Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"Quantitative and qualitative assessment of diet and its association with disease activity in pediatric ulcerative colitis.","authors":"Víctor Manuel Navas-López, Marta Herrador-López, Encarnación Torcuato-Rubio, Chen Sarbagili-Shabat, Rafael Martín-Masot","doi":"10.1002/jpn3.70146","DOIUrl":"10.1002/jpn3.70146","url":null,"abstract":"<p><strong>Objectives: </strong>Ulcerative colitis (UC) is a chronic inflammatory bowel disease with increasing global prevalence, particularly in newly industrialized countries. While diet has been implicated in disease pathogenesis, its role in modifying clinical outcomes remains unclear. This study aimed to evaluate dietary intake and habits in pediatric UC patients and assess their association with clinical remission (CR) and mucosal healing (MH).</p><p><strong>Methods: </strong>A cross-sectional study was conducted in a Spanish tertiary hospital, including UC patients aged 8-18 years. Dietary assessment was performed using a 3-day food diary, dietary questionnaires, and the NOVA classification. K-means clustering identified dietary patterns associated with CR and MH. Predictive models were developed using logistic regression, random forest, and gradient boosting.</p><p><strong>Results: </strong>A total of 47 patients were included. Patients in Cluster 1 (CR + MH) exhibited superior dietary quality, characterized by a higher intake of unprocessed/minimally processed foods, fiber, and essential micronutrients (p < 0.05). Conversely, patients without CR or MH (Cluster 3) had a diet rich in ultra-processed foods (UPFs) and saturated fats (p < 0.01). UPFs intake and poor dietary quality were significant predictors of worse outcomes, independent of pharmacological therapy.</p><p><strong>Conclusions: </strong>Dietary quality was associated with both disease activity and treatment response. While these findings highlight a potentially relevant relationship, the cross-sectional nature of the study precludes establishing causality. Higher consumption of minimally processed foods and specific micronutrients was associated with better clinical outcomes, while UPFs intake correlated with persistent inflammation. These findings highlight the importance of integrating dietary strategies into UC management to optimize therapeutic outcomes.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"570-579"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575713","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":"Amoxicillin for critically ill children with enteral nutrition intolerance (AmoxENI study): A randomized controlled trial.","authors":"Rania G Abdelatif, Abanob A Francis, Elsayed Abdelkreem, Safaa H Ahmed","doi":"10.1002/jpn3.70105","DOIUrl":"10.1002/jpn3.70105","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the efficacy of amoxicillin in treating children with enteral nutrition intolerance (ENI) in the pediatric intensive care unit (PICU).</p><p><strong>Methods: </strong>This randomized controlled trial enrolled 90 children aged 1 month to 12 years with ENI 7 days after PICU admission. On the 8th day of PICU admission, participants were equally randomized to receive either amoxicillin (10 mg/kg) or a placebo via a gastric feeding tube three times daily for 1 week. The primary outcome was achieving an enteral intake ≥ two-thirds of the energy requirement without remarkable gastrointestinal symptoms on Day 7 after study drug administration. Secondary outcomes were the increase in enteral nutrition intake and the occurrence of large gastric residual volume, vomiting, diarrhea, abdominal distention, melena/hematochezia, and skin rash.</p><p><strong>Results: </strong>The primary outcome occurred in 75.6% of participants in the amoxicillin group compared to 31.1% in the placebo group (risk ratio [RR]: 2.4; 95% confidence interval [CI]: 1.5-3.9; p < 0.001). Compared with placebo, participants who received amoxicillin demonstrated a higher increase in enteral nutrition intake (median [interquartile range]: 60% [40%-68%] vs. 24% [10%-50%], p < 0.001) as well as a lower occurrence of vomiting (2.2% vs. 35.6%; RR: 0.06, 95% CI: 0.01-0.45) and diarrhea (8.9% vs. 31.1%; RR: 0.29, 95% CI: 0.10-0.80). Both groups showed no significant differences in other outcomes.</p><p><strong>Conclusions: </strong>Amoxicillin may improve ENI in critically ill children, but further research is warranted to corroborate our findings, explore underlying pharmacological mechanisms, and evaluate clinical utility.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05828758.