Infection最新文献

{"title":"Clinical outcomes of patients hospitalized in internal medicine wards adequately treated for bloodstream infections caused by NDM-producing Klebsiella pneumoniae. Results from a real-life retrospective multi-center study in an endemic area.","authors":"Simone Meini, Roberta Del Cesta, Francesco Sbrana, Javier Rosada, Davide Carrara, Maddalena Mura, Benedetta Longo, Roberto Andreini, Giuseppe Linsalata, Alessandro Fedele, Francesco Filidei, Andrea Ripoli, Elisabetta Andreoli, Enrico Tagliaferri, Spartaco Sani","doi":"10.1007/s15010-025-02488-x","DOIUrl":"10.1007/s15010-025-02488-x","url":null,"abstract":"<p><strong>Background: </strong>New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae (NDM-Kp) represents a growing challenge for modern medicine.</p><p><strong>Objectives: </strong>To assess real-life clinical outcomes in patients adequately treated in Internal medicine units (IMUs) for bloodstream infections (BSI) caused by NDM-Kp.</p><p><strong>Methods: </strong>A two-years retrospective study was conducted recruiting 30 consecutive adult patients with NDM-Kp BSI treated with an adequate definitive antibiotic therapy (27 aztreonam plus ceftazidime/avibactam; 3 cefiderocol) in three Italian IMUs located in a highly endemic area.</p><p><strong>Results: </strong>Mean age of patients was 75.3 years, mean Charlson Comorbidity Index (CCI) 7.5. All the patients had rectal colonization. Thirty-day mortality rate was 46.7%; 78.6% of patients who died received an adequate empiric therapy. Non-survivors had mean age, CCI and SOFA score significantly higher compared to survivors (80.1 vs. 71.2, p = 0.036; 8.6 vs. 6.6, p = 0.047; 5.9 vs. 4, p = 0.043, respectively). The percentage of survivors was significantly higher among the 13 cases with community-acquired than in the 17 with hospital-acquired BSI (76.9% vs. 35.3%, p = 0.024). In the multivariate penalized logistic regression analysis, age, CCI, SOFA score and hospital-acquired BSI onset were identified as independent predictors of mortality.</p><p><strong>Conclusion: </strong>This study provides real-life data on clinical outcomes regarding old and highly multimorbid patients hospitalized in IMU for BSI caused by NDM-Kp, showing a very high 30-day mortality even in case of adequate treatment.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572878","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":"UniteID- a proposal for training pediatric ID specialists supported by an adult ID program.","authors":"Katrin Mehler, Andre Oberthuer, Gerd Faetkenheuer, Michael Weiss, Joerg Doetsch, Sarina K Butzer, Norma Jung","doi":"10.1007/s15010-025-02490-3","DOIUrl":"https://doi.org/10.1007/s15010-025-02490-3","url":null,"abstract":"","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541957","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 analysis of the Global Burden and epidemiological trends of meningitis from 1990 to 2021.","authors":"Chao Tang, Rongshou Han, Jiaxin Yang, Ning Wu, Dian He","doi":"10.1007/s15010-025-02483-2","DOIUrl":"https://doi.org/10.1007/s15010-025-02483-2","url":null,"abstract":"<p><strong>Background: </strong>Despite significant advances in prevention and treatment strategies, meningitis continues to pose a substantial global health challenge. The disease burden demonstrates marked geographical disparities, with disproportionate impact in resource-limited settings, particularly within the \"meningitis belt\" of Sub-Saharan Africa. The global meningitis burden is influenced by a complex interplay of environmental, behavioral, and socioeconomic determinants.</p><p><strong>Methods: </strong>Leveraging the Global Burden of Disease (GBD) 2021 database, we conducted a comprehensive analysis of global meningitis burden from 1990 to 2021. The study employed DisMod-MR 2.1, an advanced Bayesian meta-regression tool, for epidemiological modeling. We implemented age-period-cohort analysis to evaluate mortality trends and utilized the Comparative Risk Assessment framework to assess risk factors. The relationship between socio-demographic index (SDI) and disease burden was examined through Spearman's rank correlation analysis.</p><p><strong>Results: </strong>Our analysis revealed significant geographical and pathogen-specific variations in disease burden. Globally, the age-standardized incidence rate stands at 31.65 per 100,000 with a corresponding mortality rate of 2.95 per 100,000. The disease burden demonstrates a striking gradient across SDI levels, with low SDI regions experiencing the highest burden, approximately 17 times higher than high SDI regions. Neonatal mortality rates remain particularly concerning at 129.69 per 100,000, while under-5 mortality rates stand at 34.50 per 100,000. The Eastern Sub-Saharan African region emerges as an area of particular concern, with disease burden significantly exceeding global averages. Behavioral risks, child and maternal malnutrition, and low birth weight/short gestation emerged as the primary risk factors, each contributing to 0.15 million deaths and 13.41 million DALYs. Strong negative correlations were observed between all risk factors and SDI values (correlation coefficients ranging from - 0.55 to -0.75), indicating higher disease burden in regions with lower socio-demographic development.