Nunzia La Maida, Valeria Aquilina, Fabio Vaiano, Marco Cavallo, Carlo Alessandro Locatelli, Guido Mannaioni, Davide Arillotta, Simona Pichini, Annagiulia Di Trana, Silvia Graziano
{"title":"The rising trend of MDPHP consumption: an Italian snapshot.","authors":"Nunzia La Maida, Valeria Aquilina, Fabio Vaiano, Marco Cavallo, Carlo Alessandro Locatelli, Guido Mannaioni, Davide Arillotta, Simona Pichini, Annagiulia Di Trana, Silvia Graziano","doi":"10.1093/jat/bkaf024","DOIUrl":"10.1093/jat/bkaf024","url":null,"abstract":"<p><p>Synthetic cathinones (SCs) were confirmed as the second most prevalent class of New Psychoactive Substances (NPS) in 2024, underscoring their widespread availability and use. Notably, the SCs seizure and related intoxication cases increased within the European Union, involving mostly 3-chloromethcathinone, 3-methylmethcathinone, 2-methylmethcathinone, and N-ethylnorpentedrone. Italy has observed a distinct trend, with methylendioxy pyrrolidinohexanophenone (MDPHP) emerging as a significant concern. This technical note aims to provide a comparative analysis of the most recent data concerning the emergence and the spread of MDPHP in Italy. Data from the National Early Warning System on Drugs indicate that the total amount of seized MDPHP increased from 2021 to 2024. In 2023, MDPHP-related intoxication cases peaked at 47, considering either alone or in combination with other drugs, followed by a slight decrease in 2024. In Italy, MDPHP seems to dominate the Italian black market of SCs and with two fatalities reported. This increased demand for MDPHP raises health concerns, indicating the necessity to enhance drug-related harm reduction services and improve a multidisciplinary network that provides data for understanding the complex phenomenon of NPS.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"417-421"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633851","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}
Ana Miguel Fonseca Pego, Malik Schoffner, Vamshikrishna Reddy Sammeta, Marilyn Naeem, David R Manke, Andrew Chadeayne, Grant C Glatfelter, Michael H Baumann, Marta Concheiro-Guisán
{"title":"Development and validation of an analytical method for the determination of select 4-position ring-substituted tryptamines in plasma by liquid chromatography-tandem mass spectrometry.","authors":"Ana Miguel Fonseca Pego, Malik Schoffner, Vamshikrishna Reddy Sammeta, Marilyn Naeem, David R Manke, Andrew Chadeayne, Grant C Glatfelter, Michael H Baumann, Marta Concheiro-Guisán","doi":"10.1093/jat/bkaf045","DOIUrl":"10.1093/jat/bkaf045","url":null,"abstract":"<p><p>4-Phosporyloxy-N, N-dimethyltryptamine (psilocybin) is a psychedelic tryptamine found in certain mushroom species that has shown efficacy in the treatment of various psychiatric disorders. In conjunction with the renewed interest in therapeutic effects of psychedelics, there has been an increase in psilocybin-like designer tryptamines appearing in non-medical drug markets. The present study aimed to develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for detecting and quantifying 4-position ring-substituted tryptamines and their 4-hydroxy metabolites in plasma. Specifically, we investigated 4-phosphoryloxy-N, N-dimethyltryptamine (psilocybin), 4-acetoxy-N, N-dimethyltryptamine (psilacetin), 4-propionoxy-N, N-dimethyltryptamine (4-Pro-DMT) and their shared metabolite 4-hydroxy-N, N-dimethyltryptamine (psilocin), along with 4-methyl carbonato-N, N-di-n-propyltryptamine (4-MeCO3-DPT) and its metabolite 4-hydroxy-N, N-di-n-propyltryptamine (4-HO-DPT). Mass spectrometry analysis employed electrospray ionization (ESI) in positive mode, with two multiple reaction monitoring (MRM) transitions per analyte. Plasma samples were acidified with ascorbic acid, followed by protein precipitation with acetonitrile. Linearity was achieved across a concentration range of 0.5-100 ng/mL for all analytes, except psilocybin, which displayed linearity from 5 to 100 ng/mL. Validation results demonstrated acceptable bias (±20%) and imprecision (<20%) for all analytes. Matrix effects, evaluated in 10 samples (CV <18.3%), indicated minimal interference, although ion enhancement was observed for psilocin (31.9%) and psilocybin (45.7%). Extraction efficiency across all tryptamines was approximately 50%. The assay method was used to quantitate plasma samples from male rats treated with 1.0 mg/kg s.c. of the prodrug psilacetin, and collected before and 5, 30, 60, 120 and 240 min after injection. No psilacetin was detected, and psilocin concentrations ranged from non-detected up to 32.7 ng/mL. Overall, we successfully developed a sensitive and specific method for the detection and quantification of six tryptamines in plasma, providing a robust tool for future research and clinical applications.