Journal of Gastroenterology最新文献

{"title":"S-adenosylhomocysteine hydrolase-like protein 1 deficiency resulted in stronger inflammation reaction in acute pancreatitis.","authors":"Juan Xiao, Wanlian Li, Jian Pan, Yinhui Yang, Ji-Ao Chen, Xi-Dai Long","doi":"10.1007/s00535-026-02437-x","DOIUrl":"https://doi.org/10.1007/s00535-026-02437-x","url":null,"abstract":"<p><strong>Background: </strong>The mechanism underlying acute pancreatitis (AP) is not fully understood. And the effect of s-adenosylhomocysteine hydrolase-like protein 1 (AHCYL1) in AP is unknown.</p><p><strong>Methods: </strong>In this research, AHCYL1 pancreatic acinar cell specific knockout (CKO) mice were constructed and AP was induced. The related mechanism was investigated in mice or primary cells.</p><p><strong>Results: </strong>It was found that AHCYL1 was decreased in AP mice. CKO caused increased macrophage infiltration in AP pancreas. AHCYL1 binding to amino acid transporters decreased in AP. Amino acid uptake, mTOR inhibition, and MIF production were aggravated in AP with AHCYL1 deficiency. Differentially expressed PGK1 in proteomics was associated with both mTOR and MIF in the PPI network. PGK1 was found to be further increased in CKO AP pancreas, which was reversed by mTOR activator. MIF expression and secretion under AP were inhibited by mTOR activator or PGK1 inhibitor. MIF-induced macrophage migration could be reduced by mTOR activator or PGK1 inhibitor. N1-acetylspermine increased in the serum of CKO AP mice. CKO acinar cell culture under AP caused further increment in N1-acetylspermine production enzyme, SSAT, which was inhibited by mTOR activator or PGK1 inhibitor. MIF induced SSAT and cytokines from macrophages, and the latter was reduced by SSAT inhibitor. Finally, AHCYL1 binding to the deubiquitinase OTUD6B decreased in AP. OTUD6B knockdown caused AHCYL1 ubiquitination and its decrement. AHCYL1 recovery reduced cytokine release and macrophage infiltration in AP.</p><p><strong>Conclusion: </strong>The AHCYL1 deficiency/amino acid uptake inhibition/mTOR inhibition/PGK1 up-regulation/MIF secretion axis in acinar cells induced SSAT in macrophages and macrophage infiltration in the pancreas in AP.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864175","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":"Covert hepatic encephalopathy as a multi-organ syndrome: the gut-liver-muscle-brain axis, diagnosis, treatment, and multidisciplinary care.","authors":"Takao Miwa, Cynthia L Hsu, Masahito Shimizu, Patricia P Bloom, Bernd Schnabl","doi":"10.1007/s00535-026-02425-1","DOIUrl":"https://doi.org/10.1007/s00535-026-02425-1","url":null,"abstract":"<p><p>Covert hepatic encephalopathy (CHE) is a highly prevalent complication of liver cirrhosis. Despite the absence of overt symptoms, CHE is strongly associated with impaired quality-of-life, overt hepatic encephalopathy, and mortality. Over the past two decades, evidence regarding the pathophysiology, diagnosis, and treatment of CHE has accumulated considerably, and clinical guidelines recommend screening in patients with cirrhosis. Nevertheless, diagnostic and therapeutic algorithms have not been fully implemented in real-world practice, and many patients remain undiagnosed and untreated. Understanding the natural history of CHE is essential to improve cirrhosis care, as it provides a framework for appropriate screening, treatment decision-making, and patient counseling. CHE is a multi-organ syndrome with complex interactions between the liver, gut, skeletal muscle, kidneys, and brain, with impaired ammonia handling and systemic inflammation acting as central drivers of this organ crosstalk. Hyperammonemia induces astrocytic dysfunction, brain edema, and neuroinflammation, while systemic inflammation, oxidative stress, sarcopenia, gut dysbiosis, and altered microbial metabolites, including bile acids and short-chain fatty acids, further modulate disease expression. In this review, we summarize current understanding of CHE pathophysiology, diagnostic testing, including psychometric batteries and point-of-care tools, such as the Stroop test and animal naming test, and therapeutic options, ranging from lactulose and rifaximin to microbiome-targeted approaches, including fecal microbiota transplantation. We also highlight major challenges in CHE management, including limited implementation of testing, inadequate biomarkers, diagnostic difficulties in geriatric cirrhosis, and unmet needs in fall and driving risk management, and emphasize the importance of multidisciplinary team-based approaches to improve patient outcomes.