Journal of clinical gastroenterology最新文献

{"title":"Stool Antigen Test for Helicobacter Pylori Infection in Adults: A Meta-analysis of Diagnostic Test Accuracy.","authors":"Marcel Silva Luz, Caroline Tianeze de Castro, Fabian Fellipe Bueno Lemos, Gabriel Reis Rocha, Gabriel Lima Correa Santos, Samuel Luca Rocha Pinheiro, Luis Guilherme de Oliveira Silva, Mariana Santos Calmon, Márcio Vasconcelos Oliveira, Kádima Nayara Teixeira, Dulciene Maria de Magalhães Queiroz, Fabrício Freire de Melo","doi":"10.1097/MCG.0000000000002102","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002102","url":null,"abstract":"<p><strong>Objective: </strong>The stool antigen test (SAT) is a convenient noninvasive option for the diagnosis of Helicobacter pylori (H. pylori) infection. However, despite having been previously evaluated, there is currently a lack of evidence regarding the comparative accuracy of conventional and rapid SATs utilizing monoclonal or polyclonal antibodies in adults. Here, we perform a thorough statistical synthesis to determine and compare the diagnostic accuracy of conventional and rapid SATs for the diagnosis of H. pylori infection in adults.</p><p><strong>Materials and methods: </strong>We conducted independent searches through July 25, 2023, for studies evaluating the accuracy of SAT against a reference standard. We assessed methodological quality using Quality Assessment of Diagnostic Accuracy Studies-2 and calculated overall accuracy measures using the bivariate random-effect model. We also conducted subgroup analyses based on model and assessment technique, and Spearman correlation analysis to investigate a possible threshold effect. We generated summary receiver operating characteristic curves to assess heterogeneity and evaluated publication bias.</p><p><strong>Results: </strong>Conventional SAT demonstrated superior sensitivity (92.19% vs 85.79%), specificity (92.93% vs 91.18%), likelihood ratios (LR+ 9.68 vs 8.16; LR- 0.10 vs 0.15), and area under the curve (0.958 vs 0.940) compared with rapid SAT. Notably, the diagnostic odds ratio for conventional SAT (114.70) significantly outperformed rapid SAT (diagnostic odds ratio: 57.72). Correlation analysis revealed no threshold effect and summary receiver operating characteristic curves showed consistent accuracy for both tests.</p><p><strong>Conclusion: </strong>Our study establishes evidence of the superior diagnostic accuracy of conventional SATs over rapid SATs for detecting H. pylori infection in adults. Also, we provide valuable insights into the impact of using monoclonal or polyclonal antibodies and different assessment techniques on diagnostic accuracy measures.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391031","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":"Clinical Impact of High-dose Esomeprazole-amoxicillin Dual Therapy as Rescue Treatment for Helicobacter pylori Infection: A Prospective, Multicenter, Randomized Trial.","authors":"Chao Wang, He-Jie Wang, Keng Li, Yin Wang, Yuan-Yuan Lin, Cheng-Zhao Weng, Jie Chen, Shao-Hua Xie, Wei Jiang, Yu-Cheng Zhu","doi":"10.1097/MCG.0000000000002100","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002100","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the effectiveness and safety of high-dose dual therapy (HDDT) using esomeprazole and amoxicillin to furazolidone-based quadruple therapy (FBQT) in treating nonresponsive patients with Helicobacter pylori (H. pylori) infection.</p><p><strong>Materials and methods: </strong>A total of 209 patients with H. pylori infection, who had previously received ineffective treatment and visited an outpatient clinic, were randomly assigned to either the HDDT or FBQT groups. All patients underwent a 14-day treatment regimen, and the success rates of H. pylori eradication and safety of the treatment regimens were assessed 4 weeks posttreatment.</p><p><strong>Results: </strong>Following the 14-day treatment period, the intention-to-treat (ITT) analysis revealed eradication rates of 93.6% for HDDT and 86.9% for FBQT. In the per-protocol (PP) analysis, eradication rates were 94.5% for HDDT and 88.7% for FBQT. No significant difference in eradication rates was observed between the two groups. HDDT exhibited significantly lower rates of adverse reactions (9.1% in ITT and 9.2% in PP) compared with FBQT (58.6% in ITT and 59.8% in PP). Multivariate analysis identified interval time, alkaline phosphatase, and serum creatinine level as factors influencing the eradication rate. The area under the receiver operating curve of the interval time between the FBQT group and the HDDT group and the success of H. pylori eradication were 0.622 and 0.578, respectively. The optimal salvage treatment intervals were determined as 6 months for FBQT and 1 year for HDDT.</p><p><strong>Conclusion: </strong>HDDT using high-dose esomeprazole and amoxicillin demonstrated efficacy in treating H. pylori infection, with the added benefits of reduced side effects and improved medication compliance compared with FBQT. HDDT can be considered a rescue treatment option when other methods fail, with treatment intervals optimized accordingly.