</p><p><strong>Conclusion: </strong>While substantial progress has been achieved in global meningitis control, particularly in reducing under-5 mortality rates, significant disparities persist between high and low SDI regions. Our findings emphasize the critical need for targeted interventions in resource-limited settings and continued surveillance efforts to address remaining challenges in meningitis control.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541955","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":"Increased incidence of blood culture contaminations during and after the COVID-19 pandemic.","authors":"Hannah Tolle, Aude Nguyen, Aleece MacPhail, Nasreen Hassoun-Kheir, Marie-Noelle Chraiti, Filippo Boroli, Marie-Céline Zanella, Stephan Harbarth, Gaud Catho, Niccolò Buetti","doi":"10.1007/s15010-024-02469-6","DOIUrl":"https://doi.org/10.1007/s15010-024-02469-6","url":null,"abstract":"<p><strong>Purpose: </strong>Blood culture contamination (BCC) is mainly caused by commensal bacteria, during sample collection. It results in unnecessary antibiotic exposure, prolonged hospitalisation, additional microbiology workup and significant adverse health-economic burden. We aimed to investigate the short- and long-term impact of the COVID-19 pandemic on the incidence of BCC.</p><p><strong>Methods: </strong>We conducted a retrospective, observational cohort study at Geneva University Hospitals (HUG). We included all BCCs from January 2018 to December 2023, collected as part of a prospective hospital-wide surveillance by the infection control team. Data were analyzed using segmented Poisson regression models to evaluate BCC incidence rate ratios (IRRs) across three periods: pre-COVID-19 (2018-2019), during COVID-19 (2020-2021), and post-COVID-19 peak (2022-2023).</p><p><strong>Results: </strong>Out of 456,873 collected blood cultures, 1,247 BCCs were identified (0.27%). The contamination rate per 1000 samples increased from 1.53 pre-COVID-19 to 2.94 during COVID-19 and 3.52 post-COVID-19. Compared to the pre-COVID-period, incidence rate ratios (IRRs) for BCC increased during COVID-19 (IRR 1.84, 95% CI 1.58-2.15) and post-COVID-19 peak (IRR 2.29, 95% CI 1.97-2.66). During COVID-19, proportions of BCC were increased in intensive care units (27.4%, n = 127) and returned to baseline level post-COVID-19 (17.3%, n = 93, p < 0.001); whereas, in other wards, BCC remained elevated (42.2%, n = 227) in the post-COVID-19 period.</p><p><strong>Conclusions: </strong>We observed a significant rise in BCC incidence during and after the COVID-19 peak. The persistently elevated post-peak rates highlight ongoing challenges in regaining optimal aseptic blood culture collection practices and the need for further exploration of persisting factors increasing BCC rates.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541956","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":"Cardiac structure and function 1.5 years after COVID-19: results from the EPILOC study.","authors":"Jana Schellenberg, Lynn Matits, Daniel A Bizjak, Peter Deibert, Birgit Friedmann-Bette, Siri Göpel, Uta Merle, Andreas Niess, Norbert Frey, Oliver Morath, Gunnar Erz, Raphael S Peter, Alexandra Nieters, Dietrich Rothenbacher, Winfried V Kern, Jürgen M Steinacker","doi":"10.1007/s15010-025-02481-4","DOIUrl":"https://doi.org/10.1007/s15010-025-02481-4","url":null,"abstract":"<p><strong>Purpose: </strong>Impaired left and right ventricular (LV/RV) function during acute SARS-CoV-2 infection has been predominantly reported in hospitalized patients, but long-term cardiac sequelae in large, well-characterized cohorts remain inconclusive. This study evaluated cardiac structure and function in individuals with post-Coronavirus disease (COVID) syndrome (PCS) compared to recovered controls (CON), focusing on associations with cardiopulmonary symptoms and rapid physical exhaustion (RPE).</p><p><strong>Methods: </strong>This multicenter, population-based study included 1154 participants (679 PCS, 475 age- and sex matched CON; mean age 49 ± 12 years; 760 women) 1.5 years post-infection. Transthoracic echocardiography assessed LV global longitudinal strain (GLS), RV GLS and RV free wall strain (FWS), and other measures. Cardiopulmonary exercise testing (CPET) measured maximum respiratory oxygen uptake (VO₂max) as a marker of cardiopulmonary fitness.