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838944","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":"Conversion surgery for unresectable pancreatic ductal adenocarcinoma with liver metastasis at initial diagnosis: a nationwide multicenter study.","authors":"Daisuke Hashimoto, Tsukasa Ikeura, Aya Maekawa, Takayoshi Nakajima, Keinosuke Ishido, Aoi Hayasaki, Toshimichi Asano, Masamichi Hayashi, Isaku Yoshioka, Hiromichi Ishii, Akifumi Kimura, Hideki Motobayashi, Masaaki Murakawa, Kenjiro Okada, Toshiya Abe, Yoshiki Hirooka, Masafumi Imamura, Keiko Kamei, Shogo Kobayashi, Toru Maruo, Joe Matsumoto, Katsuyuki Miyabe, Minako Nagai, Shinsuke Nakashima, Yoshitaro Shindo, Makoto Shinzeki, Shuji Suzuki, Tatsunori Suzuki, Masayuki Tanaka, Satoshi Tanno, Tomoyuki Yokota, Kenta Murotani, Yousuke Nakai, Yosuke Inoue, Masamichi Mizuma, Michiaki Unno, Ippei Matsumoto, Tsutomu Fujii, Kenichiro Uemura, Masayuki Sho, Satoshi Hirano, Sohei Satoi, Atsushi Masamune, Yoshifumi Takeyama","doi":"10.1007/s00535-026-02432-2","DOIUrl":"https://doi.org/10.1007/s00535-026-02432-2","url":null,"abstract":"<p><strong>Background: </strong>With recent advances in chemotherapy for unresectable pancreatic ductal adenocarcinoma (PDAC) with liver metastasis (LM), attempts have been made to resect the primary tumor in patients showing favorable responses to anti-cancer treatment (so-called \"conversion surgery\"; CS). This study aimed to clarify the outcomes of CS for PDAC with LM in a nationwide multicenter study.</p><p><strong>Methods: </strong>This retrospective, multicenter study was conducted as a project study of the Japan Pancreas Society and included patients with PDAC with LM at initial diagnosis, diagnosed radiologically or intraoperatively (occult LM), who underwent CS after at least 4 months of chemotherapy between 2010 and 2022. Survival outcomes and prognostic factors were analyzed.</p><p><strong>Results: </strong>90 patients were enrolled from 31 Japanese institutions. Median duration of preoperative chemotherapy was 10.4 (range, 4.2-58.5) months, and gemcitabine plus nab-paclitaxel was the most common first-line regimen, followed by folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin. Liver metastasectomy was performed in 27 patients (30%). 82 patients (91.1%) initiated adjuvant chemotherapy, and 41 (45.6%) completed it. Overall survival (OS) from initial treatment was 53.1 (95% CI 41.6-65.7) months; OS after CS was 39.7 (95% CI 24.4-55.9) months, and disease-free survival was 14.7 (95% CI 9.3-23.4) months. Preoperative normalization of carbohydrate antigen 19-9 and pathologic negative lymph node metastasis were independent prognostic factors for OS.</p><p><strong>Conclusion: </strong>CS may provide a survival benefit for highly selected patients with PDAC and LM, including those with occult lesions, who respond well to multidisciplinary treatment.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816115","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":"Clinical significance of gadoxetate sodium-enhanced MRI for detecting liver metastasis in patients with pancreatic cancer: decadal real-world data analysis in Japan.","authors":"Atsushi Oba, Tomoyuki Taguchi, Naoto Fujikawa, Suguru Okami, Takashi Tsuji, Alexander Michel, Satoshi Goshima","doi":"10.1007/s00535-026-02431-3","DOIUrl":"https://doi.org/10.1007/s00535-026-02431-3","url":null,"abstract":"<p><strong>Background: </strong>Precise, early diagnosis of liver metastasis improves clinical outcomes in patients with pancreatic cancer. While gadoxetate sodium-enhanced magnetic resonance imaging (EOB-MRI) may offer additional benefits in detecting liver metastases in patients with pancreatic cancer, it is still unclear whether the addition of this imaging modality to contrast-enhanced computed tomography (CE-CT) confers clinical benefits regarding prognosis and access to appropriate treatments. The objective is to evaluate the treatment pathway of patients with or without EOB-MRI after a pancreatic cancer diagnosis and examine whether the addition of EOB-MRI is associated with improved survival.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using a Japanese hospital-based administrative database. Patients aged ≥ 18 years and diagnosed with pancreatic cancer between 2011 and 2021 with any record of CE-CT or MRI were included. Patients were stratified based on a record of EOB-MRI (EOB-MRI vs. non-EOB-MRI). Main outcomes were treatment pathway and overall survival (OS). OS was compared between the EOB-MRI and non-EOB-MRI groups using Cox proportional hazard regression models in the propensity-score-matched cohort.</p><p><strong>Results: </strong>A total of 39,624 patients were included. The proportion of neoadjuvant chemotherapy increased to 13.4% during recent years (2019-2021) in the EOB-MRI group versus 7.8% in the non-EOB-MRI group. Significantly longer OS in the matched cohort was observed (HR [95% CI] = 0.88 [0.83-0.94]) in the EOB-MRI group (1,442 days [1275-1604]) versus the non-EOB-MRI group (1,293 days [1187-1440]).