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"376-383"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142656","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":"Ethanol production in the gut: an autopsy case.","authors":"Maiko Kusano, Chikara Kohda, Masaya Fujishiro, Taka-Aki Matsuyama","doi":"10.1093/jat/bkaf039","DOIUrl":"10.1093/jat/bkaf039","url":null,"abstract":"<p><p>Postmortem alcohol production by microorganisms has been known to increase blood alcohol concentration, potentially leading to erroneous interpretation. Here, we present a peculiar case where postmortem toxicology detected a high ethanol concentration only in the stomach content. An 87-year-old bedridden woman was taken to senior day care facility, where the nurse attempted to take her vitals but noticed she was not breathing. The facility called for an ambulance, but she was pronounced dead soon after arriving at the hospital. She was found to be severely dehydrated, and her blood tests indicated poor health. Autopsy was performed 2 days after death, and postmortem alcohol analysis detected a high ethanol concentration only in the stomach content. Our aim was to investigate the causative agent of ethanol production; microbiological analysis identified the yeast species Candida glabrata as the responsible microorganism.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"422-426"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984712","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}
Sara Casati, Alessandro Ravelli, Michele Dei Cas, Roberta F Bergamaschi, Sofia Vanerio, Lea Sicuro, Chiara Faraone, Marta Rossi, Nicola Galante, Luca Mollica, Gabriella Roda, Paola Rota, Alessio Battistini
{"title":"Polydrug fatal intoxication involving MDPHP: Detection and in silico investigation of multiple 3,4-methylenedioxy-derived designer drugs and their metabolites.","authors":"Sara Casati, Alessandro Ravelli, Michele Dei Cas, Roberta F Bergamaschi, Sofia Vanerio, Lea Sicuro, Chiara Faraone, Marta Rossi, Nicola Galante, Luca Mollica, Gabriella Roda, Paola Rota, Alessio Battistini","doi":"10.1093/jat/bkaf048","DOIUrl":"10.1093/jat/bkaf048","url":null,"abstract":"<p><p>A drug-related fatality involving 3,4-methylenedioxy-α-pyrrolidinohexanophenone (MDPHP) is here reported. Belonging to the class of synthetic cathinones (SCs), MDPHP is a 3,4-methylenedioxy-derived designer (MDDs) drug with a pyrrolidine moiety and an alkyl portion with six carbon atoms. Other MDD pyrrolidine derivatives belong to the alkyl homologous series (C3-C5) and are known as 3,4-methylenedioxy-α-pyrrolidinopropiophenone (MDPPP), 3,4-methylenedioxy-α-pyrrolidinobutyrophenone (MDPBP) and 3,4-methylenedioxypyrovalerone (MDPV). MDDs are psychostimulant drugs of abuse that primarily act on monoamine transporters; little is known about their off-target liability. Recently, MDPHP has gained attention due to increasing seizures and involvement in human intoxications, but currently there is a lack of data about its pharmaco-toxicological effects. In the case reported here, a 58-year-old man with a history of MDPV addiction was found dead in a waterway. While no evidence of natural disease or trauma was found to account for the death, toxicological analysis revealed the presence of MDPHP in addition to MDPPP, MDPV, MDPBP, clonazepam, and citalopram. Since no standards of MDPPP and MDPBP were available at the time of the analysis, LC-QTOF analysis of the drugs and their metabolites were performed. The following concentrations of MDPHP were reported: 350 ng/mL in femoral blood (FB), 110 ng/mL in cardiac blood (CB), 1900 ng/mL in urine, 3000 ng/mL in bile, 490 ng/g in kidney, 80 ng/g in liver, 480 ng/g in lung, 98 ng/g in brain, 700 ng/mL in gastric content and 8 ng/mg in pubic hair. Other MDDs concentrations in biological fluids and tissue were significantly lower than MDPHP suggesting their presence as synthetic impurities. Finally, to better understand the binding properties of the abovementioned MDDs to several documented transporters and receptors, an in silico evaluation was performed. The medical examiner reported that the cause of death was an acute multidrug intoxication by MDPHP and clonazepam in presence of MDPPP, MDPV, MDPBP and citalopram.