Hepatology最新文献

{"title":"Proton density fat fraction for diagnosis of metabolic dysfunction associated steatotic liver disease.","authors":"Nikolaos Panagiotopoulos, Tanya Wolfson, David T Harris, Danielle Batakis, Rashmi Agni, Lael Ceriani, Yesenia Covarrubias, Gavin Hamilton, Michael S Middleton, Vitor F Martins, Anthony C Gamst, Thekla H Oechtering, Ryan Sappenfield, Santiago Horgan, Eduardo Grunvald, Luke M Funk, Garth R Jacobsen, Anne O Lidor, James A Goodman, Sami B Khoury, Claude B Sirlin, Scott B Reeder","doi":"10.1097/HEP.0000000000001318","DOIUrl":"10.1097/HEP.0000000000001318","url":null,"abstract":"<p><strong>Background aims: </strong>Prior work has shown that magnetic resonance imaging (MRI)-derived proton density fat fraction (PDFF) can diagnose metabolic dysfunction-associated steatotic liver disease (MASLD) noninvasively, but there is a paucity of data on the performance of PDFF to classify more advanced forms of the MASLD spectrum. The purpose of this study was to assess the diagnostic performance of PDFF for the diagnoses of MASLD, metabolic dysfunction-associated steatohepatitis (MASH), and fibrotic MASH in adults with obesity undergoing bariatric surgery, using contemporaneous intraoperative liver biopsy as reference.</p><p><strong>Approach results: </strong>PDFF was evaluated alone and with other potential classifiers (imaging, serum and anthropometric), using Bayesian Information Criterion-based stepwise logistic regression models. Areas under the receiver operating characteristic (ROC) curves (AUC) were computed for all models and single classifiers. Cross-validated sensitivity and specificity were calculated at Youden-based PDFF classification thresholds. Data analysis from 140 patients demonstrated that PDFF was the most accurate single classifier, with high AUC for MASLD (0.95), MASH (0.85), and fibrotic MASH (0.82) (all p<0.001). Multivariable models including PDFF outperformed those without PDFF. The Youden-based threshold for PDFF was 4.4% for MASLD (sensitivity: 87%, specificity: 86%), 6.9% for MASH (sensitivity: 77%, specificity: 66%), and 13.5% for fibrotic MASH (sensitivity: 67%, specificity: 85%).</p><p><strong>Conclusions: </strong>PDFF was the most accurate single classifier for diagnosing MASLD, MASH, and fibrotic MASH. The most accurate multivariable classification models for MASLD, MASH, and fibrotic MASH included PDFF, demonstrating the central importance of PDFF for noninvasive assessment of the MASLD spectrum.</p>","PeriodicalId":177,"journal":{"name":"Hepatology","volume":" ","pages":""},"PeriodicalIF":12.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: targeted enteral feeding for malnutrition in liver transplant candidates","authors":"Qingyu Chen","doi":"10.1097/hep.0000000000001317","DOIUrl":"https://doi.org/10.1097/hep.0000000000001317","url":null,"abstract":"","PeriodicalId":177,"journal":{"name":"Hepatology","volume":"93 1","pages":""},"PeriodicalIF":13.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Liver Transplant Comorbidity Index (LTCI) : A composite index of ambulatory Pre-LT factors to identify patients at increased risk of Post-LT Mortality.","authors":"Jennifer C Lai, Amy M Shui, Michele Molinari, Robert Rahimi, Daniela Ladner, Daniel Ganger, Matthew Kappus, Elizabeth King, Amit Tevar, Michael Volk, Andres Duarte-Rojo, Elizabeth C Verna","doi":"10.1097/HEP.0000000000001320","DOIUrl":"https://doi.org/10.1097/HEP.0000000000001320","url":null,"abstract":"<p><strong>Background: </strong>Frailty is strongly associated with mortality after liver transplantation. However, national guidelines discourage its use as a sole reason to decline a patient for liver transplantation, as some frail patients have acceptable outcomes. We aimed to develop a composite index, the Liver Transplant Comorbidity Index (LTCI), integrating frailty and other comorbidities, as a risk factor for longer-term (3-year) post-transplant mortality.