Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"Endoscopic findings in the evaluation of gastrointestinal symptoms in pediatric patients post hematopoietic stem cell transplantation.","authors":"Mordechai Slae, Mor Segal Ben-Or, Ronit Schwell, Diana Pinhasov, Diana Averbuch, Zev Davidovics, Anna Elia, Ehud Even Or, Polina Stepensky, Irina Zaidman","doi":"10.1002/jpn3.70051","DOIUrl":"https://doi.org/10.1002/jpn3.70051","url":null,"abstract":"<p><strong>Objectives: </strong>Endoscopy plays a pivotal role in diagnosing gastrointestinal (GI) symptoms of pediatric patients post hematopoietic stem cell transplantation (HSCT). There is very little data on whether endoscopic findings can predict pathological diagnosis and treatment outcomes in the pediatric population. The primary objective was to determine the association between macroscopic and microscopic findings of endoscopies in pediatric patients post-HSCT. A secondary objective was to evaluate whether macroscopic findings can predict treatment outcomes or differentiate between causes of GI symptoms.</p><p><strong>Methods: </strong>This single-center prospective study analyzed the results of endoscopic evaluation in patients aged 18 years or younger, who developed GI symptoms during and after HSCT and required an endoscopy for diagnosis. Macroscopic and microscopic findings of upper and lower endoscopies were reviewed and compared, thus evaluating the correlation between the two. Predetermined sites throughout the GI tract were examined for their macroscopic and microscopic findings, to examine whether their results suggest graft-versus-host disease (GVHD), infection, or both. Patients' change in treatment and clinical response were also assessed.</p><p><strong>Results: </strong>In 22 patients, 249 tissue samples were macroscopically and microscopically evaluated. When abnormal macroscopic findings were present, microscopic findings were present in 86.2% of the cases. In 72.1% of the endoscopic sites with normal macroscopic results, abnormal microscopic findings were present (p value = 0.004, Fisher-Freeman-Halton exact test).</p><p><strong>Conclusion: </strong>This study provides further evidence supporting the correlation between macroscopic and microscopic evaluation in the diagnosis of GVHD post-HSCT, however, normal macroscopic findings do not rule out the presence of GVHD.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041087","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":"Distinct and reproducible esophageal motility patterns in children with esophageal atresia.","authors":"Sharman P Tan Tanny, Assia Comella, Lisa McCall, John M Hutson, Sue Finch, Mark Safe, Warwick J Teague, Taher I Omari, Sebastian K King","doi":"10.1002/jpn3.70019","DOIUrl":"10.1002/jpn3.70019","url":null,"abstract":"<p><strong>Objectives: </strong>Esophageal atresia (EA) is a significant congenital anomaly, with most survivors experiencing esophageal dysmotility. Currently, there is no reliable way to predict which patients will develop significant, life-threatening dysmotility. Using high-resolution impedance manometry (HRIM), this study aimed to characterize the common pressure topography patterns in children with repaired EA.</p><p><strong>Methods: </strong>This prospective longitudinal cohort study focused on children (<18 years) with repaired EA. Utilizing HRIM, esophageal motility patterns were studied. Repeat manometric assessments were performed in a selected group.</p><p><strong>Results: </strong>Seventy-five patients with EA (M:F = 43:32, median age 15 months [3 months to 17 years]) completed 133 HRIM studies. The majority (54 out of 75, 85.3%) had EA with distal tracheo-esophageal fistula. Thirty-five out of 75 (46.7%) underwent one study, 24 out of 75 (32.0%) two studies, 14 out of 75 (18.7%) three studies, and 2 out of 75 (2.7%) four studies. Seventy-two patients had analyzable studies. Three common motility patterns were demonstrated: (1) aperistalsis (26 out of 72, 36.1%); (2) distal esophageal contraction (25 out of 72, 34.7%); and (3) pressurization (6 out of 72, 8.3%). A minority demonstrated combination patterns, including aperistalsis with weak distal contraction (10 out of 72, 13.9%) and aperistalsis with pressurization (2 out of 72, 2.8%). Contraction was normal in 3 out of 72 (4.2%). At repeat assessment, the dominant motility pattern persisted in 26 out of 38 (68.4%) of the second studies and 9 out of 15 (60.0%) of the third studies.</p><p><strong>Conclusion: </strong>Utilizing HRIM in children with repaired EA, we have demonstrated objective, distinct, and reproducible motility patterns. In this cohort, the majority of motility patterns were maintained longitudinally, and dysphagia scores remained unchanged, even after dilatation.