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"384-393"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181844","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":"A validated screening and confirmation method for 946 drugs and metabolites using LC-QTOF-MS with SWATH acquisition.","authors":"Maria Sarkisian, Luke N Rodda","doi":"10.1093/jat/bkaf037","DOIUrl":"10.1093/jat/bkaf037","url":null,"abstract":"<p><p>A streamlined liquid chromatography quadrupole time-of-flight mass spectrometry method utilizing protein precipitation and filtration extraction was developed to achieve rapid and reliable screening and confirmation for blood and urine matrices. This method targets 946 drugs and metabolites across 35 drug classes via sequential window acquisition of all theoretical mass spectra with variable customized windows to enhance spectral clarity, and was validated per established guidelines to ensure high accuracy and reproducibility. Combined with complementary in-house methods, this approach meets and exceeds the testing requirements outlined in ANSI/ASB standards and recommendations for postmortem, drug-facilitated crime, and Tier I and II driving under the influence of drug analyses. The method demonstrated efficient and sensitive performance, achieving limits of detection as low as 0.1 ng/mL. It accurately identified expected detections across 67 proficiency test samples and 224 authentic case samples, with high accuracy and reliability in the detection of both traditional drugs and novel psychoactive substances. The method employs an in-house built library and incorporates in-batch standards analyzed alongside case samples to ensure contemporaneous identification criteria, making it suitable for confirmation and reporting purposes. By expanding the analytical capabilities to include a vast range of analytes, this method improves the likelihood of identifying substances that may otherwise go undetected and reduces the need for multiple separate tests, thereby enhancing the overall effectiveness of toxicological investigations.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"407-416"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964574","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}
Elizabeth Pobee, Gloria Daziani, Prince S Gameli, Giuseppe Basile, Jeremy Carlier, Anastasio Tini
{"title":"Identification of alexamorelin consumption biomarkers using human hepatocyte incubations and high-resolution mass spectrometry.","authors":"Elizabeth Pobee, Gloria Daziani, Prince S Gameli, Giuseppe Basile, Jeremy Carlier, Anastasio Tini","doi":"10.1093/jat/bkaf038","DOIUrl":"10.1093/jat/bkaf038","url":null,"abstract":"<p><p>Alexamorelin is a synthetic peptide and growth hormone secretagogue (GHS) with potential performance-enhancing properties, making its use and abuse a topic of interest in clinical research and doping monitoring. Alexamorelin mimics the natural peptide hormone ghrelin by binding to the GHS type 1a receptor (GHS-R1a) in the pituitary gland, thereby promoting endogenous growth hormone release. Identifying alexamorelin and/or its metabolite biomarkers is crucial for effective doping controls. The purpose of this study was to determine and characterize biomarkers associated with alexamorelin intake. In silico metabolite predictions were performed using GLORYx freeware, and in vitro incubations were conducted with pooled human hepatocytes from 10 donors. Samples were analysed using liquid chromatography-high-resolution tandem mass spectrometry (LC-HRMS/MS), with data processed through Thermo Scientific's Compound Discoverer. GLORYx predicted 21 single-reaction metabolites. N-Acetylation