</p><p><strong>Results: </strong>PCS participants exhibited significantly lower LV GLS (-20.25% [-21.28 - -19.22] vs. -20.73% [-21.74 - -19.72], p = 0.003), reduced diastolic function (E/A 1.16 [1.04-1.27] vs. 1.21 [1.1-1.32], p = 0.022) and decreased TAPSE (24.45 mm [22.14-26.77] vs. 25.05 mm [22.78-27.32], p = 0.022) compared to CON, even after adjusting for confounders. RV strain values were similar between groups. LV GLS correlated inversely with VO₂max (p = 0.004) and positively with RPE (p = 0.050), though no associations were observed with other cardiopulmonary symptoms.</p><p><strong>Conclusions: </strong>This study demonstrates subtle yet consistent reductions in LV function, specifically LV GLS and diastolic function, and exercise capacity in PCS compared to CON. While these changes are within reference ranges, their potential impact on clinical outcomes warrants further investigation. These findings highlight the need for cardiac assessments and long-term follow-up in symptomatic PCS patients.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483036","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":"Correction: Successful therapy of a newborn with Stenotrophomonas maltophilia nosocomial pneumonia with cefiderocol.","authors":"Janina Trauth, Rahel Schuler, Markus Waitz, Harald Ehrhardt, Moritz Fritzenwanker, Susanne Herold","doi":"10.1007/s15010-025-02487-y","DOIUrl":"https://doi.org/10.1007/s15010-025-02487-y","url":null,"abstract":"","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491926","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":"Oral nonabsorbable antibiotics for prevention of recurrent cholangitis; a brief report study.","authors":"Jesús Fortún, Miguel Angel Rodríguez-Gandía, Vicente Pintado, Pilar Martín-Dávila, Miguel García-González, Javier Graus, Rosa Martín-Mateos, Javier Sáez de la Fuente, Alfonso Muriel, Santiago Moreno","doi":"10.1007/s15010-025-02491-2","DOIUrl":"https://doi.org/10.1007/s15010-025-02491-2","url":null,"abstract":"<p><strong>Background: </strong>Patients with recurrent cholangitis are at risk of developing life-threatening sepsis. Selective decontamination of the digestive tract (SDD) involving oral nonabsorbable antibiotics has been primarily applied to children undergoing Kasai portoenterostomy surgery.</p><p><strong>Methods: </strong>In this study, SDD containing colistin, tobramycin, and nystatin was administered to eight patients with recurrent cholangitis, and the incidence density before and after SDD administration was analyzed.</p><p><strong>Results: </strong>The overall incidence density of cholangitis requiring hospital admission was 0.37 per 100 patient days during the SDD period and was significantly lower than observed before SDD administration (1.05 per 100 patient days) [RR: 0.35 (95% CI: 0.21-0.59); p: <0.001, two-sided]. This was not associated with an increased risk of resistance during SDD administration.</p><p><strong>Conclusion: </strong>In this study SDD reduced by 65% the frequency and severity of recurrent cholangitis. In addition, this procedure is patient-friendly and microbiologically safe.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457825","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":"Toxigenic Corynebacterium ulcerans in raw milk of a cow with acute mastitis: case report and historical review on milk-transmitted diphtheria.","authors":"Andreas Sing, Laura Macias Luaces, Alexandra Dangel, Stefano Deramo, Katja Bengs, Vyacheslav G Melnikov, Anja Berger","doi":"10.1007/s15010-025-02477-0","DOIUrl":"https://doi.org/10.1007/s15010-025-02477-0","url":null,"abstract":"<p><strong>Purpose: </strong>Historically, a considerable number of diphtheria outbreaks, mainly in the UK and the USA, have been epidemiologically or bacteriologically linked to the consumption of milk and dairy products. However, with the introduction of milk pasteurization and hygienic improvements in livestock farming and animal welfare, no cases of milk-linked human diphtheria outbreaks or bovine mastitis due to toxigenic corynebacterial have been reported in the recent decades. Here we report the first isolation of a toxigenic Corynebacterium ulcerans strain from the milk of a cow with acute mastitis within nearly 40 years and outside of UK or Finland.</p><p><strong>Methods: </strong>The isolated strain was analysed by state-of-the-art bacteriological methods including toxigenicity testing by a novel Lateral Flow Immunoassay and Elek test, molecular typing was done by whole genome sequencing and MLST/cgMLST analysis. Due to the rarity of our finding, an extensive historical review of milk-associated diphtheria outbreaks was performed.</p><p><strong>Results: </strong>The obtained sequence type ST-331 is also found in human isolates of cutaneous diphtheria. cgMLST analysis, however, found no close relationship to 43 human ST-331 isolates from our German strain collection or to two animal samples from a zoonic cluster of this ST.