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576210","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":"The Effects of Gluten-free Diet on Body Mass Indexes in Adults with Celiac Disease: A Systematic Review and Meta-analysis of Observational Studies.","authors":"Noam Peleg, Yaron Niv, Ram Dickman, Doron Boltin, Alex Krauthammer, Michal Herman-Edelstein, Nidal Issa, Jacob E Ollech, Tom Konikoff, Rachel Gingold-Belfer","doi":"10.1097/MCG.0000000000001998","DOIUrl":"10.1097/MCG.0000000000001998","url":null,"abstract":"<p><strong>Goals and background: </strong>Gluten-free diet (GFD) includes a higher intake of sugars and fats. Previous studies have investigated its effect on body mass index (BMI) in celiac disease (CD) patients but had contradictive conclusions. Thus, we conducted a systematic review and meta-analysis examining the effect of GFD on BMI in CD patients.</p><p><strong>Study: </strong>Systematically, we conducted literature research using Medline, Scopus, and Embase, and we identified 1565 potential studies/abstracts. Only studies of patients with CD under a GFD with recorded BMI before and after dietary intervention were included. Subgroup analyses based on study design and BMI categories were performed. We calculated the pooled odds ratios (ORs) and 95% confidence intervals (Cls) for the number of patients in each BMI group according to the World Health Organization (WHO) definitions after GFD using fixed and random effect meta-analysis.</p><p><strong>Results: </strong>The analysis included 10 studies and 38 sub-studies/data sets, which encompassed 2450 patients from 5 countries. We found nonsignificant odds for changing the BMI group (pooled OR 0.972, 95% CI: 0.858-1.101, P =0.65) after GFD. However, looking specifically at BMI subgroups, we found higher odds for BMI category change after GFD in underweight patients (OR 0.588, 95% CI: 0.479-0.723, P <0.001), and overweight patients,25<BMI<30, (OR 1.332, 95% CI: 1.167-1.521, P <0.001). No publication bias was demonstrated, and the amount of heterogeneity between studies was moderate ( I2 =54.13).</p><p><strong>Conclusion: </strong>Although crucial in patients with CD, GFD is associated with increased BMI in some CD patient populations. Accordingly, special considerations and follow-up should be maintained in overweight patients with CD after GFD.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"989-997"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305777","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":"Somatization Mediates the Relationship Between Childhood Trauma and Pain Ratings in Patients with Irritable Bowel Syndrome.","authors":"Abigail Schubach, Brian M Quigley, Jeffrey M Lackner, Gregory D Gudleski","doi":"10.1097/MCG.0000000000001974","DOIUrl":"10.1097/MCG.0000000000001974","url":null,"abstract":"<p><strong>Goals: </strong>To identify potential mechanisms by which childhood trauma may lead to the adult development of abdominal symptoms in patients with irritable bowel syndrome (IBS).</p><p><strong>Background: </strong>Patients with IBS frequently report a history of childhood trauma. The pathophysiology by which abdominal pain arises in patients with IBS is multidimensional, consisting of both peripheral factors, such as altered motility, inflammation, and bacterial overgrowth, as well as central factors, such as psychological distress and neuro-hormonal dysregulation.</p><p><strong>Study: </strong>Adult psychological factors (anxiety, depression, and somatization) were examined to determine if they mediate the relationship between retrospective reports of childhood trauma and current adult IBS abdominal symptoms in a study of 436 patients (M age=41.6, 79% F) meeting Rome III diagnosis criteria. Childhood trauma was measured using retrospective questions assessing physical and sexual abuse. Psychological factors in adulthood were measured with the subscales of the Brief Symptom Inventory-18. Outcome variables included adult IBS symptoms of abdominal pain, bloating, and satisfaction with bowel habits from the IBS Symptoms Severity Scale.</p><p><strong>Results: </strong>Results indicated that somatization mediated the relationship between childhood abuse and abdominal pain and bloating but not bowel satisfaction.</p><p><strong>Conclusions: </strong>This study provides insight into the multifactorial nature of IBS-associated abdominal pain in patients with a history of childhood trauma, elucidating the need for a trauma-informed treatment approach for patients with histories of abuse.