Journal of clinical gastroenterology最新文献

{"title":"The Global Burden of Esophageal Cancer in Older Adults: Spatiotemporal Patterns and Disparities, 1990-2021.","authors":"Minxia Yang, Liejiong Wang, Xiuxia Chen, Feng Xuan","doi":"10.1097/MCG.0000000000002241","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002241","url":null,"abstract":"<p><strong>Goals: </strong>To assess esophageal cancer (EC) burdens among older adults aged 60+ from 1990 to 2021.</p><p><strong>Background: </strong>With the aging global population, EC in elderly presents a significant health challenge.</p><p><strong>Study: </strong>2021 Global Burden of Disease (GBD) data were used to calculate age-standardized rates (ASRs) for incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression was used to calculate the average annual percentage change (AAPC) to assess temporal trends. Pearson's correlation analysis investigated the relationship between socio-demographic index (SDI) and the male-to-female ratios of ASRs.</p><p><strong>Results: </strong>In 2021, there were 421,336 incident cases, 655,313 prevalent cases, 410,902 deaths, and 8,059,156 DALYs due to EC in older adults globally, doubling since 1990. The age-standardized incidence rate, age-standardized mortality rate, and age-standardized DALYs rate exhibited decline from 1990 to 2021, with respective AAPCs of -0.62 (95% CI: -0.76 to -0.48), -0.9 (95% CI: -1.05 to -0.75), and -1.11 (95% CI: -1.25 to -0.97), while age-standardized prevalence rate (AAPC: -0.04, 95% CI: -0.16 to 0.09) remained stable. Western Sub-Saharan Africa experienced the steepest rise in ASRs from 1990 to 2021, while East Asia recorded the highest ASRs in 2021. The male-to-female ratios for all ARSs increased globally from 1990 to 2021, with a significantly positive correlation between the gender ratios and SDI.</p><p><strong>Conclusion: </strong>EC poses a growing challenge for elderly populations, with clear geographic and gender disparities. Targeted interventions are necessary to mitigate the increasing burden in older adults.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955819","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":"Proficiency in Esophageal Peroral Endoscopic Myotomy: A Meta-Analysis of Learning Curves.","authors":"Yizhong Wu, Alexander Grieme, Manuel Garza, Erica Yatsynovich, Erik Rahimi, Azizullah Beran, Marco Spadaccini, Lumir Kunovsky, Daryl Ramai","doi":"10.1097/MCG.0000000000002240","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002240","url":null,"abstract":"<p><strong>Introduction: </strong>Our analysis examines the learning curve of peroral endoscopic myotomy (POEM) training using procedure duration as a key indicator of proficiency.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane, and Web of Science from inception until November 2024 for studies evaluating the learning curve of POEM. We divided the data into 0-20, 20-40, and 40-60 cumulative procedure phases of learning. Analysis of variance was performed with Tukey HSD post hoc tests to analyze differences in procedure time between groups. We also calculated means from the pooled data for the number of procedures to achieve proficiency, plateau procedure time postproficiency, plateau myotomy speed, and myotomy length. In addition, an analysis based on an inverse curve regression was also performed to assess the proficiency threshold.</p><p><strong>Results: </strong>Eleven studies, including 3197 POEM procedures, were included. Mean procedure time for the first, second, and third phases of learning were 99.4±35.2, 87.4±23.1, and 85.4±23.1 minutes, respectively. The 0-20 group had significantly higher mean procedure time than the 20-40 group (P<0.0001) and the 40-60 group (P<0.0001). Mean procedure time was not significantly different between the 20-40 and 40-60 groups (P=0.69). Mean number of procedures to achieve proficiency was 33.29. Mean plateau procedure time following achievement of proficiency was 80.25 minutes. Mean postproficiency plateau myotomy speed was 7.71 minutes per cm of myotomy. Mean length of myotomy was 10.43±1.86 cm.</p><p><strong>Conclusion: </strong>POEM learners achieved proficiency in procedure speed in the 20-40 learning phase with no significant change with further experience.