Microbial drug resistance最新文献

{"title":"Genomic Analysis of a Linezolid-Resistant <i>Staphylococcus capitis</i> Causing Bacteremia: Report from a University Hospital in Central Italy.","authors":"Lucia Brescini,&nbsp;Simona Fioriti,&nbsp;Sonia N Coccitto,&nbsp;Marzia Cinthi,&nbsp;Marina Mingoia,&nbsp;Oscar Cirioni,&nbsp;Andrea Giacometti,&nbsp;Eleonora Giovanetti,&nbsp;Gianluca Morroni,&nbsp;Andrea Brenciani","doi":"10.1089/mdr.2022.0330","DOIUrl":"https://doi.org/10.1089/mdr.2022.0330","url":null,"abstract":"<p><p>Although coagulase negative staphylococci are rarely associated with complicated diseases, in some cases they cause life-threatening infections. Here we described a clinical case of a bacteremia due to a methicillin- and linezolid-resistant <i>Staphylococcus capitis</i> in a patient previously treated with linezolid. Whole genome sequencing revealed the common mutation G2576T in all rDNA 23S alleles and several acquired resistance genes. Moreover, the isolate was epidemiologically distant from the NRCS-A clade, usually responsible for nosocomial infections in neonatal intensive care units. Our findings further confirm the ability of minor staphylococci to acquire antibiotic resistances and challenge the treatment of these infections.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 9","pages":"388-391"},"PeriodicalIF":2.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10511472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole Genome Sequencing of an Extensively Drug-Resistant <i>Raoultella planticola</i> Isolate Containing <i>bla</i>_KPC-2, <i>bla</i>_NDM-1, and <i>bla</i>_CTX-M-15.","authors":"Paulo Victor Batista Marini,&nbsp;Eliandro Reis Tavares,&nbsp;Cintia Werner Motter,&nbsp;Letícia Busato Migliorini,&nbsp;Romário Oliveira de Sales,&nbsp;Nayara Helisandra Fedrigo,&nbsp;Danielle Rosani Shinohara,&nbsp;Mariangela Hungria,&nbsp;Sueli Fumie Yamada-Ogatta,&nbsp;Maria Cristina Bronharo Tognim","doi":"10.1089/mdr.2022.0229","DOIUrl":"https://doi.org/10.1089/mdr.2022.0229","url":null,"abstract":"<p><p><i>Raoultella planticola</i> harboring genes that confer resistance to antimicrobials, such as carbapenems, have been associated with severe infections in immunocompromised patients. In this study, we reported the first whole genome sequence of a Brazilian isolate of <i>R. planticola</i> and the genomic context of antibiotic resistance markers. By whole-genome sequencing (WGS) of a carbapenem-resistant <i>R. planticola</i> isolate, RpHUM1, we found 23 resistance-encoding genes belonging to 9 classes of antibiotics (aminoglycosides, β-lactams, fluoroquinolones, fosfomycin, macrolides, phenicols, sulfonamides, tetracycline, and diaminopyrimidine derivatives) and 3 plasmids (RpHUM1pEaer-4382s, RpHUM1_pFDAARGOS_440, and RpHUM1pRSF1010). This isolate coharbored the genes <i>bla</i>_KPC-2, which is carried by the plasmid RpHUM1pEaer-4382s, and <i>bla</i>_NDM-1 and <i>bla</i>_CTX-M-15 all located in the accessory genome. In addition, these genes were associated with, at least, one mobile genetic element. This comprehensive knowledge is of great importance for implementation of control measures to prevent the rapid dissemination of this neglected microorganism and their genetic resistance background.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 9","pages":"392-400"},"PeriodicalIF":2.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10215067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Letter from the Editor-in-Chief.","authors":"","doi":"10.1089/mdr.2023.29006.igb","DOIUrl":"https://doi.org/10.1089/mdr.2023.29006.igb","url":null,"abstract":"","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 9","pages":"387"},"PeriodicalIF":2.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10513562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cellular Attributes of <i>Candida albicans</i> Biofilm-Associated in Resistance Against Multidrug and Host Immune System.","authors":"Dushyant Kumar,&nbsp;Awanish Kumar","doi":"10.1089/mdr.2022.0347","DOIUrl":"https://doi.org/10.1089/mdr.2022.0347","url":null,"abstract":"<p><p>One of the ubiquitous hospital-acquired infections is associated with <i>Candida albicans</i> fungus. Usually, this commensal fungus causes no harm to its human host, as it lives mutually with mucosal/epithelial tissue surface cells. Nevertheless, due to the activity of various immune weakening factors, this commensal starts reinforcing its virulence attributes with filamentation/hyphal growth and building an absolute microcolony composed of yeast, hyphal, and pseudohyphal cells, which is suspended in an extracellular gel-like polymeric substance (EPS) called biofilms. This polymeric substance is the mixture of the secreted compounds from <i>C. albicans</i> as well as several host cell proteins. Indeed, the presence of these host factors makes their identification and differentiation process difficult by host immune components. The gel-like texture of the EPS makes it sticky, which adsorbs most of the extracolonial compounds traversing through it that aid in penetration hindrance. All these factors further contribute to the multidrug resistance phenotype of <i>C. albicans</i> biofilm that is spotlighted in this article. The mechanisms it employs to escape the host immune system are also addressed effectively. The article focuses on cellular and molecular determinants involved in the resistance of <i>C. albicans</i> biofilm against multidrug and the host immune system.