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"1034-1042"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544781","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":"A New Era in Colorectal Cancer Screening With Cell-free DNA (cfDNA) Tests-A View From Pakistan.","authors":"Khushal Khan, Kashif Mehmood, Shayan Ahmad","doi":"10.1097/MCG.0000000000002050","DOIUrl":"10.1097/MCG.0000000000002050","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"1058"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751825","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":"Conventional Versus Traction Endoscopic Submucosal Dissection for Colorectal Tumors: A Meta-analysis of Randomized Controlled Trials.","authors":"Sahib Singh, Babu P Mohan, Saurabh Chandan, Neil Sharma, Rakesh Vinayek, Sudhir Dutta, Sergey V Kantsevoy, Michelle Le, Douglas G Adler","doi":"10.1097/MCG.0000000000001973","DOIUrl":"10.1097/MCG.0000000000001973","url":null,"abstract":"<p><strong>Introduction: </strong>Compared with conventional endoscopic submucosal dissection (C-ESD) for colorectal lesions, the traction method (T-ESD) allows the lesion to be stabilized with easier dissection. However, randomized controlled trials (RCTs) have reported conflicting results on the clinical outcomes of T-ESD as compared with C-ESD. We conducted a meta-analysis to compile the data.</p><p><strong>Methods: </strong>Multiple databases were searched for RCTs evaluating C-ESD versus T-ESD for colorectal tumors. The end points of interest were procedure time (min), resection speed (mm²/min), R0 resection, en bloc resection, delayed bleeding, and perforation. Standard meta-analysis methods were employed using the random-effects model.</p><p><strong>Results: </strong>Six RCTs with a total of 566 patients (C-ESD n=284, T-ESD n=282) were included. The mean age was 67±10 y and 60% were men. As compared with the T-ESD technique, the C-ESD group was associated with longer procedure time (SMD 0.91, 95% CI 0.58 to 1.23, P <0.00001) and lesser resection speed (SMD -1.03, 95% CI -2.01 to -0.06, P =0.04). No significant difference was found in the 2 groups with respect to R0 resection rate (RR 1.00, 95% CI 0.94 to 1.06, P =0.87), en bloc resection (RR 0.99, 95% CI 0.97 to 1.01, P =0.35), delayed bleeding (RR 0.66, 95% CI 0.17 to 2.59, P =0.55) and perforation (RR 2.16, 95% CI 0.75 to 6.27, P =0.16).</p><p><strong>Discussion: </strong>On meta-analysis, pooled procedure time was significantly faster with T-ESD compared with C-ESD. The clinical outcomes, however, were comparable.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"1016-1021"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519298","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":"World Gastroenterology Organisation (WGO) News and Events.","authors":"James Melberg","doi":"10.1097/MCG.0000000000002077","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002077","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":"58 10","pages":"i"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882218","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":"The Crohn's Disease-Health Index: Development and Evaluation of a Novel Outcome Measure.","authors":"Anika Varma, Jennifer Weinstein, Jamison Seabury, Spencer Rosero, Ellen Wagner, Christine Zizzi, Aaron Kaat, Elizabeth Luebbe, Nuran Dilek, John Heatwole, Lawrence Saubermann, Larissa Temple, Scott Rogoff, Chad Heatwole","doi":"10.1097/MCG.0000000000001976","DOIUrl":"10.1097/MCG.0000000000001976","url":null,"abstract":"<p><strong>Objective: </strong>We sought to develop and validate the Crohn's Disease-Health Index (CD-HI), a disease-specific, patient-reported outcome measure that serially measures Crohn's disease (CD) symptomatic burden in adults with CD.</p><p><strong>Background: </strong>As therapeutic interventions are tested among patients with CD, responsive outcome measures are needed to track disease progression and therapeutic gain during clinical trials.</p><p><strong>Patients and methods: </strong>We conducted a national cross-sectional study of individuals with CD to identify the most prevalent and impactful symptoms of CD. The most relevant symptoms were included in the CD-HI. We used factor analysis, qualitative patient interviews, test-retest reliability evaluation, and known group validity testing to evaluate and optimize the CD-HI.</p><p><strong>Results: </strong>The CD-HI contains 12 subscales that comprehensively measure CD burden using the patient's perspective. Fifteen adults with CD beta tested the CD-HI and found the instrument to be clear, easy to use, and relevant to them. Twenty-three adults with CD participated in an assessment of test-retest reliability, which indicated high reliability of individual questions, subscales, and the full instrument (intraclass correlation coefficient = 0.84 for the full instrument). The CD-HI and its subscales demonstrated a high internal consistency (Cronbach α = 0.98 for the full instrument). The CD-HI distinguished between groups of individuals with CD known to differ in disease severity.