</p><p><strong>Conclusion: </strong>The risk of milk-associated diphtheria due to C. ulcerans, although today extremely rare, should be avoided by milk pasteurization and the respective hygienic standards.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457829","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":"RSV is the main cause of severe respiratory infections in infants and young children in Germany - data from the prospective, multicenter PAPI study 2021-2023.","authors":"Martin Wetzke, Matthias Lange, Cordula Koerner-Rettberg, Alexander Kiefer, Michael Kabesch, Sven Armbrust, Kerim Abdelkhalek, Christiane Lex, Markus Hufnagel, Sebastian Bode, Michael Dördelmann, Michael Lorenz, Stefan Arens, Markus Panning, Holger Köster, Rolf Kramer, Mathieu Bangert, Frank Eberhardt, Grit Barten-Neiner, Christine Happle","doi":"10.1007/s15010-025-02484-1","DOIUrl":"https://doi.org/10.1007/s15010-025-02484-1","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) is one of the main causes of morbidity in infants and young children worldwide. Current data on RSV-associated disease burden in Germany before the introduction of new immunization strategies is lacking.</p><p><strong>Methods: </strong>The PAPI study is a multicenter, prospective surveillance study of lower respiratory tract infections (LRTI) in children aged ≤ 24 months in Germany.</p><p><strong>Results: </strong>Data from 1607 children with LRTI hospitalized in twelve German hospitals between September 2021 and May 2023 were analyzed. Among these children, RSV was the most frequently detected pathogen (57.1%), followed by rhino/entero-, metapneumo- and parainfluenza virus. Children with RSV were significantly younger than those with LRTI of other causes (mean of 5.6 ± SD 6.1 vs. mean of 10.1 ± SD 7.3 months, p < 0.001) and more frequently affected in their first six months of life. RSV positive children were significantly more likely to develop hypoxemia (61.9% vs. 44.3%, p < 0.001) and need for intravenous or enteral fluid supplementation (48.1% vs. 43.1%, p = 0.009; 13.2% vs. 5.9%, p < 0.001) than those without RSV.</p><p><strong>Conclusion: </strong>RSV is the dominant pathogen for LRTI-associated hospitalizations in children ≤ 24 months in Germany and associated with a particularly high need for treatment. The ongoing implemented use of RSV immunization according to current recommendations could lead to significant reduction in early childhood morbidity in Germany.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457898","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":"Primary HIV-1 infection presenting with nephrotic-range proteinuria and severe acute kidney injury mimicking imported Lassa fever.","authors":"Frieder Pfäfflin, Ralf Schindler, Miriam Songa Stegemann, Wolfgang Schneider, Leif Erik Sander, Philipp Enghard, Stephan Achterberg, Dirk Schürmann","doi":"10.1007/s15010-024-02466-9","DOIUrl":"https://doi.org/10.1007/s15010-024-02466-9","url":null,"abstract":"<p><strong>Purpose: </strong>Primary HIV-1 infection (PHI) can present with protean clinical manifestations. We report a rare presentation of PHI that underscores that a high index of suspicion is required for diagnosis of PHI.</p><p><strong>Methods: </strong>We report on a 54-yearold previously healthy woman of African descent who presented with sudden-onset nephrotic-range proteinuria and acute kidney injury (AKI) requiring hemodialysis in the setting of febrile multiple organ dysfunction syndrome. Both the epidemiological and clinical features initially pointed to imported Lassa fever, but this was ruled out. She was eventually diagnosed with PHI. We reviewed the literature for other patients who presented with PHI and AKI requiring hemodialysis.</p><p><strong>Results: </strong>Kidney biopsy evaluation, including conventional and electron microscopy, revealed minimal change disease (MCD) and diffuse tubular damage leading to AKI. To date, MCD has not been reported to be associated with PHI and severe AKI. A literature search revealed six additional cases of severe PHI-associated AKI requiring hemodialysis. In four cases, severe rhabdomyolysis with tubulotoxic myoglobinuria played the primary causative role, while in one case each AKI was associated with HIV-associated nephropathy (HIVAN) and hemolytic uremic syndrome, respectively.</p><p><strong>Conclusions: </strong>Severe AKI requiring hemodialysis is a rare manifestation of PHI and may be associated with several conditions, most commonly PHI-associated rhabdomyolysis with tubulotoxic myoglobinuria. Severe AKI in PHI may also occur as a complication of MCD manifesting with nephrotic-range proteinuria. PHI should be considered in the differential diagnosis in patients presenting with severe proteinuria and AKI in the setting of febrile multiple organ dysfunction syndromes, including hemorrhagic fever diseases.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440680","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}