Nature Medicine最新文献

{"title":"A multimodal vision foundation model for clinical dermatology","authors":"Siyuan Yan, Zhen Yu, Clare Primiero, Cristina Vico-Alonso, Zhonghua Wang, Litao Yang, Philipp Tschandl, Ming Hu, Lie Ju, Gin Tan, Vincent Tang, Aik Beng Ng, David Powell, Paul Bonnington, Simon See, Elisabetta Magnaterra, Peter Ferguson, Jennifer Nguyen, Pascale Guitera, Jose Banuls, Monika Janda, Victoria Mar, Harald Kittler, H. Peter Soyer, Zongyuan Ge","doi":"10.1038/s41591-025-03747-y","DOIUrl":"https://doi.org/10.1038/s41591-025-03747-y","url":null,"abstract":"<p>Diagnosing and treating skin diseases require advanced visual skills across domains and the ability to synthesize information from multiple imaging modalities. While current deep learning models excel at specific tasks such as skin cancer diagnosis from dermoscopic images, they struggle to meet the complex, multimodal requirements of clinical practice. Here we introduce PanDerm, a multimodal dermatology foundation model pretrained through self-supervised learning on over 2 million real-world skin disease images from 11 clinical institutions across 4 imaging modalities. We evaluated PanDerm on 28 diverse benchmarks, including skin cancer screening, risk stratification, differential diagnosis of common and rare skin conditions, lesion segmentation, longitudinal monitoring, and metastasis prediction and prognosis. PanDerm achieved state-of-the-art performance across all evaluated tasks, often outperforming existing models when using only 10% of labeled data. We conducted three reader studies to assess PanDerm’s potential clinical utility. PanDerm outperformed clinicians by 10.2% in early-stage melanoma detection through longitudinal analysis, improved clinicians’ skin cancer diagnostic accuracy by 11% on dermoscopy images and enhanced nondermatologist healthcare providers’ differential diagnosis by 16.5% across 128 skin conditions on clinical photographs. These results show PanDerm’s potential to improve patient care across diverse clinical scenarios and serve as a model for developing multimodal foundation models in other medical specialties, potentially accelerating the integration of artificial intelligence support in healthcare.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"26 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228531","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":"Adjunct-to-insulin therapy using SGLT2 inhibitors in youth with type 1 diabetes: a randomized controlled trial","authors":"Farid H. Mahmud, Petter Bjornstad, Cheril Clarson, Antoine Clarke, Samantha J. Anthony, Jacqueline Curtis, Yesmino T. Elia, Lynne McArthur, Luc Mertens, Rahim Moineddin, Susan Kirsch, Nicole Coles, Maria Maione, Michelle Furman, Funmbi Babalola, Kalie L. Tommerdahl, Jennifer Harrington, Michael C. Riddell, Pottumarthi Prasad, Lennox Huang, Hiddo J. L. Heerspink, David Z. I. Cherney","doi":"10.1038/s41591-025-03723-6","DOIUrl":"https://doi.org/10.1038/s41591-025-03723-6","url":null,"abstract":"<p>Sodium glucose co-transporter 2 inhibitors (SGLT2i) reduce the risk of chronic kidney disease (CKD) progression in type 2 diabetes, but their effects in type 1 diabetes (T1D) are not completely understood. ATTEMPT (Adolescent Type 1 Diabetes Treatment with SGLT2i for Hyperglycemia and Hyperfiltration Trial) is a 22-week, double-blind, randomized, placebo-controlled trial to assess dapagliflozin, as an adjunct to insulin, in youth with T1D. Ninety-eight participants (12–21 years of age, 53% female) were randomly assigned to dapagliflozin 5 mg or placebo alongside ketone monitoring and diabetic ketoacidosis (DKA) risk mitigation education. The primary outcome was change in measured glomerular filtration rate (mGFR) using iohexol clearance. Dapagliflozin reduced mGFR by 8.8 ml min⁻¹ 1.73 m⁻² when compared to placebo (95% confidence interval (CI): −12.7 to −4.8; <i>P</i> &lt; 0.0001), and participants with higher baseline mGFR experienced greater attenuation with dapagliflozin (<i>r</i>: −0.58; <i>P</i> &lt; 0.0001). HbA1c decreased by 0.47% (95% CI: −0.66 to −0.28), and time in range (glucose levels 70–180 mg dl⁻¹, 4–10 mmol L⁻¹) increased by 9.0% (95% CI: 3.8–14.3). Body weight decreased by 2.8 kg (95% CI: −3.7 to −2.0) with dapagliflozin. No differences were observed with respect to total daily insulin dose (U kg⁻¹). Adverse events were similar between groups, with one mild DKA case in the dapagliflozin group. In youth with T1D, dapagliflozin as an adjunct-to-insulin treatment reduced mGFR, improved glycemic control and was safe when combined with ketone testing and risk mitigation strategies. ClinicalTrials.gov: NCT04333823.