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955803","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":"Evaluating Myotomy Length in POEM for Achalasia: A Grade-Assessed Meta-Analysis of Randomized Controlled Trials.","authors":"Islam Rajab, Husam Abu Suilik, Ameer Awashra, Othman Saleh, Moayad Alhawi, Abdelrahman Ashour, Mohamed S Elgendy, Mohamed Abu Suilik, Mina F Alkomos, Yana Cavanagh, Abdallah Hussein","doi":"10.1097/MCG.0000000000002243","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002243","url":null,"abstract":"<p><strong>Background: </strong>Peroral endoscopic myotomy (POEM) is a standard achalasia treatment, matching surgery in efficacy. However, myotomy length varies. Shorter myotomies are gaining attention for potential benefits. This study compares short versus long myotomies to identify the optimal approach.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of Randomized Controlled Trials (RCTs) retrieved from PubMed (MEDLINE), Scopus, Web of Science (WoS), and Cochrane Central Register of Controlled Trials (CENTRAL) until November 28, 2024. Pooled results were calculated using risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes, with 95% CI (PROSPERO ID: CRD42024621638).</p><p><strong>Results: </strong>Four RCTs with 419 patients were included. Clinical success (Eckardt score ≤3) showed no significant difference between short and long myotomy (97.4% vs. 95.9%, RR: 1.02 with 95% CI: 0.98-1.06, P=0.33), Reflux symptoms (RR: 0.93, 95% CI: 0.60-1.47, P=0.77), and reflux esophagitis (RR: 0.83, 95% CI: 0.55-1.27, P=0.39). However, short myotomy significantly reduced pathologic acid exposure (RR: 0.57, 95% CI: 0.36-0.91, P=0.02), procedural time (MD: -16.61 min, 95% CI: -26.40 to -6.81, P<0.001), and hospital stay (MD: -2.37 d, 95% CI: -4.67 to -0.06, P=0.04). Intraprocedural complications were similar (P=0.73), as was integrated relaxation pressure (P=0.95), indicating similar postoperative esophageal function.</p><p><strong>Conclusion: </strong>Short myotomy reduced acid exposure, procedure time, and hospital stay in POEM for achalasia without compromising clinical success or symptom improvement. It shows potential as an effective treatment, but large-scale RCTs are needed for definitive clinical endorsement.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955840","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":"When Normal Imaging Says Enough: Rethinking the Role of Patency Capsule in Crohn's Disease.","authors":"Mengjia Chen, Yuanhan Lin, Bujiang Wang","doi":"10.1097/MCG.0000000000002246","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002246","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955823","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":"Refining Risk Estimates Between Pancreatitis and Pancreatic Cancer in Meta-Analytic Models.","authors":"Jinyu Wu, Shiquan Yu","doi":"10.1097/MCG.0000000000002245","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002245","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955860","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":"Efficacy of Nonpharmacological Interventions and Combination With Pharmacological Interventions for Gastroesophageal Reflux Disease: A Systematic Review and Network Meta-Analysis.","authors":"Mei Huang, Zelin Yu, Linlin Wu, Hanyu Liu, Peiqi Li, Jia Yu, Hantong Hu, Jianqiao Fang, Xiaomei Shao","doi":"10.1097/MCG.0000000000002239","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002239","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of nonpharmacological therapies for patients with gastroesophageal reflux disease (GERD) has been progressively proved. However, the specific differences in effectiveness among various nonpharmacological interventions and their combinations with pharmacological interventions remain unclear, and the optimal intervention strategy has yet to be conclusively determined.</p><p><strong>Methods: </strong>Systematic searches were conducted in PubMed, Web of Science, Embase, Cochrane, and CNKI from inception to November 6, 2024. A network meta-analysis was conducted using a random effects consistency model within a Bayesian framework with lower esophageal sphincter (LES) pressure as the primary outcome indicator.</p><p><strong>Result: </strong>Thirty-three studies involving 10 nonpharmacological interventions were included. Acupoint stimulation with traditional Chinese medicine (TCM) (SMD=5.83, 95% CI: 1.23 to 10.16), and breathing training with conventional Western medicine (CWM) (SMD=3.88, 95% CI: 0.45 to 7.52) significantly improved LES pressure and reduced esophageal acid exposure time (AET) (SMD=-5.01 to -3.32). In terms of safety, acupoint stimulation with TCM (logOR=-2.51, 95% CI: -5.91 to -0.19) exhibited a significant advantage over CWM. However, acupoint stimulation combined with TCM and breathing training with CWM did not demonstrate a significant improvement in GERD health-related quality of life questionnaire (HRQL) scores.