</p><p><strong>Methods: </strong>This 8-center prospective Functional Assessment in Liver Transplantation (FrAILT) Study included adult recipients of a primary deceased donor liver transplant from 2012-2022. Frailty was measured using the Liver Frailty Index (LFI ≥4.5=frail). Other candidate variables included demographics, laboratories, and comorbidities. Cox proportional hazards regression with best subset selection was used to identify risk factors of 3-year post-transplant death. The final model was selected based on Aikaike Information Criterion and clinical pragmatism.</p><p><strong>Results: </strong>Of 1,472 liver transplant recipients. 290 (20%) were frail. Three-year post-transplant mortality was higher in frail versus non-frail patients (13 vs. 8%; p=0.03). The final LTCI included 5 variables: frailty, coronary artery disease, hepatocellular carcinoma, renal dysfunction, and diabetes. Three-year post-transplant mortality in low-, moderate-, and high-risk LTCI groups was 93%, 87%, and 80% respectively. In multivariable analysis, after adjusting for donor factors (age, DCD), both moderate- (HR 2.23; 95% CI 1.46-3.40; p<0.001) and high-risk (HR 2.78; 95% CI 1.67-4.64; p<0.001) status were associated with 3-year post-transplant mortality.</p><p><strong>Conclusion: </strong>The LTCI, comprising 5 pre-transplant clinical parameters, effectively identifies patients at increased risk of post-transplant mortality. By integrating frailty in the context of other co-morbidities, the LTCI can help providers better weigh the relative transplant risks and benefits and standardize selection of transplant candidates.</p>","PeriodicalId":177,"journal":{"name":"Hepatology","volume":" ","pages":""},"PeriodicalIF":12.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: HDV RNA assays: Performance characteristics, clinical utility, and challenges.","authors":"Heiner Wedemeyer, Mitchell Leus, Thomas R Battersby, Jeffrey Glenn, Emmanuel Gordien, Saleem Kamili, Hema Kapoor, Harald H Kessler, Oliver Lenz, Marc Lütgehetmann, Tonya Mixson-Hayden, Christian O Simon, Michael Thomson, Gabriel Westman, Veronica Miller, Norah Terrault, Pietro Lampertico","doi":"10.1097/HEP.0000000000001262","DOIUrl":"https://doi.org/10.1097/HEP.0000000000001262","url":null,"abstract":"","PeriodicalId":177,"journal":{"name":"Hepatology","volume":" ","pages":""},"PeriodicalIF":12.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil serine proteases NE and PR3 controlled by the miR-223/STAT3 axis potentiate MASH and liver fibrosis.","authors":"Pengfei Zhang, Dongyang Liu, Lihong Wu, Xiaoqin Wu, Kaixuan Yan, Mengqi Fan, Danqi Zou, Erfei Song, Yumeng Jiang, Ying Xu, Xiaoping Wu, Shufei Zang, Fei Zhu, Yuqi Chen, Zhikang Cen, Mengqiao Bi, Yuying Zhang, Xicheng Wang, Wei Liu, Rongxin Zhang, Cunchuan Wang, Ruby Lai Chong Hoo, Aimin Xu, Dewei Ye","doi":"10.1097/HEP.0000000000001309","DOIUrl":"https://doi.org/10.1097/HEP.0000000000001309","url":null,"abstract":"<p><strong>Background aims: </strong>Metabolic dysfunction-associated steatohepatitis (MASH) and its related liver fibrosis represent a substantial public health burden with limited treatment options. Although MASH is associated with enhanced neutrophil infiltration in the liver, the mediators and mechanisms underlying neutrophil-driven progression of MASH and fibrosis remain largely unknown. This study aimed to investigate the role of neutrophil serine proteases neutrophil elastase (NE) and proteinase 3 (PR3) in the development of MASH and fibrosis.</p><p><strong>Approach: </strong>Liver biopsies from 121 morbidly obese patients were recruited for analysis. NE-/-, PR3-/-, microRNA-223 (miR-223)-/- mice and their wild type controls were fed a choline-deficient, L-amino acid-defined, high-fat diet to induce MASH fibrosis. Bone marrow transplantation was performed to generate mice with miR-223 chimerism in bone marrow-derived cells.