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"248 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228539","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 People-First Liver Charter","authors":"Jeffrey V. Lazarus, Dana Ivancovsky Wajcman, Silvana Pannain, Paul N. Brennan, Melina I. Manolas, Peter Jepsen, Carla Treloar, Anish K. Arora, Philippa C. Matthews, Camila A. Picchio, Trenton M. White, Jason Grebely, Juan Vaz, Hannes Hagström, Kenneth H. Rabin, Scott Isaacs, Rogério T. Ribeiro, Michael Roden, Michael Betel, José Willemse, Luis Antonio Díaz, Alina M. Allen, Naim Alkhouri, Jörn M. Schattenberg, Dídac Mauricio, Mary E. Rinella, Elisa Pose, Emmanuel A. Tsochatzis, Michael Ninburg, Kenneth Cusi, William Alazawi, Ajay Duseja, Gema Frühbeck, Holly Lofton, Priya Jaisinghani, Fasiha Kanwal, Gamal Shiha, Shira Zelber-Sagi, Larry Holden, Marcela Villota-Rivas","doi":"10.1038/s41591-025-03759-8","DOIUrl":"https://doi.org/10.1038/s41591-025-03759-8","url":null,"abstract":"Reducing the stigma and discrimination that people living with liver conditions experience requires rethinking how diagnoses, diseases, etiologies and circumstances are perceived — a shift that begins with the language used to name and describe them.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"36 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218908","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":"Ethics and integrity in uncertain times","authors":"","doi":"10.1038/s41591-025-03795-4","DOIUrl":"https://doi.org/10.1038/s41591-025-03795-4","url":null,"abstract":"The newly launched PREPARED Code presents a much-needed framework to ensure that research during pandemics is trustworthy and accessible to all.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"124 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144219234","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":"A microRNA-based dynamic risk score for type 1 diabetes","authors":"Mugdha V. Joglekar, Wilson K. M. Wong, Pooja S. Kunte, Hrishikesh P. Hardikar, Reshmi A. Kulkarni, Ikhlak Ahmed, Ryan J. Farr, Nhan Ho Trong Pham, Madilyn Coles, Simranjeet Kaur, Cody L. Maynard, Riley Hayward, Vinod Thorat, Aniruddha Pant, Ammira A. Akil, Kim C. Donaghue, Alicia J. Jenkins, Milan K. Piya, Maria E. Craig, William M. Hague, Chittaranjan S. Yajnik, Juliana C. N. Chan, A. M. James Shapiro, Elizabeth A. Davis, Timothy W. Jones, Stephen E. Gitelman, Ronald C. W. Ma, Flemming Pociot, Anandwardhan A. Hardikar","doi":"10.1038/s41591-025-03730-7","DOIUrl":"https://doi.org/10.1038/s41591-025-03730-7","url":null,"abstract":"<p>Identifying individuals at high risk of type 1 diabetes (T1D) is crucial as disease-delaying medications are available. Here we report a microRNA (miRNA)-based dynamic (responsive to the environment) risk score developed using multicenter, multiethnic and multicountry (‘multicontext’) cohorts for T1D risk stratification. Discovery (wet and dry lab) analysis identified 50 miRNAs associated with functional β cell loss, which is a hallmark of T1D. These miRNAs measured across <i>n</i> = 2,204 individuals from four contexts (4C: Australia, Denmark, Hong Kong SAR People’s Republic of China, India) led to a four-context, miRNA-based dynamic risk score (DRS) that effectively stratified individuals with and without T1D. Generative artificial intelligence was used to create an enhanced four-context, miRNA-based DRS, which offered good predictive power (area under the curve = 0.84) for T1D stratification in a separate multicontext validation dataset (<i>n</i> = 662), and accurately predicted future exogenous insulin requirement at 1 hour of islet transplantation. In a clinical trial assessing the imatinib drug therapy, baseline miRNA signature, rather than clinical characteristics, distinguished drug responders from nonresponders at 1 year. This study harnessed machine learning/generative artificial intelligence approaches, identifying and validating a miRNA-based DRS for T1D discrimination and treatment efficacy prediction.