</p><p><strong>Conclusions: </strong>The addition of EOB-MRI was associated with increased survival times in patients with pancreatic cancer.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816154","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":"Reply to Letter \"Gastric cancer in autoimmune gastritis: ranking the risk\" by Prof. Massimo Rugge.","authors":"Nobutake Yamamichi, Rika Aoki, Chihiro Takeuchi","doi":"10.1007/s00535-026-02435-z","DOIUrl":"https://doi.org/10.1007/s00535-026-02435-z","url":null,"abstract":"","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816305","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":"IgG4-related disease in gastroenterology: from pathogenesis to clinical management and long-term outcomes.","authors":"Yifei Wang, Luyi Peng, Wen Zhang","doi":"10.1007/s00535-026-02424-2","DOIUrl":"https://doi.org/10.1007/s00535-026-02424-2","url":null,"abstract":"<p><p>IgG4-related disease is a rare, immune-mediated, multisystem fibroinflammatory condition. It is characterized by elevated serum IgG4 concentrations and tissue infiltration of IgG4-positive plasma cells with distinctive histopathological features, including storiform fibrosis and obliterative phlebitis. Gastroenterological involvement is diverse and represents a critical diagnostic consideration, encompassing the pancreas, bile ducts, liver, esophagus, stomach, and intestine. In this review, we summarize the current understanding of genetic susceptibility and environmental risk factors underlying this disease, and systematically describe the clinical presentations, histopathological characteristics, imaging findings, and serological profiles of each major gastroenterological manifestation. We further review evidence-based treatment regimens ranging from glucocorticoids and conventional immunosuppressants to emerging biologic therapies, discuss organ-specific therapeutic responses, and identify predictors of disease relapse along with long-term surveillance strategies. From a gastroenterologist's perspective, this review aims to provide a practical and integrated framework to facilitate early recognition, accurate differentiation from mimicking conditions such as pancreaticobiliary malignancies, and optimized long-term management of this complex yet treatable disease.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816186","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":"Selective IL-23 inhibitors in ulcerative colitis: current evidence and perspectives for multimodal personalized treatment: a narrative review.","authors":"Ichitaro Horiuchi, Akira Horiuchi, Ken Sugimoto","doi":"10.1007/s00535-026-02429-x","DOIUrl":"https://doi.org/10.1007/s00535-026-02429-x","url":null,"abstract":"<p><p>The heterogeneity of ulcerative colitis (UC) results in variable biological responses. Although anti-tumor necrosis factor (anti-TNF) agents remain a cornerstone of therapy, 30-40% of patients experience primary non-response, which is often linked to persistent activation of the interleukin-23 (IL-23) pathway. There is increasing evidence that the IL-23-Th17-neutrophil axis plays a central role in mucosal inflammation and treatment resistance. Phase II and III trials of selective IL-23 inhibitors for UC have demonstrated high rates of endoscopic and histologic remission, with safety profiles comparable to those of anti-TNF agents. These agents have demonstrated efficacy in various patient subgroups, including those with a history of anti-TNF failure. This supports their potential as effective alternatives to existing biologics. Based on these data, we propose a multimodal framework for personalized treatment selection that integrates three diagnostic pillars: (1) noninvasive biomarkers, such as serum leucine-rich alpha-2 glycoprotein and fecal calprotectin, to differentiate between systemic and mucosal inflammation, (2) the Mayo Endoscopic Subscore to guide therapeutic intensity, and (3) quantitative histopathology, specifically the Komagane subclassification of Geboes Grade 3, to identify IL-23-Th17-dominant activity. This integrative approach may enable predicting biologic responses, risk stratification, and the individualized use of selective IL-23 inhibitors. We propose this strategy as a model for generating hypotheses for future personalized medicine studies in UC.