</p><p><strong>Results: </strong>NE and PR3 content in human liver with MASH and fibrosis was markedly increased in close association with histological features. Genetic ablation or AAV-mediated inhibition of NE and PR3 substantially alleviated MASH and liver fibrosis in mice. Mechanistic study revealed that miR-223 suppressed neutrophilic NE and PR3 by targeting STAT3. MiR-223 deficiency augmented inflammation and fibrosis in mouse liver. Bone marrow transplantation-induced miR-223 chimerism significantly affected hepatic NE/PR3 content and the progression of MASH fibrosis in mice.</p><p><strong>Conclusions: </strong>Our findings reveal that NE and PR3 are key factors triggering liver inflammation to potentiate the development of MASH and liver fibrosis, offering insight into the development of new therapeutic approaches that target NE and PR3.</p>","PeriodicalId":177,"journal":{"name":"Hepatology","volume":" ","pages":""},"PeriodicalIF":12.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early screening, diagnosis and recurrence monitoring of hepatocellular carcinoma in chronic hepatitis B patients based on serum N-glycomics analysis: A cohort study.","authors":"Rui Su, Xuemei Tao, Lihua Yan, Yonggang Liu, Cuiying Chitty Chen, Ping Li, Jia Li, Jing Miao, Feng Liu, Wentao Kuai, Jiancun Hou, Mei Liu, Yuqiang Mi, Liang Xu","doi":"10.1097/HEP.0000000000001316","DOIUrl":"https://doi.org/10.1097/HEP.0000000000001316","url":null,"abstract":"<p><strong>Background and aims: </strong>Hepatocellular carcinoma (HCC) poses a significant global health burden, with hepatitis B virus (HBV) being the predominant etiology in China. However, current diagnostic markers lack the requisite sensitivity and specificity. This study aims to develop and validate serum N-glycomics-based models for the diagnosis and prognosis of HCC in patients with chronic hepatitis B (CHB)-related cirrhosis.</p><p><strong>Approach and results: </strong>This study enrolled a total of 397 patients with CHB-related cirrhosis and HCC for clinical management. N-glycomics profiling was conducted on all participants and clinical data were collected. First, machine learning-based models, HCC-GRF and HCC-GSVM, were established for early screening and diagnosis of HCC using N-glycomics. The AUC values in the validation set were 0.967 (95% CI: 0.930-1.000) and 0.908 (0.840-0.976) for HCC-GRF and HCC-GSVM, respectively, outperforming AFP [0.687 (0.575-0.765)] and PIVKA-II [0.665 (0.507-0.823)]. It also showed superiority in subgroups analysis and external validation. Calibration and decision curve analysis also showed good predictive performance. Additionally, we developed a prognostic model, the prog-G model, based on N-glycans to monitor recurrence in HCC patients after curative treatment. During the follow-up period, it was observed that this model correlated with the clinical condition of the patients and could identify all recurrent HCC cases (n=12) prior to imaging findings, outperforming AFP (n=7) and PIVKA-II (n=9), while also detecting recurrent lesions earlier than imaging.</p><p><strong>Conclusions: </strong>N-glycomics models can effectively predict the occurrence and recurrence of HCC to improving the efficiency of clinical decision-making and promoting the precision treatment of HCC.</p>","PeriodicalId":177,"journal":{"name":"Hepatology","volume":" ","pages":""},"PeriodicalIF":12.