </strong>We documented 4 subtypes of CHHs. We found that expectant management strategies have increasingly replaced invasive interventions in patients with CHH over the past 2 decades.</p><p><strong>Research registration unique identifying number (uin): </strong>We have already registered at Clinicaltrials.gov. The UIN number is NCT03331744.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AARC score and urine NGAL predict terlipressin non-response and mortality in patients with acute-on-chronic liver failure.","authors":"Rakhi Maiwall, Samba Siva Rao Pasupuleti, Archana Rastogi, Fagun Sharma, Ashini Kumar Hidam, Sherin Thomas, Shiv Kumar Sarin","doi":"10.1007/s12072-024-10749-4","DOIUrl":"https://doi.org/10.1007/s12072-024-10749-4","url":null,"abstract":"<p><strong>Background and aim: </strong>Acute-on-chronic liver failure (ACLF) patients with hepatorenal syndrome (HRS-AKI) have limited response to vasoconstrictors and worse outcomes, requiring biomarkers for early detection.</p><p><strong>Methods: </strong>In a prospective cohort of ACLF patients (n = 240), urine NGAL was performed in patients with the clinical diagnosis of HRS-AKI, while in a subset of patients (n = 30), a complete panel of 17 urinary biomarkers was assessed for identifying terlipressin non-response (T-NR).</p><p><strong>Results: </strong>ACLF patients with HRS-AKI, aged 45.84 ± 10.6 years, 91.2% males, 74.2% with alcohol etiology, mean urine NGAL of 1541.66 ± 1684.69 ng/ml, AARC score 10.19 ± 1.86, 155 (64.5%) had T-NR at day 4. T-NR was maximal for AARC grade 3 and was associated with a higher need of dialysis (50.3% vs 5.9%; OR 16.21, 6.23-42.19) and 28-day mortality (49.0% vs. 17.9%; HR 3.42, 1.96-5.95). AARC grade 3 (OR 38.21, 2.93-497.74), (HR 5.10, 1.19-21.84) and urine NGAL (OR 11.53, 5.66-23.49; AUROC 0.97, NGAL > 900 ng/ml) (HR 1.23, 1.02-1.49) were independent predictors of T-NR and 28-day mortality, respectively. It was interesting to observe a significant elevation in renal injury and a decrease in the repair markers in T-NR (p < 0.05).</p><p><strong>Conclusion: </strong>Almost 60% of patients with ACLF and HRS-AKI experience non-response to terlipressin which predicts higher mortality and need for dialysis. High NGAL above 900 ng/ml predicts T-NR with 100% specificity for T-NR. ACLF patients with HRS, with AARC grade 3 and high NGAL have a high likelihood of T-NR and should be considered for alternative therapeutic modalities.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semaglutide and the risk of adverse liver outcomes in patients with nonalcoholic fatty liver disease and type 2 diabetes: a multi-institutional cohort study.","authors":"Chia-Chih Kuo, Min-Hsiang Chuang, Chun-Hsien Li, Po-Yu Huang, Hsing-Tao Kuo, Chih-Cheng Lai","doi":"10.1007/s12072-024-10752-9","DOIUrl":"https://doi.org/10.1007/s12072-024-10752-9","url":null,"abstract":"<p><strong>Background: </strong>Semaglutide has shown potential liver benefits in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D). However, no direct comparisons have been made between semaglutide and other antidiabetic medications, including sodium-glucose cotransporter-2 inhibitors (SGLT2i), thiazolidinediones (TZD), and dipeptidyl peptidase-4 inhibitors (DPP-4i), regarding liver outcomes in patients with both NAFLD and T2D.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the TriNetX electronic health record database, a multinational and multi-institutional database. Adults with NAFLD and T2D who received their first prescription for either semaglutide or other antidiabetic medications were included. New users of semaglutide were matched 1:1 via propensity score matching with users of SGLT2i, DPP-4i, and TZD. The primary outcome was major adverse liver outcome (MALO), a composite end point consisting of decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation. Secondary outcomes included the individual components of MALO and all-cause mortality.