</p><p><strong>Conclusion: </strong>Acupoint stimulation combined with TCM and breathing training with CWM, when compared with CWM and other nonpharmacological interventions, is considered a potential adjunctive therapeutic approach for GERD, demonstrating both efficacy and safety. However, methodological limitations necessitate cautious interpretation of results.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955808","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":"Evaluating the Impact of Early Palliative Care Consultation on 30-Day and 90-Day Readmissions Among Patients With Decompensated Cirrhosis: A National Perspective.","authors":"Aya Akhras, Saadia Nabi, Kristen Santana, Luis Santiago Zayas, Waseem Wahood, Deannys Batista, Sinay Ceballos, Bernardo Reyes, Franklin Kasmin","doi":"10.1097/MCG.0000000000002235","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002235","url":null,"abstract":"<p><strong>Introduction: </strong>Decompensated cirrhosis leads to recurrent hospitalizations among patients with chronic liver disease. Addressing goals of care early can help alleviate stress, reduce health care utilization and potentially improve quality of life in these patients. Research has shown that palliative care (PC) is used infrequently and often too late in decompensated cirrhosis. Moreover, patients with cirrhosis who are denied a liver transplant are rarely referred to PC. We investigated the impact of PC consultations on unplanned readmissions among patients with decompensated cirrhosis in a nationally representative cohort.</p><p><strong>Methods: </strong>The National Readmission Database was queried from 2010 to 2019 for patients with decompensated cirrhosis using corresponding International Classification of Diseases, 10th edition codes. Patients were categorized by whether they received PC consultation during their index admission. Multivariable, hierarchical logistic regression was conducted to assess factors of receiving PC and unplanned 30-day and 90-day readmissions.</p><p><strong>Results: </strong>Among 1,630,819 patients with decompensated cirrhosis, 121,400 (7.4%) received PC consultation at index admission. Patients had higher odds of receiving PC consultations with increasing age (OR: 1.026), comorbidities such as congestive heart failure (OR: 1.172), renal failure (OR: 1.31), metastatic cancer (OR: 2.82), solid tumors without metastasis (OR: 2.37), and alcohol use disorder (OR: 1.34) (P<0.001). Moreover, patients who received PC consultations had significantly lower odds of unplanned 30-day (OR: 0.337) and 90-day (OR: 0.268) readmissions compared with patients without (P<0.001).</p><p><strong>Conclusion: </strong>PC consultation was associated with lower odds of unplanned 30-day and 90-day readmission among patients with decompensated cirrhosis. Because patients with multiple comorbidities were most likely to receive PC, earlier and broader engagement of PC may further alleviate stress and improve outcomes in this high-risk population.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955857","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":"Fecal Short and Branched Chain Acids as Possible Biomarkers for Inflammatory Bowel Disease and UC and CD Subgroups? A Case-Control Study.","authors":"Justin K Gray, Baochuan Guo, Abdelraheem Baniahmad, Buthina Odat, Nadia Abdelkader, Rebecca L Bearden","doi":"10.1097/MCG.0000000000002237","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002237","url":null,"abstract":"<p><strong>Goals: </strong>Investigate feasibility of short (SCFA) and branched chain fatty acids (BCFA) in human stool as biomarkers for inflammatory bowel disease (IBD).</p><p><strong>Background: </strong>Interest in fecal SCFAs and BCFAs has increased. Evidence shows strong connections between these metabolites and IBD pathogenesis and pathophysiology.</p><p><strong>Study: </strong>A case-control study of 74 stool samples (21 healthy; 24 ulcerative colitis, UC; 29 Crohn's disease, CD) was quantified using a validated, gas chromatography-mass spectrometry (GC-MS) method for acetic, propionic, isobutyric, butyric, isovaleric, valeric, and caproic acid (μg/g stool). Bristol Stool Form Scale (BSFS) and pH were recorded.</p><p><strong>Results: </strong>Receiver operator curve (ROC) analysis resulted in area under the curve (AUC) value of 0.96 (95% CI: 0.89-0.98, P <0.001), with 92% sensitivity and 81% specificity using the acetic/(propionic+butyric+isovaleric+valeric acid) transformation between healthy and IBD groups. ROC analysis resulted in AUC of 0.83 (95% CI: 0.66-0.92, P <0.001), with 75% sensitivity and 86% specificity using the acetic/(isobutyric/propionic acid) transformation between UC and CD subgroups. Acetic acid was the most abundant SCFA (72/74 samples) and nonsignificantly different between groups (healthy vs. IBD; P ≥0.05, 0.161 and UC vs. CD; P ≥0.025, 0.623).