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 9","pages":"423-437"},"PeriodicalIF":2.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10156202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An <i>Enterococcus faecium</i> Isolated from Bovine Feces in Italy Shares <i>optrA</i>- and <i>poxtA</i>-Carrying Plasmids with Enterococci from Switzerland.","authors":"Marzia Cinthi,&nbsp;Sonia Nina Coccitto,&nbsp;Serena Simoni,&nbsp;Carla Vignaroli,&nbsp;Andrea Brenciani,&nbsp;Eleonora Giovanetti","doi":"10.1089/mdr.2023.0055","DOIUrl":"https://doi.org/10.1089/mdr.2023.0055","url":null,"abstract":"<p><p>To investigate the occurrence of oxazolidinone resistance genes, 18 florfenicol-resistant enterococci were isolated from 66 fecal samples collected from several cattle farms in central Italy. The PCR screening indicated that only a bovine florfenicol-resistant isolate, <i>Enterococcus faecium</i> 249031-C, was positive for the presence of <i>optrA</i> and <i>poxtA</i> genes. The strain was tested for its susceptibility to florfenicol, chloramphenicol, linezolid, tedizolid, tetracycline, erythromycin, and vancomycin. Whole Genome Sequencing analysis showed that <i>E. faecium</i> 249031-C, belonging to the ST22 lineage, harbored two plasmids: the <i>optrA</i>-carrying p249031-S (179 kb) and the <i>poxtA</i>-carrying p1818-c (23 kb). p249031-S, containing a new <i>optrA</i>-carrying Tn<i>7695</i> transposon, was closely related to the plasmid pF88_1 of <i>E. faecium</i> F88, whereas p1818-c had already been detected in a human <i>E. faecium</i>, both enterococci were from Switzerland. The linezolid resistance genes were cotransferred to the <i>E. faecium</i> 64/3 recipient. Circular forms from both <i>optrA</i>- and <i>poxtA</i>-carrying genetic contexts were obtained. The occurrence of oxazolidinone resistance genes in a bovine <i>E. faecium</i> isolate and their localization on conjugative and mobilizable plasmids pose a risk for public health.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 9","pages":"438-442"},"PeriodicalIF":2.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10156705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>In Vitro</i> Activity of Cefiderocol, Cefepime-Zidebactam, and β-Lactam Combinations Versus Other Antibiotic Classes Against Various Sequence Types of Clinically Isolated Carbapenemase-Producing <i>Klebsiella pneumoniae</i>.","authors":"Phadungkiat Khamnoi, Noppadon Jumroon, Jakkrit Khamphakul, Narong Chaihongsa, Pitak Santanirand","doi":"10.1089/mdr.2023.0070","DOIUrl":"10.1089/mdr.2023.0070","url":null,"abstract":"<p><p><b><i>Aim:</i></b> This study aimed to establish the <i>in vitro</i> efficacy and susceptibility profiles of new β-lactam antibiotics against clinically isolated carbapenemase-producing <i>Klebsiella pneumoniae</i> (CPKP) strains. <b><i>Materials and Methods:</i></b> A total of 117 nonduplicated CPKP isolates were tested against cefiderocol, cefepime-zidebactam, ceftazidime-avibactam, tigecycline, and other 20 antibiotics by broth microdilution. The carbapenemase genes were identified using PCR and sequencing, while multilocus sequence typing established the bacterial strains. <b><i>Results:</i></b> Three significant sequence types (STs), including ST147, ST16, and ST11, were shown to be the dominant STs, which occupied ∼90% of the tested population. Three carbapenemase genes, <i>bla</i>_NDM-1, <i>bla</i>_OXA-181, and <i>bla</i>_OXA-232, were detected. The <i>bla</i>_NDM-1 was found in ST147 and ST16 but not in ST11, while the <i>bla</i>_OXA-232 was not detected in ST147. The majority of ST16 isolates contained both <i>bla</i>_NDM-1 and <i>bla</i>_OXA-232, which was not seen in other strains. Cefiderocol, cefepime-zidebactam, and tigecycline were the most active agents against CPKP. Both MIC₅₀ and MIC₉₀ of these three antibiotics remained within the susceptible categories, while nearly all other antibiotics were in the resistant levels. However, in ST11, which carried only <i>bla</i>_OXA genes without <i>bla</i>_NDM-1, ceftazidime-avibactam was effective with the MIC₉₀ at 2 μg/mL. In addition, amikacin was shown to have good activity in ST11. In contrast, gentamicin was active in only ST16 and ST147. <b><i>Conclusions:</i></b> This study is the first report that demonstrates the prevalence of CPKP, distribution of strains, resistant genes, and antimicrobial susceptibility profiles in northern Thailand. These data would contribute to appropriate individual treatment and the selection of infection control strategies.