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"712-721"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275165","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":"Rectal budesonide: A potential game changer after Kasai hepatoportoenterostomy.","authors":"Stefanie Langreen, Nathalie Pauer, Eva D Pfister, Norman Junge, Ulrich Baumann, Omid Madadi-Sanjani, Claus Petersen, Jens Dingemann, Nagoud Schukfeh","doi":"10.1002/jpn3.70147","DOIUrl":"10.1002/jpn3.70147","url":null,"abstract":"<p><strong>Objectives: </strong>Intravenous or oral steroid administration in patients with biliary atresia (BA) after Kasai hepatoportoenterostomy (HPE) is commonly practiced, however, the benefits remain controversial. Some studies suggest no positive effects while risking steroid associated side effects. Rectal application of glucocorticoids has so far only been assessed by our group with promising short-term results. We now aim to evaluate the impact of rectal budesonide administration on long-term native liver survival in patients undergoing HPE for BA.</p><p><strong>Methods: </strong>We performed a retrospective cohort study and included all patients after HPE who received rectal budesonide (2 mg) for 3 months from 2011 to 2022, compared to a historical control group without any glucocorticoid treatment. Jaundice-free native liver survival (jfNLS) was assessed at 6 months, 2 years, 5 years, and 10 years post-Kasai. Serious adverse effects of budesonide were documented.</p><p><strong>Results: </strong>Our analysis confirmed our previously published improvements in jfNLS at 6 months (53% vs. 39%) and 2 years (45% vs. 22%), while revealing sustained benefits at 5 years (40% vs. 23%) and 10 years (32% vs. 13%). However, these benefits were exclusive to patients with nonsyndromic BA. No serious budesonide-associated adverse side effects were found.</p><p><strong>Conclusions: </strong>Our findings support the efficacy of rectal budesonide application in enhancing long-term outcomes, providing a safe therapeutic approach and improving jfNLS after HPE for BA, without severe adverse effects. Prospective randomized controlled trials are required to further evaluate its potential post-Kasai benefits and compare it to systemic glucocorticoid therapy.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"626-633"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540616","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":"Impact of placental and peripheral blood DNA methylation on celiac disease susceptibility.","authors":"Alba Hernangomez-Laderas, Ariadna Cilleros-Portet, Mikel de la Peña-Sanz, Sergi Marí, Corina Lesseur, Itziar González-Moro, Bárbara P González-García, Jia Chen, Iraia García-Santisteban, Carmen J Marsit, Jose Ramon Bilbao, Nora Fernandez-Jimenez","doi":"10.1002/jpn3.70124","DOIUrl":"10.1002/jpn3.70124","url":null,"abstract":"<p><strong>Objectives: </strong>Several studies suggest that the first immunogenic insult in celiac disease (CeD) could occur during fetal development. The placenta is a key organ that could link the environment with the genome and future outcomes, including CeD. Our objective is to determine the involvement of placental DNA methylation (DNAm) as potential mediator of the genetic susceptibility to CeD.</p><p><strong>Methods: </strong>We used Summary-data-based Mendelian Randomization to infer what part of the susceptibility to CeD acts through DNAm in placenta or peripheral blood. We interrogated whether DNAm of the CpGs identified correlated with the expression of adjacent genes in the same tissues, and repeated the procedure only in cases and controls carrying the HLA-DQ2 risk haplotype.</p><p><strong>Results: </strong>We identified 248 and 215 CpGs associated with CeD in placenta and blood, respectively. Among the former, the DNAm of seven CpGs correlated with the placental expression of ZFP57. In contrast, in the latter group, the most represented gene was RNF5, with DNAm of 11 CpGs correlating with its expression in blood. In HLA-DQ2 positive individuals, we observed a decrease of placental CpGs associated with CeD, with a remarkable exception in chromosome 2, close to AHSA2. In blood, we identified 44 CpGs associated with CeD in the HLA region, with HLA-DPA1 showing the largest number of DNAm-expression associations.</p><p><strong>Conclusions: </strong>Our results suggest that placenta does not seem to be a crucial effector in CeD, and show potentially causal relationships between blood DNAm and CeD, with independent signals in the HLA, and particularly in the HLA-DPA1 gene.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"587-595"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368922","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":"Natural progression and prediction markers in non-clinically significant oesophageal varices in children.","authors":"Cody Chan, Akshat Goel, Robert Hegarty, Bethany Tucker, Vandana Jain, Eirini Kyrana, Tassos Grammatikopoulos","doi":"10.1002/jpn3.70136","DOIUrl":"10.1002/jpn3.70136","url":null,"abstract":"<p><strong>Objectives: </strong>Limited literature exists on non-clinically significant varices (nCSV) and progression in children with portal hypertension (PHT). This study investigates trends and associations in this cohort.