was identified as the primary transformation, with the highest probability score (98%), and occurring either at the C-terminal Ala or the N-terminal Lys. Other predicted transformations included N-oxidation, hydroxylation, amide hydrolysis, oxidative deamination, and phase II N-glucuronidation, with probability scores below 40%. All these transformations were predicted to occur at the two C-terminal (Ala or His) or N-terminal (d-Phe or Lys) amino acids. After 3 h of incubation with hepatocytes, only one metabolite (known as examorelin or hexarelin) was detected, resulting from the C-terminal cleavage of the Ala amino acid; this metabolic reaction is mediated by a carboxypeptidase. The alexamorelin signal decreased approximately 150-fold after 3 h, indicating significant hepatic metabolism. However, examorelin itself is a commercially available GHS secretagogue, and thus, it is not specific to alexamorelin consumption. Detecting alexamorelin remains critical to documenting its use.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":"394-400"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225557","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}
Laura Labay, Kari M Midthun, Sherri L Kacinko, Donna M Papsun
{"title":"Drug Identification in Biologicals on Clothing, Bedding, and Other Materials.","authors":"Laura Labay, Kari M Midthun, Sherri L Kacinko, Donna M Papsun","doi":"10.1093/jat/bkaf057","DOIUrl":"https://doi.org/10.1093/jat/bkaf057","url":null,"abstract":"<p><p>Toxicology testing is an integral component of postmortem, drug-facilitated crime, and driving under the influence investigations. Recommendations pertaining to traditional matrices, sample amounts, and collection container types are well documented in the literature and guidance documents. However, not all cases have traditional toxicological specimens available (e.g., blood with a fluoride additive), and thus require non-traditional toxicology test options. In these cases, a forensic laboratory is contacted to determine if non-traditional objects, such as clothing, bedding, automotive, personal hygiene, or household items, stained with biological material, are suitable for analysis. Comprehensive method validation, as required for routine toxicology tests, is not practical to complete for these items, but this should not deter the toxicology laboratory from taking on this work. Herein, we describe a developed and implemented process for qualitative analysis of biological fluids on/in objects, which ensures the robustness and reliability of reported results. The specific procedures used, which include sample preparation, the incorporation of specialized quality control samples made from the items themselves, analytical acceptance criteria, and reporting considerations are thoroughly detailed. Positive findings from cases were obtained for a variety of drugs, encompassing illicit, prescription, novel psychoactive substances, and over-the-counter medications. Some examples include identification of zolpidem from vomit on clothing; cocaine, cocaine metabolites, levamisole, codeine, acetaminophen, and caffeine in stains on bedding; and diphenhydramine, doxylamine, and dextromethorphan in stains on a mattress pad cover. This methodology is fit-for-purpose and suitable for the toxicological investigation of these unique specimens without any significant limitations. This testing process may be used to identify past drug exposure, associate drug exposure to a particular location or scene, and/or provide insight into an event when a missing person has not been found.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528061","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}
Adeolu O Adegoke, Alexandria N Jackson, Sonia L La'ulu, Chelsie Anderson, Joseph W Rudolf, Jessica M Boyd, Kamisha L Johnson-Davis