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"9 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144219316","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":"Inherited mitochondrial genetics as a predictor of immune checkpoint inhibition efficacy in melanoma","authors":"Kelsey R. Monson, Robert Ferguson, Joanna E. Handzlik, Leah Morales, Jiahan Xiong, Vylyny Chat, Sasha Dagayev, Alireza Khodadadi-Jamayran, Danny Simpson, Esther Kazlow, Anabelle Bunis, Chaitra Sreenivasaiah, Milad Ibrahim, Iryna Voloshyna, Wouter Ouwerkerk, Rosalie M. Luiten, Mariaelena Capone, Gabriele Madonna, Yuting Lu, Yongzhao Shao, Anna Pavlick, Michelle Krogsgaard, Janice Mehnert, Hao Tang, Sonia Dolfi, Daniel Tenney, John B. A. G. Haanen, Thomas F. Gajewski, F. Stephen Hodi, Keith T. Flaherty, Kasey Couts, William Robinson, Igor Puzanov, Marc S. Ernstoff, Osama Rahma, Michael Postow, Ryan J. Sullivan, Jason J. Luke, Paolo A. Ascierto, Iman Osman, Tomas Kirchhoff","doi":"10.1038/s41591-025-03699-3","DOIUrl":"https://doi.org/10.1038/s41591-025-03699-3","url":null,"abstract":"<p>Response to immune checkpoint inhibitors (ICIs) in metastatic melanoma (MM) varies among patients, and current baseline biomarkers predicting treatment outcomes are limited. As mitochondrial (MT) metabolism has emerged as an important regulator of host immune function, we explored the association of host MT genetics (MT haplogroups) with ICI efficacy in 1,225 ICI-treated patients with MM from the clinical trial CheckMate-067 and the International Germline Immuno-Oncology Melanoma Consortium. We discovered and validated significant associations of MT haplogroup T (HG-T) with resistance to anti-programmed cell death protein-1-based ICI (both single-agent and combination) and have shown that HG-T is independent from established tumor predictors. We also found that patients belonging to HG-T exhibit a unique nivolumab-resistant baseline peripheral CD8⁺ T cell repertoire compared to other MT haplogroups, providing, to our knowledge, the first link between MT inheritance, host immunity and ICI resistance. The study proposes a host blood-based biomarker with stand-alone clinical value predicting ICI efficacy and points to an ICI-resistance mechanism associated with MT metabolism, with clinical relevance in immuno-oncology.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"31 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144219312","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":"Stem cell therapies advance in Parkinson’s disease and beyond","authors":"","doi":"10.1038/d41591-025-00036-6","DOIUrl":"https://doi.org/10.1038/d41591-025-00036-6","url":null,"abstract":"Landmark trials using stem cells to treat Parkinson’s disease in the USA and Japan mark a turning point for cell therapy in neurodegeneration. Similar approaches to Alzheimer’s disease and amyotrophic lateral sclerosis are also showing early signs of promise.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"1 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144211491","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":"Individual variations in glycemic responses to carbohydrates and underlying metabolic physiology","authors":"Yue Wu, Ben Ehlert, Ahmed A. Metwally, Dalia Perelman, Heyjun Park, Andrew Wallace Brooks, Fahim Abbasi, Basil Michael, Alessandra Celli, Caroline Bejikian, Ekrem Ayhan, Yingzhou Lu, Samuel M. Lancaster, Daniel Hornburg, Lucia Ramirez, David Bogumil, Sarah Pollock, Frank Wong, Denver Bradley, Georg Gutjahr, Ekanath Srihari Rangan, Tao Wang, Lettie McGuire, P. Venkat Rangan, Helge Ræder, Zohar Shipony, Doron Lipson, Tracey McLaughlin, Michael P. Snyder","doi":"10.1038/s41591-025-03719-2","DOIUrl":"https://doi.org/10.1038/s41591-025-03719-2","url":null,"abstract":"<p>Elevated postprandial glycemic responses (PPGRs) are associated with type 2 diabetes and cardiovascular disease. PPGRs to the same foods have been shown to vary between individuals, but systematic characterization of the underlying physiologic and molecular basis is lacking. We measured PPGRs using continuous glucose monitoring in 55 well-phenotyped participants challenged with seven different standard carbohydrate meals