</p><p><strong>Results: </strong>A total of 648,070 adult patients with T2D and NAFLD were identified, and patients were categorized into three different comparison groups based on their drug of interest. Semaglutide was associated with a lower risk of MALO compared to SGLT2i (adjusted hazard ratio [aHR], 0.73; 95% CI 0.60-0.88), DPP-4i (aHR, 0.72; 95% CI 0.56-0.86), and TZD (aHR, 0.76; 95% CI 0.56-0.99). Additionally, semaglutide was linked to a lower risk of all-cause mortality compared to SGLT2i (aHR, 0.62; 95% CI 0.53-0.72), DPP-4i (aHR, 0.42; 95% CI 0.36-0.49), and TZD (aHR, 0.67; 95% CI 0.54-0.83).</p><p><strong>Conclusion: </strong>Semaglutide is associated with better liver outcomes and a lower risk of all-cause mortality compared to SGLT2i, DPP-4i, and TZD in patients with NAFLD and T2D.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national epidemiology of hepatoblastoma in children from 1990 to 2021: a trend analysis.","authors":"Chengnan Guo, Zhenqiu Liu, Xin Zhang, Shuzhen Zhao, Hong Fan, Haili Wang, Yi Li, Tianye Wang, Luojia Dai, Jiayi Huang, Xingdong Chen, Tiejun Zhang","doi":"10.1007/s12072-024-10750-x","DOIUrl":"https://doi.org/10.1007/s12072-024-10750-x","url":null,"abstract":"<p><strong>Background and purpose: </strong>Hepatoblastoma is the most common primary liver cancer in children, yet comprehensive understanding of its epidemiology is limited globally. We aimed to estimate the global trend of hepatoblastoma in children from 1990 to 2021.</p><p><strong>Methods: </strong>We collected data on hepatoblastoma in children aged 0 to 10 years from 1990 to 2021, derived from Global Burden of Disease (GBD) 2021. Three disease burden indicators, including incidence, mortality, and disability-adjusted life-years (DALYs), were studied. The corresponding average annual percentage changes (AAPCs) were used to explore the temporal trends of hepatoblastoma.</p><p><strong>Results: </strong>In 2021, hepatoblastoma accounted for 4048 incident cases, 2416 deaths, and 213,478 DALYs globally. Incidence, mortality, and DALYs of hepatoblastoma decreased significantly from 1990 to 2021, with AAPCs of -2.12, -2.53, and -2.53. The highest incidence of hepatoblastoma was observed among those aged < 28 days in 2021 (2.57 per 100,000 individuals). Only high-income region showed an upward trend in incidence from 1990 to 2021, with an AAPC of 0.57. The Western Pacific region had the fastest decrease in the incidence, mortality, and DALY rate of hepatoblastoma. Human development level (HDI) was positively associated with the AAPC in incidence from 1990 to 2021, while HDI was negatively associated with the incidence, mortality, and DALY rate of hepatoblastoma in 2021.</p><p><strong>Conclusion: </strong>Global efforts over the past 3 decades have substantially decreased the disease burden of hepatoblastoma in children. However, increases in the incidence of hepatoblastoma in high-income region merit attention. The highest disease burden of hepatoblastoma was observed in the neonatal period. Improved understanding of hepatoblastoma epidemiology may facilitate prevention and management.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The dynamic patterns of metabolic-associated fatty liver disease and its severity and risk of cardiovascular disease.","authors":"Haozhe Cui, Yongliang Chen, Zhiming Zhao","doi":"10.1007/s12072-024-10745-8","DOIUrl":"https://doi.org/10.1007/s12072-024-10745-8","url":null,"abstract":"<p><strong>Background: </strong>While metabolic-associated fatty liver disease (MAFLD) is widely recognized as a risk factor for cardiovascular disease (CVD), the connection between the dynamic patterns of severity of hepatic steatosis and the associated CVD risk remains uncertain.</p><p><strong>Method: </strong>This study included 71,098 participants from the Kailuan Study without CVD or cancer who underwent two consecutive biennial health screenings between 2006 and 2008 and were followed up until 2022. MAFLD and its severity were assessed using ultrasound. Participants were categorized into four groups based on dynamic MAFLD patterns: MAFLD-free, MAFLD-progression, MAFLD-regression, and MAFLD-persistence. MAFLD-regression was further divided into regression from mild MAFLD and regression from moderate/severe MAFLD. Cox proportional hazard regression models analyzed the association between the progression and regression of MAFLD and CVD risk.