</p><p><strong>Conclusions: </strong>This research supports the use of the CD-HI as a valid, sensitive, reliable, and relevant patient-reported outcome to determine the multifactorial disease burden of those with CD, assess the relevance and merit of future CD therapies, and support drug labeling claims.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"1043-1051"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drugs Effective for Nonsteroidal Anti-inflammatory Drugs or Aspirin-induced Small Bowel Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Younghee Choe, Jae Myung Park, Joon Sung Kim, Yu Kyung Cho, Byung-Wook Kim, Myung-Gyu Choi, Na Jin Kim","doi":"10.1097/MCG.0000000000001975","DOIUrl":"10.1097/MCG.0000000000001975","url":null,"abstract":"<p><strong>Objective: </strong>The frequency of small bowel (SB) injuries has increased due to the increased use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin. This study was a systematic review and meta-analysis to compare drugs effective for SB injuries caused by NSAIDs or aspirin use.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and Cochrane registries for randomized controlled trials through February 2023. The extracted data included changes in the number of erosions or ulcers in the jejunum or ileum observed through capsule endoscopy in patients taking NSAIDs or aspirin and administration of various mucoprotectants. We investigated the therapeutic or preventive efficacy of these drugs. The methodological bias was evaluated using Risk of Bias 2.0.</p><p><strong>Results: </strong>Eighteen randomized controlled trials of drugs effective for NSAIDs or aspirin-induced SB injuries were included and analyzed. The agents used to treat or prevent SB injuries were rebamipide, misoprostol, geranylgeranylacetone, and probiotics. In the meta-analysis, the mucoprotectants that showed a significant effect in treating NSAID users, who developed SB injuries, were misoprostol (mean difference: -9.88; 95% CI: -13.26 to -6.50). Meanwhile, the mucoprotectant that can prevent SB injuries caused by NSAIDs or aspirin in the general population was rebamipide (mean difference: -1.85; 95% CI: -2.74 to -0.96).</p><p><strong>Conclusions: </strong>Misoprostol was effective in treating SB injuries caused by NSAIDs or aspirin (CRD42023410946).</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"1003-1010"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620095","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":"Quality Indicator Development for the Approach to Ineffective Esophageal Motility: A Modified Delphi Study.","authors":"Afrin N Kamal, Priya Kathpalia, David A Leiman, Albert J Bredenoord, John O Clarke, C Prakash Gyawali, David A Katzka, Adriana Lazarescu, John E Pandolfino, Roberto Penagini, Sabine Roman, Edoardo Savarino, Marcelo F Vela, Fouad Otaki","doi":"10.1097/MCG.0000000000001963","DOIUrl":"10.1097/MCG.0000000000001963","url":null,"abstract":"<p><strong>Goals: </strong>Develop quality indicators for ineffective esophageal motility (IEM).</p><p><strong>Background: </strong>IEM is identified in up to 20% of patients undergoing esophageal high-resolution manometry (HRM) based on the Chicago Classification. The clinical significance of this pattern is not established and management remains challenging.</p><p><strong>Study: </strong>Using RAND/University of California, Los Angeles Appropriateness Methods, we employed a modified-Delphi approach for quality indicator statement development. Quality indicators were proposed based on prior literature. Experts independently and blindly scored proposed quality statements on importance, scientific acceptability, usability, and feasibility in a 3-round iterative process.</p><p><strong>Results: </strong>All 10 of the invited esophageal experts in the management of esophageal diseases invited to participate rated 12 proposed quality indicator statements. In round 1, 7 quality indicators were rated with mixed agreement, on the majority of categories. Statements were modified based on panel suggestion, modified further following round 2's virtual discussion, and in round 3 voting identified 2 quality indicators with comprehensive agreement, 4 with partial agreement, and 1 without any agreement. The panel agreed on the concept of determining if IEM is clinically relevant to the patient's presentation and managing gastroesophageal reflux disease rather than the IEM pattern; they disagreed in all 4 domains on the use of promotility agents in IEM; and had mixed agreement on the value of a finding of IEM during anti-reflux surgical planning.</p><p><strong>Conclusion: </strong>Using a robust methodology, 2 IEM quality indicators were identified. These quality indicators can track performance when physicians identify this manometric pattern on HRM. This study further highlights the challenges met with IEM and the need for additional research to better understand the clinical importance of this manometric pattern.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"975-980"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}