</p><p><strong>Methods: </strong>This retrospective cohort study analysed 70 children with nCSV undergoing surveillance endoscopy between January 2012 and 2024. Laboratory parameters, prediction scores and fibroscan results were collected. Statistical analysis include Mann-Whitney U test, chi-squared test and receiver operating characteristic.</p><p><strong>Results: </strong>Ten children (14.3%) presented with portal vein thrombosis (PVT), 26 (37.1%) with non-biliary atresia chronic liver disease (CLD) and 34 (48.6%) with biliary atresia (BA). Twenty-five children (35.7%) had variceal progression, with median years until progression of 3 years recorded in PVT and CLD (PVT: 1-6 years, CLD: 2-8 years), and 2 years (1-10 years) in BA. Haemoglobin count (Hb) (area under the curve [AUC] = 0.943), risk score (AUC = 0.748), and spleen stiffness by fibroscan (SSM) (AUC = 1.00) revealed optimal accuracy in predicting progression in PVT, with similar findings in CLD (von Willebrand Factor score [vWFAg score]: AUC = 1.00, risk score: AUC = 0.767, SSM: AUC = 0.882). Suboptimal accuracy was seen in BA biomarkers.</p><p><strong>Conclusions: </strong>Risk score is a reliable marker to monitor variceal progression in CLD and PVT. Interim noninvasive scores could be trialled along with surveillance OGD to validate results. Caution is advised extending endoscopy period for children with BA. Due to small subgroup sizes, larger cohort studies are needed to validate SSM and vWFAg score in children with nCSV.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"644-652"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575711","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":"Post-endoscopic fever and infection in paediatric patients with intestinal failure.","authors":"Johannes Hilberath, Omar Afrigh, Toni Illhardt, Drieke Vermeulen, Christoph Slavetinsky, Tobias Jhala, Bernd Fode, Hanna Renk, Justus Lieber, Jörg Fuchs, Ekkehard Sturm","doi":"10.1002/jpn3.70141","DOIUrl":"10.1002/jpn3.70141","url":null,"abstract":"<p><strong>Objectives: </strong>Routine antimicrobial prophylaxis (AMP) for preventing bacteraemia and infection during paediatric gastrointestinal (GI) endoscopy is not recommended and is reserved for high-risk scenarios. However, in the unique group of children with intestinal failure (IF) and a central venous catheter (CVC), the incidence of post-endoscopic fever (PEF) and infection and the usefulness of AMP in protecting the indwelling catheter are unknown. This study evaluated fever and infection rates post-endoscopy, and the role of AMP in children with IF and CVC.</p><p><strong>Methods: </strong>This retrospective single-centre observational study included children with IF and CVC who underwent GI endoscopy at our intestinal rehabilitation centre between 2019 and 2024. Owing to a policy change, routine AMP was terminated in 2022. AMP group (intravenous [i.v.] antibiotics) and no-AMP group (no i.v. AMP) were compared using chi-square and Mann-Whitney U tests.</p><p><strong>Results: </strong>A total of 233 endoscopies in 108 in-patients with IF and CVC were analysed: median age at endoscopy, 68 months (range: 1-206 months); female, 54.6%; short bowel syndrome, 73.1%. Intravenous AMP was used in 71.2% of the procedures. Median follow-up after endoscopy was 2 days. There were no differences between the AMP and no-AMP groups in terms of age, type of endoscopy, interventional procedures, or pre-endoscopic use of enteral antibiotics or proton-pump inhibitors. The overall PEF rate was 6%, with no significant difference between groups. No infections, including central line-associated bloodstream infections, were observed.</p><p><strong>Conclusions: </strong>The frequency of PEF in children with IF is approximately 10 times higher than the recently reported incidence rate of 0.55% in paediatric patients. Since no bloodstream infections were confirmed, and AMP did not prevent PEF, routine administration of AMP for diagnostic endoscopy in children with IF is not indicated.