{"title":"Immunalysis Tapentadol Assay Reformulation Resolves Tramadol Interference.","authors":"Adeolu O Adegoke, Alexandria N Jackson, Sonia L La'ulu, Chelsie Anderson, Joseph W Rudolf, Jessica M Boyd, Kamisha L Johnson-Davis","doi":"10.1093/jat/bkaf060","DOIUrl":"https://doi.org/10.1093/jat/bkaf060","url":null,"abstract":"<p><p>This study evaluated the performance of the Immunalysis Tapentadol 343 Urine Enzyme Immunoassay (EIA) screening kit, focusing on the prevalence of false-positive results due to cross-reactivity with tramadol. Tapentadol is a dual-action analgesic, modulating μ-opioid receptors and inhibiting norepinephrine reuptake, while tramadol, a structurally related compound, is a weak μ-opioid receptor agonist and norepinephrine/serotonin reuptake inhibitor. Cross-reactivity between these compounds can complicate urine drug screening results for adherence monitoring in chronic pain management. A total of 28 samples initially produced false-positive results for tapentadol BNl using the Immunalysis Tapentadol 343 Urine EIA screening kit. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to confirm the absence of tapentadol. Of the false-positive samples, 61% contained tramadol at concentrations below the manufacturer-reported cross-reactivity threshold of 60,000 ng/mL, indicating assay limitations in specificity. To address this issue, a newly reformulated Immunalysis Tapentadol 343UR Urine HEIA kit was evaluated for tramadol cross-reactivity. Upon retesting the 28 false-positive samples with the reformulated kit, no false positives were detected, with results consistent with LC-MS/MS confirmation. The rate of false-positive tapentadol screen in urine has substantially reduced since the implementation of the new tapentadol kit in routine testing. These findings demonstrate the importance of assay verification to assess cross-reactivity, particularly for structurally related compounds. The reformulated Immunalysis Tapentadol 343UR kit shows improved specificity, reducing false-positive rates and enhancing the accuracy of tapentadol detection in clinical and forensic toxicology applications.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528073","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}
Charles Perkins, Corissa Rodgers, Peter Stout, Dayong Lee
{"title":"Evaluation of Sevoflurane Interference with Forensic Blood Ethanol Analysis, Including Sevoflurane Stability, and an Authentic Case.","authors":"Charles Perkins, Corissa Rodgers, Peter Stout, Dayong Lee","doi":"10.1093/jat/bkaf058","DOIUrl":"https://doi.org/10.1093/jat/bkaf058","url":null,"abstract":"<p><p>Sevoflurane, a volatile anesthetic routinely used in clinical settings, was investigated to determine the extent of its interference with in-house forensic blood ethanol analysis. This potential interference could have a significant impact on the analysis and subsequently the interpretation of ethanol in human performance antemortem forensic toxicology casework (e.g., Driving While Under the Influence (DWI) cases). Blood samples with ethanol concentrations spanning 0.02-0.40 g/100 mL were fortified with sevoflurane and analyzed using two different dual-column headspace-gas chromatography with flame ionization detection instruments. Sevoflurane was found to elute as an interference peak near ethanol on column 1 (BAC1) and co-elute with ethanol on column 2 (BAC2); the differences were due to the column chemistries. Analyte identification and quantification acceptance criteria monitored included peak-to-valley ratio (resolution) and percent difference between individual column concentrations and the average value of both column concentrations. A 2023 DWI case exhibited potential sevoflurane interference and demonstrated the importance of ethanol reporting acceptance criteria for detecting such interference. In the majority of experiments with sevoflurane and ethanol present in the samples, sevoflurane presence caused failing acceptance criteria to report ethanol results, but if acceptance criteria were met, the ethanol concentration was slightly elevated. An additional sevoflurane stability study showed that the highly volatile sevoflurane could evaporate between analysis and re-analysis due to additional tube openings. The decrease of sevoflurane was monitored at each opening of the tube using relative peak areas. HFSC re-analyzes suspected sevoflurane samples, as the additional tube openings could allow sevoflurane to evaporate.</p>","PeriodicalId":14905,"journal":{"name":"Journal of analytical toxicology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528062","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}