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between metabolic syndrome and cholangiocarcinoma risk: A large-scale population-based cohort study.","authors":"Tzu-I Chen, Ming-Huang Chen, Szu-Ching Yin, Chih-Jo Lin, Tram Kim Lam, Chia-Wei Huang, Yi-Ting Chen, Xia-Rong Liu, Yun-Zheng Gao, Wan-Lun Hsu, Hsuan-Yu Chen, Ta-Sen Yeh, Jill Koshiol, Mei-Hsuan Lee","doi":"10.1097/HEP.0000000000001312","DOIUrl":"https://doi.org/10.1097/HEP.0000000000001312","url":null,"abstract":"<p><strong>Background and aims: </strong>This large-scale, population-based cohort study examined the associations between metabolic syndrome and cholangiocarcinoma risk, including its intra- and extra-hepatic forms.</p><p><strong>Approach and results: </strong>A total of 4,932,211 adults aged ≥40 years participated in a government-initiated health checkup program (2012-2017), which collected lifestyle data, anthropometric measurements, and biochemical tests. Follow-up continued until 2021, with data linkage to National Cancer and Death Registries to ascertain the occurrence of cholangiocarcinoma and obtain vital status information. Fine and Gray models accounted for competing risks. During 35,879,371 person-years of follow-up, 6,117 cholangiocarcinoma cases were identified, with an incidence rate of 17.05 (95% CI: 15.90-18.20) per 100,000 person-years. Individuals with metabolic syndrome had significantly higher incidences of both intra- and extra-hepatic cholangiocarcinoma (p<0.0001). The multivariate-adjusted hazard ratio (HR) for cholangiocarcinoma among those with metabolic syndrome was 1.20 (1.14-1.27). Stratification analyses by age, sex, liver enzyme levels, and comorbidities consistently demonstrated an increased cholangiocarcinoma risk among individuals with metabolic syndrome. A dose-response relationship was observed, with a higher number of metabolic components correlating with an elevated cholangiocarcinoma risk, even after accounting for all-cause mortality as a competing risk. The adjusted subdistribution HRs ranged from 1.16 (95% CI: 1.02-1.32) for individuals with one metabolic component to 1.67 (95% CI: 1.45-1.94) for those with five (p for trend <0.0001).</p><p><strong>Conclusions: </strong>The positive association between metabolic syndrome and cholangiocarcinoma risk suggests that managing metabolic risk factors might reduce the occurrence of both intra- and extra-hepatic cholangiocarcinoma.</p>","PeriodicalId":177,"journal":{"name":"Hepatology","volume":" ","pages":""},"PeriodicalIF":12.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning analysis of magnetic resonance imaging accurately detects early-stage perihilar cholangiocarcinoma in patients with primary sclerosing cholangitis","authors":"Yashbir Singh, John E. Eaton, Sudhakar K. Venkatesh, Christopher L. Welle, Byron Smith, Shahriar Faghani, Mette Vesterhus, Tom H. Karlsen, Kristin K. Jorgensen, Trine Folseraas, Kosta Petrovic, Anne Negard, Ida Bjoerk, Andreas Abildgaard, Aliya F. Gulamhusein, Kartik Jhaveri, Gregory J. Gores, Sumera I. Ilyas, Timucin Taner, Julie K. Heimbach, Ty S. Diwan, Nicholas F. LaRusso, Konstantinos N. Lazaridis, Bradley J. Erickson","doi":"10.1097/hep.0000000000001314","DOIUrl":"https://doi.org/10.1097/hep.0000000000001314","url":null,"abstract":"Background and aims: Among those with primary sclerosing cholangitis (PSC), perihilar CCA (pCCA) is often diagnosed at a late-stage and is a leading source of mortality. Detection of pCCA in PSC when curative action can be taken is challenging. Our aim was to create a deep learning model that analyzed magnetic resonance imaging (MRI) to detect early-stage pCCA and compare its diagnostic performance with expert radiologists. Approach and results: We conducted a multicenter, international, retrospective cohort study involving adults with large duct PSC who underwent contrast-enhanced MRI. Senior abdominal radiologists reviewed the images. All patients with pCCA had early-stage cancer and were registered for liver transplantation. We trained a 3D DenseNet-121 model, a form of deep learning, using MRI images and assessed its performance in a separate test cohort. The study included 398 patients (training cohort n=150; test