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"899-908"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458395","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":"Feeding hope: A quality improvement initiative to improve identification of food insecurity.","authors":"Nicole Misner, Patoula Panagos-Billiris, Michelle Yavelow, Chaitanya Chaphalkar, Athanasios Tsalatsanis, Racha T Khalaf","doi":"10.1002/jpn3.70010","DOIUrl":"10.1002/jpn3.70010","url":null,"abstract":"<p><strong>Objectives: </strong>Food insecurity (FI), limited or uncertain access to adequate food, impacts every state, county, and community in the United States. The goals of this quality improvement (QI) initiative were to first achieve greater than 90% compliance with FI screening for patients seen at pediatric GI clinics within 1 year and second increase the proportion of families identified as FI connected with resources to 50% at follow-up visits.</p><p><strong>Methods: </strong>Using plan-do-study-act cycles, interventions were implemented to (1) educate, (2) create a screening process, (3) optimize communication with EMR utilization, and (4) connect families to resources. Descriptive statistics on all variables collected were performed. Differences between the FI and food secure groups were assessed using the Mann-Whitney test for continuous variables and the Chi-squared test for categorical variables. QIMacros® Quality Improvement/SPC Software for Excel was used to create process control charts to show improvement.</p><p><strong>Results: </strong>During the timeframe from August 29, 2022, to February 29, 2024, 2946 visits were completed in the GI clinic, and 58% (1731 patients) were screened for FI. Of the patients that were screened for FI, 13% screened positive. Compliance with FI screening improved to 90%, and connection to resources improved to 75%. Race, ethnicity, preferred language, and insurance were all significantly associated with FI, p < 0.001 CONCLUSIONS: This QI initiative demonstrates standardized FI screening improves FI identification and connection to resources.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"776-782"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391172","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":"Pediatric endoscopic ultrasound-guided liver biopsy: 3-year experience.","authors":"Talia S Schwartz, Marialena Mouzaki, Lara Berklite, Oscar F Lopez-Nunez, Alexander Miethke, Stavra A Xanthakos, David S Vitale","doi":"10.1002/jpn3.70001","DOIUrl":"10.1002/jpn3.70001","url":null,"abstract":"<p><strong>Objectives: </strong>Liver biopsy is the gold standard for diagnosing and staging liver diseases. Endoscopic ultrasound-guided liver biopsy (EUS-LB) has been reported in adults with equivalent or better safety profiles than percutaneous liver biopsies. The aim of this study was to retrospectively assess the safety and efficacy of EUS-LB in pediatric patients.</p><p><strong>Methods: </strong>This was a retrospective chart review of consecutive pediatric patients undergoing EUS-LB at Cincinnati Children's Hospital Medical Center from March 2020 to April 2023. Patients ≤21 years old were included. EUS-LB was performed via fine-needle biopsy technique with transduodenal and/or transgastric approach. Histology was independently reviewed by one of two expert pathologists, including length (cm) and complete portal tract (CPT) number per the American Association for the Study of Liver Diseases (AASLD) adequacy criteria. Demographics, clinical data, technical information, diagnostic success, and adverse events were recorded.</p><p><strong>Results: </strong>Eighty-three patients were included in the analysis, with various indications that required liver biopsy. All biopsies achieved diagnostic and technical success, with 77 (93%) meeting both AASLD criteria for adequacy. Most patients (57, 69%) underwent biopsy of both hepatic lobes, with an overall median of two needle passes. Total specimen length was a median of 7.9 cm (interquartile range [IQR] 5.2-10.3), and the median maximum intact specimen was 4.2 cm (IQR 3.1-5.4). The median CPT number was 24 (IQR 17-32) per patient. Four mild adverse events (5%) occurred; none involved bleeding.</p><p><strong>Conclusions: </strong>EUS-LB was well tolerated and yielded samples that were technically and diagnostically successful in a pediatric population, with comparable safety to percutaneous liver biopsy.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"920-925"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365188","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":"Colonic transit studies and colonic manometry in pediatric constipation.","authors":"Atchariya Chanpong, Elizabeth Morris, Teresa Di Chio, Andreia Nita, Keith Lindley, Anna Rybak, Bruce Goodwin, Lorenzo Biassoni, Nikhil Thapar, Osvaldo Borrelli","doi":"10.1002/jpn3.70025","DOIUrl":"10.1002/jpn3.70025","url":null,"abstract":"<p><strong>Objectives: </strong>In a subgroup of children with refractory constipation, colonic function investigations, such as colonic transit scintigraphy (CS) and colonic manometry (CM), are used to define the underlying pathophysiologic mechanisms. There are limited studies comparing colonic transit and contractile function. We aimed to correlate CS and CM and assess whether specific manometric patterns might predict the luminal transit findings.