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 9","pages":"416-422"},"PeriodicalIF":2.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10149788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and <i>In Vivo</i> Assessment of Virulence in Shiga Toxin-Producing <i>Escherichia coli</i> Clinical Isolates from Greater Cairo Area.","authors":"Rana Elshimy,&nbsp;Hamdallah Zedan,&nbsp;Tarek H Elmorsy,&nbsp;Rania Abdelmonem Khattab","doi":"10.1089/mdr.2022.0348","DOIUrl":"https://doi.org/10.1089/mdr.2022.0348","url":null,"abstract":"<p><p><b><i>Background:</i></b> Shiga toxin-producing <i>Escherichia coli</i> (STEC) has been identified as an important etiologic agent of human disease in Egypt. <b><i>Aims:</i></b> To investigate the occurrence and describe the characterization as well as prevalence of STEC in Greater Cairo hospitals as well as molecular characterization of virulence and resistance genes. <b><i>Methods:</i></b> Four hundred seventy <i>E. coli</i> clinical isolates were collected from eight hospitals and analyzed by genotypic and phenotypic methods for STEC, followed by histopathological examination and scoring of different organs lesions. <b><i>Results:</i></b> The highest proportion of isolates was from urine (151 isolates), whereas the lowest was from splenic drain (3 isolates). In tandem, when serogrouping was performed, 15 serogroups were obtained where the most prevalent was O157 and the least prevalent was O151. All isolates were positive when screened for identity gene <i>gad</i> A, while only typable strains were screened for seven virulence genes <i>stx</i>1 (gene encoding Shiga toxin 1), <i>stx</i>2 (gene encoding Shiga toxin 2), <i>tsh</i> (gene encoding thermostable hemagglutinin), <i>eae</i>A (gene encoding intimin), <i>invE</i> (gene encoding invasion protein), <i>aggR</i> (gene encoding aggregative adherence transcriptional regulator), and <i>ast</i>A (aspartate transaminase) where the prevalence was 48%, 30%, 50%, 57%, 7.5%, 12%, and 58%, respectively. Of 254 typable isolates, 152 were STEC carrying <i>stx</i>1 or <i>stx</i>2 genes or both. <b><i>Conclusions:</i></b> Relying on <i>in vivo</i> comparison between different <i>E. coli</i> pathotypes via histopathological examination of different organs, <i>E. coli</i> pathotypes could be divided into mild virulent, moderate virulent, and high virulent strains. Statistical analysis revealed significant correlation between different serogroups and presence of virulence genes.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 9","pages":"407-415"},"PeriodicalIF":2.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10157184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>In Vitro</i> Activity of Cefiderocol Against Meropenem-Nonsusceptible Gram-Negative Bacilli with Defined β-Lactamase Carriage: SIDERO-WT Surveillance Studies, 2014-2019.","authors":"Mark G Wise, James A Karlowsky, Meredith A Hackel, Miki Takemura, Yoshinori Yamano, Roger Echols, Daniel F Sahm","doi":"10.1089/mdr.2022.0279","DOIUrl":"10.1089/mdr.2022.0279","url":null,"abstract":"<p><p>We examined the <i>in vitro</i> susceptibility of meropenem-nonsusceptible Enterobacterales, <i>Pseudomonas aeruginosa</i>, and <i>Acinetobacter baumannii</i> complex isolates from five consecutive annual SIDERO-WT surveillance studies (2014-2019) to cefiderocol and comparator agents in the context of their carbapenemase carriage. 1,003 Enterobacterales, 1,758 <i>P. aeruginosa</i>, and 2,809 <i>A. baumannii</i> complex isolates from North America and Europe that were meropenem nonsusceptible (CLSI M100, 2022) were molecularly characterized for β-lactamase content by PCR followed by Sanger sequencing or by whole genome sequencing. Among Enterobacterales, 91.5% of metallo-β-lactamase (MBL)-producing, 98.4% of KPC-producing, 97.3% of OXA-48 group-producing, and 98.7% of carbapenemase-negative, meropenem-nonsusceptible isolates were cefiderocol susceptible (MIC ≤4 mg/L). Among <i>P. aeruginosa</i>, 100% of MBL-producing, 100% of GES carbapenemase-producing, and 99.8% of carbapenemase-negative, meropenem-nonsusceptible isolates were cefiderocol susceptible (MIC ≤4 mg/L). Among <i>A. baumannii</i> complex, 60.0% of MBL-producing, 95.6% of OXA-23 group-producing, 89.5% of OXA-24 group-producing, 100% of OXA-58 group-producing, and 95.5% of carbapenemase-negative, meropenem-nonsusceptible isolates were cefiderocol susceptible (MIC ≤4 mg/L). Cefiderocol was inactive against <i>A. baumannii</i> complex isolates carrying a PER or VEB β-lactamase (<i>n</i> = 103; 15.5% susceptible). Ceftazidime-avibactam and ceftolozane-tazobactam were inactive against MBL-carrying and <i>A. baumannii</i> complex isolates; ceftolozane-tazobactam was also inactive against serine carbapenemase-carrying Enterobacterales and <i>P. aeruginosa</i>. In summary, cefiderocol was highly active <i>in vitro</i> against Gram-negative isolates carrying MBLs and serine carbapenemases, as well as carbapenemase-negative, meropenem-nonsusceptible isolates.