cohort n=248). pCCA was present in 230 individuals (training cohort n=64; test cohort n=166). In the test cohort, the respective performances of the model compared to the radiologists were: sensitivity 87.9% versus 50.0%, <jats:italic toggle=\"yes\">p</jats:italic>&lt;0.001; specificity 84.1% versus 100.0%, <jats:italic toggle=\"yes\">p</jats:italic>&lt;0.001; area under receiving operating curve 86.0% versus 75.0%, <jats:italic toggle=\"yes\">p</jats:italic>&lt;0.001. Even when a mass was absent, the model had a higher sensitivity for pCCA than radiologists (91.6% vs. 50.6%, <jats:italic toggle=\"yes\">p</jats:italic>&lt;0.001) and maintained good specificity (84.1%). Conclusion: The 3D DenseNet-121 MRI model effectively detects early-stage pCCA in PSC patients. Compared to expert radiologists, the model missed fewer cases of cancer.","PeriodicalId":177,"journal":{"name":"Hepatology","volume":"3 1","pages":""},"PeriodicalIF":13.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher level of Hepatitis B Surface antigen associated with delayed development of hepatocellular carcinoma in immune-tolerant patients","authors":"Tai-Chung Tseng, Tetsuya Hosaka, Mei-Hung Pan, Chun-Jen Liu, Fumitaka Suzuki, Chien-Jen Chen, Tung-Hung Su, Hiromitsu Kumada, Wan-Ting Yang, Hung-Chih Yang, Chen-Hua Liu, Pei-Jer Chen, Hwai-I. Yang, Jia-Horng Kao","doi":"10.1097/hep.0000000000001313","DOIUrl":"https://doi.org/10.1097/hep.0000000000001313","url":null,"abstract":"Background: Active viral replication in patients with chronic HBV infection is a major risk factor for hepatocellular carcinoma (HCC). However, the HCC risk in highly viremic patients, such as immune-tolerant patients, remains unclear. This study aimed to investigate the relationship between viral factors and HCC risk in patients with chronic HBV infection, focusing on immune-tolerant patients. Patients and Methods: A total of 6,139 non-cirrhotic Taiwanese patients with chronic HBV infection were enrolled, comprising 2,666 patients from ERADICATE-B study and 3,473 patients from REVEAL-HBV study. The primary endpoint was HCC development. The relationships between viral factors and HCC risk in HBeAg-positive and HBeAg-negative patients were analyzed separately. Results: Over a median 21.7-year follow-up, 547 patients developed HCC. The relationship between viral factors and HCC risk varied depending on HBeAg status. HCC risk increased with viral load and plateaued at ≥5 log<jats:sub>10</jats:sub> IU/mL in HBeAg-negative patients, while showing limited correlation in HBeAg-positive patients. Conversely, HBsAg levels were positively associated with HCC risk in HBeAg-negative patients but negatively associated in HBeAg-positive patients. Further investigation focusing on HBeAg-positive immune-tolerant patients showed that HBsAg levels ≥10,000 IU/mL (vs. &lt;10,000 IU/mL) were associated with delayed HCC development, which was validated both internally through various subgroup analyses and externally by an independent Japanese cohort. Conclusion: Predictive roles of HBV DNA and HBsAg levels in HCC development differ between HBeAg-negative and HBeAg-positive patients. Particularly, among immune-tolerant patients, HBsAg levels ≥10,000 IU/mL showed delayed development of HCC, suggesting HBsAg as a biomarker to define genuine immune-tolerant patients.","PeriodicalId":177,"journal":{"name":"Hepatology","volume":"54 1","pages":""},"PeriodicalIF":13.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAD-Driven pathways in hepatocellular carcinoma metastasis","authors":"Carmen Chak-Lui Wong, Chun-Ming Wong","doi":"10.1097/hep.0000000000001315","DOIUrl":"https://doi.org/10.1097/hep.0000000000001315","url":null,"abstract":"","PeriodicalId":177,"journal":{"name":"Hepatology","volume":"25 1","pages":""},"PeriodicalIF":13.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}