</p><p><strong>Methods: </strong>Children with refractory constipation undergoing both CS and CM between 2012 and 2022 at two Tertiary Pediatric Gastroenterology Services were retrospectively reviewed. For CS, the geometric center (GC) was used to quantify the transit across the different colonic segments and studies were categorized into normal transit, recto-sigmoid hold-up, and slow transit. Contractile patterns from CM were classified into equivalent regional subtypes as normal, distal colonic dysmotility and pan-colonic dysmotility, respectively.</p><p><strong>Results: </strong>Twenty-two patients (59% male, median age: 10.94 years) were included. No significant agreement in the subtype of constipation was found between CS and CM (K = 0.224, p = 0.070). However, a strong correlation was observed between the numeric score of the GC at 6 h and the amplitude of bisacodyl-induced high amplitude propagating contractions (HAPCs) in the rectosigmoid (r = 0.761, p = 0.007). Moreover, a higher percentage of radiotracers in the ascending colon at 24 h was related to a higher number of bisacodyl-induced HAPCs.</p><p><strong>Conclusions: </strong>Scintigraphic GC at 6 h showed a substantial correlation with parameters from CM in the rectosigmoid colon, implicating the potential role of this colonic region as a gatekeeper for colonic luminal transit.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"909-919"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542294","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":"Hepatic venous wedge pressure gradient measurements in intestinal failure associated liver disease.","authors":"Joseph Valamparampil, Rachel M Brown, Simon McGuirk, Jane Hartley, Ye Htun Oo, Khalid Sharif, Darius Mirza, Girish L Gupte","doi":"10.1002/jpn3.70016","DOIUrl":"10.1002/jpn3.70016","url":null,"abstract":"<p><strong>Objectives: </strong>Historically, in children with intestinal failure associated liver disease (IFALD), the presence of splenomegaly and moderate bridging fibrosis would be considered as evidence of advanced liver disease and portal hypertension and be recommended for liver-inclusive intestinal transplant graft. In our experience, the assessment of portal hypertension based on conventional investigations, which are well established in other chronic liver diseases, could be misleading in some children with IFALD, and further investigations could help in assessing the severity of liver disease. Hepatic venous wedge pressure gradient (HVWPG) is used in chronic liver diseases for objectively assessing the severity of portal hypertension. We postulated that HVWPG may be useful to assess the severity of portal hypertension in children with IFALD and, therefore, help in the decision-making process for the need for a liver-inclusive intestinal graft.</p><p><strong>Methods: </strong>Retrospective analysis of children with IFALD who had HVWPG measured between 2005 and 2020. Demographic details, laboratory parameters, liver biopsy, HVWPG and clinical outcomes were reviewed. Children were grouped into two categories based on HVWPG gradient: HVWPG ≥ 10 mmHg (significant portal hypertension) and HVWPG < 10 mmHg.</p><p><strong>Results: </strong>Between 2005 and 2020, 23 children (median age: 33 months, interquartile range: 11-54) had 27 HVWPG measurements (4 children had repeat measurements). No procedural complications were documented. 16/23 children had HVWPG < 10 mmHg, 7/23 children had HVWPG ≥ 10 mmHg. Of the 16 children with HVWPG < 10 mmHg, 10 children were referred to the local team for intestinal rehabilitation, while 6 children were recommended for transplantation (4 for isolated intestinal transplant and 2 for liver-inclusive intestinal transplant) as they fulfilled other indications for intestinal transplantation (impaired venous access, etc.). Of the seven children who had significant portal hypertension (HVWPG ≥ 10 mmHg), six were recommended for liver-inclusive intestinal transplant. There was a cohort of four children with at least bridging fibrosis and HVWPG < 10 mmHg who had repeat measurements due to failed intestinal rehabilitation strategies to wean from parenteral nutrition and worsening clinical signs (increasing splenomegaly, etc.). Two children were recommended for liver-inclusive intestinal transplant in view of increase in HVWPG to ≥10 mmHg.</p><p><strong>Conclusions: </strong>HVWPG measurements can guide in the decision-making process in children with IFALD, especially those with bridging fibrosis without significant clinical evidence of portal hypertension for deciding on the need for liver-inclusive intestinal transplantation.