</p><p><strong>Result: </strong>After a mean follow-up of 12.63 ± 3.16 years, 7838 individuals experienced incident CVD, 5374 had strokes, 1321 had myocardial infarctions, and 1819 developed heart failure. After adjusting for potential confounders, MAFLD-progression was associated with a higher CVD risk compared to MAFLD-free (HR 1.25, 95% CI 1.17-1.33), but this risk decreased with increasing age. Individuals with MAFLD-persistence had the highest CVD risk (HR 1.54, 95% CI 1.46-1.62). Compared to persistent MAFLD, regression from mild MAFLD was associated with a lower CVD risk (HR 0.83, 95% CI 0.76-0.91).</p><p><strong>Conclusion: </strong>The progression of MAFLD can increase the risk of CVD, while regression of MAFLD can decrease the risk of CVD. These findings suggest that the dynamic patterns of MAFLD significantly influence CVD risk.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In response to \"Key considerations in portal vein thrombosis management\".","authors":"Patrick Northup, Abraham Cheloff, Luke Bonanni, Joshua Kirschenbaum, Naveena Luke, Jenny Engelman, Joshua Ross, Gabriel Fuligni","doi":"10.1007/s12072-024-10747-6","DOIUrl":"https://doi.org/10.1007/s12072-024-10747-6","url":null,"abstract":"","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive genomic profiling for advanced hepatocellular carcinoma in clinical practice.","authors":"Takeshi Terashima, Tatsuya Yamashita, Kuniaki Arai, Noboru Takata, Tomoyuki Hayashi, Akihiro Seki, Hidetoshi Nakagawa, Kouki Nio, Noriho Iida, Shinya Yamada, Tetsuro Shimakami, Hajime Takatori, Kunihiro Tsuji, Hajime Sunagozaka, Eishiro Mizukoshi, Masao Honda, Shinji Takeuchi, Taro Yamashita","doi":"10.1007/s12072-024-10741-y","DOIUrl":"https://doi.org/10.1007/s12072-024-10741-y","url":null,"abstract":"<p><strong>Aim: </strong>Although several therapeutic agents show efficacy in advanced hepatocellular carcinoma (HCC), biomarkers such as comprehensive genomic profiling (CGP) for the selection of second-line treatments after immunotherapy have not been established. We evaluated the value of CGP for the treatment decision in patients with HCC.</p><p><strong>Methods: </strong>We retrospectively studied 52 patients with advanced HCC who received CGP tests at three tertiary hospitals between February 2022 and November 2023. Genomic profiles were obtained using one of three CGP tests; 49 and 3 patients were evaluated using tissue-based and blood-based assay, respectively. The impact of CGP results on subsequent treatment selection in clinical practice and correlations between representative gene alterations and patient characteristics or responses to immunotherapy were evaluated.</p><p><strong>Results: </strong>The most frequently observed variants were TERT mutations, followed by CTNNB1, TP53, ARID1A, and MYC mutations. Potentially druggable gene alterations were observed in 45 patients (87%), and 34 patients (65%) were recommended to receive treatments based on specific gene alterations by a molecular tumor board. Treatments were covered by health insurance in 13 patients (25%). Five patients (10%) received the recommended treatment by the date of data cut-off. There were no differences in the efficacy of immunotherapy with respect to mutation status in hTERT, CTNNB1, TP53, ARID1A, and MYC.</p><p><strong>Conclusions: </strong>The results of the present study suggested that druggable gene alterations may provide useful information not only in proposing alternative treatment after standard of care but also in selecting second-line targeted treatments after immunotherapy for patients with advanced HCC.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key considerations in portal vein thrombosis management.","authors":"Jianyu Lv, Chengfei Du, Junbin Yan","doi":"10.1007/s12072-024-10746-7","DOIUrl":"https://doi.org/10.1007/s12072-024-10746-7","url":null,"abstract":"","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}