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"736-742"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560357","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":"NASPGHAN position statement: Enabling quality pediatric gastroenterology care through electronic health record data capture and visualization.","authors":"Jennifer A Lee, Steve Miller, Catharine M Walsh, Khyati Mehta, Kevin L Watson, Christopher E Hayes, Cary Sauer, Jeannie S Huang","doi":"10.1002/jpn3.70125","DOIUrl":"10.1002/jpn3.70125","url":null,"abstract":"<p><p>Clinical practice guidelines are structured recommendations, derived from evidence-based research, aiming to inform, improve, and standardize patient care. This position paper considers the critical role the electronic health record (EHR) plays in data collection and implementation of guidelines. We describe EHR functionalities necessary to make guidelines actionable within the EHR and provide overview of data storage to inform design of data capture tools to reduce overall clinician workload. After reviewing current knowledge and practices, we have formulated the recommendation that NASPGHAN committees should develop clinical guidelines that identify specific and relevant health assessment measures with strong validity evidence, including patient-reported outcome measures. Guidelines should also outline clinical pathways, incorporating clinical decision support algorithms to provide feedback to users, and order sets to ensure the right guidance is provided for the right patient at the right time. Patient populations should be defined by using standard code sets. Committees should identify disease-specific health assessment measures with strong validity of evidence and identify areas where measures are still needed. Committees should offer guidance on population-based disease management and data visualization tools.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"852-865"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475749","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":"Celiac disease diagnosis in clinical practice: ESPGHAN quality of care survey from 129 pediatric hospitals across 28 countries.","authors":"Anna Litwin, Thu Giang Le Thi, Nabil El-Lababidi, Angelika Kindermann, Rouzha Pancheva, Konstantinos Gerasimidis, Cristina Campos Goncalves, Paula Crespo Escobar, Tena Niseteo, Katharina Ikrath, Sibylle Koletzko","doi":"10.1002/jpn3.70143","DOIUrl":"10.1002/jpn3.70143","url":null,"abstract":"<p><strong>Objectives: </strong>European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines recommend first-line serology for suspected celiac disease (CeD), measuring only transglutaminase antibodies (TGA-immunoglobulin A [IgA]) plus total IgA. If TGA-IgA is ≥10 times the normal value, pediatric gastroenterologists (pedGI) may diagnose CeD without biopsies if autoantibodies against endomysial antibodies (EMA-IgA) are positive in a 2nd blood sample. This Quality-of-Care (QoC) project benchmarked diagnostic workup in clinical practice using ESPGHAN CeD guidelines as reference.</p><p><strong>Methods: </strong>A pseudonymized survey on CeD practices was sent to 141 hospitals within the ESPGHAN QoC-network in 28 countries.</p><p><strong>Results: </strong>Questionnaires were completed by 129/141 (91.5%) hospitals, with 121 (94%) having pedGI staff. As reasons conflicting with good QoC for CeD in their setting, responders assumed knowledge deficits among the public (57%), primary care providers (64%), non-GI physicians (16%), and pedGIs (0%). For initial testing, 66% of physicians ordered only total IgA and TGA-IgA, 7% did not use this combination, and 29% ordered additional serology (TGA-IgG, EMA, antibodies against deaminated gliadin peptide, or native gliadin). Regarding conflicting results for TGA-IgA and histopathology in IgA-sufficient children, 61% incorrectly classified negative TGA-IgA with Marsh 2 and 57% with Marsh 3 lesions as \"potential CeD,\" while 49% excluded CeD in the case of villous atrophy and negative TGA-IgA. Routine practice did not align with the ESPGHAN recommendations regarding performance of duodenal biopsies (27%), EMA-testing (34%), and diagnosis of CeD in IgA-deficient children (32%).</p><p><strong>Conclusions: </strong>We identified areas for improving QoC regarding both effectiveness and efficacy, in pediatric patients with suspected CeD, and consequently developed easy-to-use tools to improve guideline implementation.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"606-617"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575627","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":"Sonographic evidence of hepatic steatosis is highly prevalent in at-risk children under 4 years of age.","authors":"Alexandra O Glenn, Shannon Green, Marialena Mouzaki, Andrew T Trout","doi":"10.1002/jpn3.70142","DOIUrl":"10.1002/jpn3.70142","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"679-682"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575714","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":"Impact of trainee participation on pediatric endoscopy quality indicators and faculty compensation.","authors":"Jeannie S Huang, Lillian Choi, Jenifer R Lightdale, Tom K Lin, Catharine M Walsh","doi":"10.1002/jpn3.70133","DOIUrl":"10.1002/jpn3.70133","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"761-764"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608624","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}