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"840-846"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523598","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":"Mast cells and corticotropin-releasing hormone receptors in duodenal tissue of children with functional dyspepsia.","authors":"Haley Pearlstein, Timothy Chao, Zhaoping He, Zarela Molle-Rios","doi":"10.1002/jpn3.12477","DOIUrl":"10.1002/jpn3.12477","url":null,"abstract":"<p><strong>Objectives: </strong>Functional dyspepsia (FD) is a disorder of the gut-brain interaction characterized by epigastric pain, nausea, and/or early satiety. Existing literature suggests a physical link between psychiatric diagnoses and disorders of the gut-brain interaction at intestinal mast cells (MC) via corticotropin-releasing hormone (CRH) and its intestinally located receptors (CRHR1/CRHR2). Our study aimed to further clarify the physiologic connection between pediatric psychiatric illness and FD.</p><p><strong>Methods: </strong>Study subjects were identified and classified into three groups. The FD group met Rome IV criteria and had insignificant gross endoscopic and histologic findings on gastric and duodenal biopsies. The control group reported no gastrointestinal symptoms or documented psychiatric illness. A third group consisted of Helicobacter pylori (HP)-positive dyspepsia patients independent of psychiatric history. Duodenal biopsy blocks were stained with antibodies targeting MCs, CRH, and CRHR1/CRHR2.</p><p><strong>Results: </strong>We included 49 patients: 21 FD, nine controls, and 19 HP patients. We found a statistical difference between duodenal MC density in FD versus controls and HP versus controls (p < 0.05). We found no significant CRHR2 staining in the control group, yet the FD and HP groups yielded strong stains. We found a significant increase in MC density and CRHR2 staining in patients with a psychiatric history versus without (p < 0.05).</p><p><strong>Conclusion: </strong>Our data show increased MC density and stronger CRHR2 staining in patients with FD and in patients with a psychiatric history. Our data support a pathophysiologic theory of FD development via a \"gut-brain axis\" intersecting at the level of MCs with influence via peripheral CRH.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"767-775"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573318","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":"Evaluation of fecal neutrophil gelatinase-associated lipocalin levels in childhood inflammatory bowel disease.","authors":"Aysenur Kardas Yildiz, Nafiye Urganci, Ayşe Merve Usta","doi":"10.1002/jpn3.70015","DOIUrl":"10.1002/jpn3.70015","url":null,"abstract":"<p><strong>Objectives: </strong>Inflammatory bowel disease (IBD) is an immune-mediated, chronic, remitting, and relapsing disease. Calprotectin, used in monitoring the disease activity, is expressed from neutrophilic granulocytes during inflammation. Neutrophil gelatinase-associated lipocalin (NGAL) is strongly expressed in both granulocytes and the intestinal epithelial cell layer. The aim of the study was to compare fecal NGAL (FNGAL) with fecal calprotectin (FCAL) in children with IBD.</p><p><strong>Methods: </strong>Forty-four children with IBD and 22 healthy children were included in the study. The patients were divided into two groups, patients with active disease and remission group. Clinical and demographic characteristics, disease activity scores, and serum and fecal markers of the patients were recorded.</p><p><strong>Results: </strong>The mean age of the patients was 13.2 ± 3.4 years (range 6-17 years) and male/female: 0.62. FNGAL levels of patients with active disease were higher than those in the remission group (p < 0.001). A statistically significant positive correlation was observed between Pediatric Ulcerative Colitis Activity Index scores and white blood cell count, platelets, neutrophil-to-albumin ratio (NAR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and FNGAL. There was a positive correlation between Pediatric Crohn's Disease Activity Index scores and platelets, NAR, ESR, CRP, and FNGAL, whereas there was a statistically significantly negative correlation with activity scores and albumin. While FNGAL had 95.5% sensitivity and 81.8% specificity, FCAL had 86.7% sensitivity and 85.7% specificity.</p><p><strong>Conclusions: </strong>FNGAL levels were found to be high and sensitive in determining disease activity in our patients with IBD, suggesting that it may be a valuable biomarker.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"792-798"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449202","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":"Providing effective feedback for training: Is there a role for informatics?","authors":"Nidhi P Goyal, Jeannie S Huang","doi":"10.1002/jpn3.70003","DOIUrl":"10.1002/jpn3.70003","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"743-746"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382709","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":"Observation of the efficacy of upadacitinib as salvage therapy for refractory pediatric inflammatory bowel disease.","authors":"Tianlu Mei, Yi Wang, Chunna Zhao, Jie Wu, Xiaolin Ye","doi":"10.1002/jpn3.70024","DOIUrl":"10.1002/jpn3.70024","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"812-815"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515677","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}