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816228","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":"Pathophysiology, assessment, and treatment of pain in patients with pancreatic ductal adenocarcinoma.","authors":"Mahya Faghih, Marko Damm, Charlotte Gutzler, Michael Hirth, Marie-Theres Kassik, Louise Kuhlmann, Patrick Michl, Søren S Olesen, Anna E Phillips, Vikesh K Singh, Asbjørn M Drewes","doi":"10.1007/s00535-026-02423-3","DOIUrl":"https://doi.org/10.1007/s00535-026-02423-3","url":null,"abstract":"<p><p>Pain is one of the most frequent and debilitating symptoms associated with pancreatic ductal adenocarcinoma (PDAC). More than 60% of patients suffer from significant pain at diagnosis. The prevalence increases during the progression of the disease and is associated with anorexia, weight loss, and impaired social interactions. The pathophysiology of pain includes the combined effects of tumor growth and spread, perineural invasion, neuroimmune interactions, peripheral nerve remodeling, and central nervous system sensitization. Pain is additionally modulated by comorbid conditions, such as anxiety or depression, as well as treatment-related toxicity. Previous reports have used simple unidimensional scales to assess pain intensity, but as pain in PDAC is multidimensional, there is a need to develop new and robust instruments to assess pain. The treatment follows the World Health Organization three-step analgesic ladder. Non-opioid analgesics can be used to improve pain, but strong opioids are often used to relieve pain and suffering. When opioids are used, there should be a focus on the management of the side effects. Patients with anxiety and depression may benefit from treatment with selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants that also have effects on pain. In some cases, more experimental drugs such as ketamine may be used. Celiac plexus neurolysis and local irradiation therapies are supplementary methods used to treat PDAC pain, but the response is unpredictable, and the durability is relatively short. The reduced survival associated with celiac ganglia injection, especially in patients with advanced disease, has also tempered enthusiasm.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816208","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":"HLA-DQB1*03:01 and HLA-DQA1*05:05 as key genetic determinants of infliximab response and immunogenicity in Japanese patients with inflammatory bowel disease.","authors":"Ryuya Osaka, Takeo Naito, Seik-Soon Khor, Yoichi Kakuta, Yosuke Kawai, Masao Nagasaki, Hiroshi Meguro, Hideya Iwaki, Daisuke Okamoto, Hiroshi Nagai, Yusuke Shimoyama, Rintaro Moroi, Hisashi Shiga, Yoshitaka Kinouchi, Atsushi Masamune","doi":"10.1007/s00535-026-02354-z","DOIUrl":"10.1007/s00535-026-02354-z","url":null,"abstract":"<p><strong>Background: </strong>Specific human leukocyte antigen (HLA) genotypes, particularly HLA-DQA1*05, have been proposed as predictors for infliximab (IFX) treatment response and immunogenicity in Western populations. However, the evidence regarding the effect of HLA-DQA1*05 remains limited in East Asian populations, including in Japan. Moreover, HLA-DQA1*05 frequency differs substantially from those in Western populations. Comprehensive analyses of the association between HLA alleles and IFX treatment outcomes may contribute to the identification of novel prognostic markers for IFX therapies.</p><p><strong>Methods: </strong>We retrospectively analyzed 301 biologic-naïve Japanese patients with inflammatory bowel disease (IBD). IFX persistence was assessed at both 2-digit and 4-digit HLA allele resolutions, and associations with anti-drug antibody levels at 1 year after the initiation of IFX therapy were evaluated.</p><p><strong>Results: </strong>At the 2-digit resolution analysis, HLA-DQB1*03 (hazard ratio [HR] = 2.39, p = 1.89E-06) and HLA-DQA1*05 (HR = 1.99, p = 3.91E-04) were significantly associated with early IFX discontinuation. At the 4-digit resolution analysis, HLA-DQB1*03:01 (HR = 2.03, p = 9.42E-05) and HLA-DQA1*05:05 (HR = 2.18, p = 4.42E-05) showed similar associations. All HLA-DQA1*05:05 alleles formed haplotypes with HLA-DQB1*03:01. Importantly, HLA-DQB1*03:01 was also associated with early discontinuation of IFX even when it formed haplotypes with alleles other than HLA-DQA1*05:05. Both HLA-DQB1*03:01 and HLA-DQA1*05:05 were significantly associated with elevated anti-drug antibody levels (p = 3.23E-03 and 3.54E-03, respectively).</p><p><strong>Conclusions: </strong>HLA-DQB1*03:01 encompasses the information of HLA-DQA1*05:05 and serves as a strong genetic predictor of IFX treatment persistence and immunogenicity in Japanese patients with IBD, offering a potential biomarker for personalized therapy.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":"547-558"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132166","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":"Checking the shape of hepatocellular carcinoma: how irregular is irregular?","authors":"Teh-Ia Huo, Shu-Yein Ho","doi":"10.1007/s00535-026-02359-8","DOIUrl":"10.1007/s00535-026-02359-8","url":null,"abstract":"","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":"677-678"},"PeriodicalIF":5.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142517","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}