</p><p><strong>Conclusions: </strong>Fecal SCFAs and BCFAs demonstrated feasibility as biomarkers for IBD. Increased sensitivity and specificity were achieved over fecal calprotectin (FCP) tests between healthy and IBD patients. No useable data was found in the literature to use a validation cohort.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955793","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":"Effectiveness of Switching From Intravenous to Subcutaneous Infliximab in Patients With Inflammatory Bowel Disease: An individual participant data meta-analysis.","authors":"Fraser Cummings, Philip J Smith, Mathurin Fumery, Sohail Rahmany, Sreedhar Subramanian, Buki Kwon, Soyeon Park, Young Nam Lee, Anthony Buisson","doi":"10.1097/MCG.0000000000002228","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002228","url":null,"abstract":"<p><strong>Goals: </strong>We assessed clinical outcomes over 6 months in an integrated analysis of inflammatory bowel disease (IBD) patients switching from intravenous (IV) to subcutaneous (SC) infliximab (IFX).</p><p><strong>Background: </strong>Real-world data from large multinational IBD patient populations treated with SC IFX are lacking.</p><p><strong>Study: </strong>This individual participant data meta-analysis combined anonymized data from 3 real-world cohorts and evaluated clinical remission [Crohn's disease (CD): Harvey-Bradshaw Index (HBI)/modified HBI (mHBI) <5; ulcerative colitis (UC): Simple Clinical Colitis Activity Index (SCCAI)/partial Mayo score (PMS) <3], disease activity (HBI/mHBI/SCCAI/PMS), treatment persistence, pharmacokinetics, immunogenicity, biomarkers [fecal calprotectin (FCP); C-reactive protein (CRP)], and reasons for discontinuation. Subgroup analyses determined the effect of clinical parameters on outcomes.</p><p><strong>Results: </strong>Of 428 patients (CD, n=302; UC, n=126), 85.4% were in clinical remission at baseline, which was maintained at 6 months (84.7%), and was higher in patients with CD versus UC (89.8% vs. 71.9%; P<0.001); disease activity scores remained low. High treatment persistence was observed (94.5%) at 6 months. Median serum IFX levels increased from 5.6 μg/mL at baseline to 16.0 μg/mL at 6 months. Most patients (96.1%) maintained negative antidrug antibody status and low levels of FCP and CRP up to 6 months. Drug discontinuation rate was low (5.8%). Intensified preswitch IV IFX was the only factor negatively associated with CD remission at 6 months [intensified vs. standard estimated marginal mean probability difference -0.107 (95% CI: -0.191, -0.024); P=0.012].</p><p><strong>Conclusions: </strong>Switching from IV to SC IFX maintains clinical effectiveness in patients with IBD regardless of various patient factors.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873433","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":"Association of NAFLD and Cardiovascular Events: A Systematic Review and Meta-analysis.","authors":"Mannat K Bhatia, Archit Garg, Junaid Ali, Allan Santos, Mehar K Bhatia, Birgurman Singh, Mehak Bassi, Arkady Broder, Douglas G Adler","doi":"10.1097/MCG.0000000000002232","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002232","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated fatty liver disease (MAFLD) is increasingly recognized as a risk factor for cardiovascular disease (CVD) but the association remains unclear. This systematic review and meta-analysis aimed to quantify these associations.</p><p><strong>Methodology: </strong>We searched multiple databases for articles reporting CVD outcomes in MAFLD and conducted meta-analysis.</p><p><strong>Results: </strong>A total of 49 studies encompassing 1,553,770 individuals with MAFLD were included. MAFLD without advanced fibrosis was significantly associated with increased risks of fatal (HR 1.46, 95% CI 1.23-1.73; P<0.01), nonfatal (HR 1.54, CI 1.29-1.84; P<0.01), and combined CVD events (HR 1.60; CI 1.30-1.97; P<0.01). MAFLD with advanced fibrosis was significantly associated with combined CVD events (HR 1.79, CI 1.09-2.92; P<0.01) but not with fatal CVD events (HR 1.23, CI 1.00-1.52; P=0.06) or nonfatal CVD events (HR 1.08, CI 0.82-1.42; P=0.582).</p><p><strong>Conclusion: </strong>MAFLD, even without advanced fibrosis, is an independent risk factor for CVD. The risk is amplified with advanced fibrosis, particularly for combined CVD events.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784374","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}