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 8","pages":"360-370"},"PeriodicalIF":2.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10387160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9917318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Role of Sphingolipids in Amphotericin B Drug Resistance.","authors":"Kashish Madaan,&nbsp;Vinay Kumar Bari","doi":"10.1089/mdr.2022.0353","DOIUrl":"https://doi.org/10.1089/mdr.2022.0353","url":null,"abstract":"<p><p>Invasive fungal infections in humans are common in people with compromised immune systems and are difficult to treat, resulting in high mortality. Amphotericin B (AmB) is one of the main antifungal drugs available to treat these infections. AmB binds with plasma membrane ergosterol, causing leakage of cellular ions and promoting cell death. The increasing use of available antifungal drugs to combat pathogenic fungal infections has led to the development of drug resistance. AmB resistance is not very common and is usually caused by changes in the amount or type of ergosterol or changes in the cell wall. Intrinsic AmB resistance occurs in the absence of AmB exposure, whereas acquired AmB resistance can develop during treatment. However, clinical resistance arises due to treatment failure with AmB and depends on multiple factors such as the pharmacokinetics of AmB, infectious fungal species, and host immune status. <i>Candida albicans</i> is a common opportunistic pathogen that can cause superficial infections of the skin and mucosal surfaces, thrush, to life-threatening systemic or invasive infections. In addition, immunocompromised individuals are more susceptible to systemic infections caused by <i>Candida</i>, <i>Aspergillus</i>, and <i>Cryptococcus</i>. Several antifungal drugs with different modes of action are used to treat systemic to invasive fungal infections and are approved for clinical use in the treatment of fungal diseases. However, <i>C. albicans</i> can develop a variety of defenses against antifungal medications. In fungi, plasma membrane sphingolipid molecules could interact with ergosterol, which can lead to the alteration of drug susceptibilities such as AmB. In this review, we mainly summarize the role of sphingolipid molecules and their regulators in AmB resistance.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 8","pages":"319-332"},"PeriodicalIF":2.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9917822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the MDR Direct Flow Chip Kit for the Detection of Multiple Antimicrobial Resistance Determinants.","authors":"Ángel Rodríguez-Villodres,&nbsp;Antonio Galiana-Cabrera,&nbsp;Ignacio Torres Fink,&nbsp;Rosario Duran Jiménez,&nbsp;José Miguel Cisneros,&nbsp;José Antonio Lepe","doi":"10.1089/mdr.2022.0264","DOIUrl":"https://doi.org/10.1089/mdr.2022.0264","url":null,"abstract":"<p><p>The objective of this study was to evaluate the accuracy of the MDR Direct Flow Chip Kit for the detection of antimicrobial resistance (AMR) determinants from bacterial colonies. Ninety-two clinical isolates with known AMR determinants genotypically characterized were used. The MDR Direct Flow Chip Kit is a microarray-based assay that included 55 AMR determinants for beta-lactams (23), quinolones (13), aminoglycosides (5), macrolides (5), sulfonamides (3), colistin (2), vancomycin (2), chloramphenicol (1), and linezolid (1). The MDR Direct Flow Chip Kit correctly detects 52 of 53 AMR determinants tested. The <i>cfr</i> gene (linezolid resistance) was not detected. The global sensibility, specificity, positive predictive value, and the negative predictive value calculated were 98%, 100%, 100%, and 97%. The Cohen's Kappa coefficient calculated was 0.97 [95% Confidence Interval (0.90-1.03)]. In conclusion, the MDR Direct Flow Chip is an accurate assay for the detection of multiple AMR determinants in one simple reaction.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":"29 8","pages":"381-385"},"PeriodicalIF":2.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9907176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}