administered in replicate. We also examined whether preloading a rice meal with fiber, protein or fat (‘mitigators’) altered PPGRs. We performed gold-standard metabolic tests and multi-omics profiling to examine the physiologic and molecular basis for interindividual PPGR differences. Overall, rice was the most glucose-elevating carbohydrate meal, but there was considerable interindividual variability. Individuals with the highest PPGR to potatoes (potato-spikers) were more insulin resistant and had lower beta cell function, whereas grape-spikers were more insulin sensitive. Rice-spikers were more likely to be Asian individuals, and bread-spikers had higher blood pressure. Mitigators were less effective in reducing PPGRs in insulin-resistant as compared to insulin-sensitive participants. Multi-omics signatures of PPGR and metabolic phenotypes were discovered, including insulin-resistance-associated triglycerides, hypertension-associated metabolites and PPGR-associated microbiome pathways. These results demonstrate interindividual variability in PPGRs to carbohydrate meals and mitigators and their association with metabolic and molecular profiles.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"260 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144211492","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":"Atezolizumab plus paclitaxel and bevacizumab as first-line treatment of advanced triple-negative breast cancer: the ATRACTIB phase 2 trial","authors":"María Gion, Isabel Blancas, Patricia Cortez-Castedo, Alfonso Cortés-Salgado, Frederik Marmé, Salvador Blanch, Serafín Morales, Nieves Díaz, Isabel Calvo-Plaza, Sabela Recalde, Alejandro Martínez-Bueno, Manuel Ruiz-Borrego, Elisenda Llabrés, María Teresa Taberner, Michelino de Laurentiis, Silvia García-Vicente, José Antonio Guerrero, Olga Boix, Jose Rodríguez-Morató, Miguel Sampayo-Cordero, Gabriele Antonarelli, José Manuel Pérez-García, Javier Cortés, Antonio Llombart-Cussac","doi":"10.1038/s41591-025-03734-3","DOIUrl":"https://doi.org/10.1038/s41591-025-03734-3","url":null,"abstract":"<p>Triple-negative breast cancer (TNBC) is a highly aggressive subtype of breast cancer with poor prognosis. The current first-line treatment for advanced TNBC (aTNBC) is determined by the expression of programmed cell death-ligand 1 (PD-L1). In the ATRACTIB trial—a multicenter, single-arm, phase 2 study—we evaluated the combination of atezolizumab, paclitaxel and bevacizumab as first-line treatment for patients with aTNBC, independently of PD-L1 status. The primary endpoint was investigator-assessed progression-free survival. One hundred female patients were enrolled, with most evaluable tumors being PD-L1-negative (97.6%). The primary endpoint was met, with a median progression-free survival of 11.0 months (95% confidence interval (CI): 9.0–13.4; <i>P</i> &lt; 0.001). The objective response rate was 63.0% (95% CI: 52.8–72.4) and median overall survival was 27.4 months (95% CI: 23.4–37.4). No treatment-related deaths or new safety signals were observed. This combination demonstrated significant antitumor activity as first-line therapy for aTNBC patients and merits further investigation. ClinicalTrials.gov Identifier: NCT04408118.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"8 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144211488","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":"Peri-operative atezolizumab in early-stage triple-negative breast cancer: final results and ctDNA analyses from the randomized phase 3 IMpassion031 trial","authors":"Elizabeth A. Mittendorf, Zoe June Assaf, Nadia Harbeck, Hong Zhang, Shigehira Saji, Kyung Hae Jung, Roberto Hegg, Andreas Koehler, Joohyuk Sohn, Hiroji Iwata, Melinda L. Telli, Cristiano Ferrario, Kevin Punie, Aditi Qamra, Max Dieterich, Yun Xu, Mario Liste-Hermoso, Esther Shearer-Kang, Luciana Molinero, Stephen Y. Chui, Carlos H. Barrios","doi":"10.1038/s41591-025-03725-4","DOIUrl":"https://doi.org/10.1038/s41591-025-03725-4","url":null,"abstract":"<p>Previously published results demonstrated that the randomized phase 3 IMpassion031 trial met its primary objective: adding atezolizumab to neoadjuvant chemotherapy significantly improved pathologic complete response (pCR) rate in patients with stage II/III triple-negative breast cancer (TNBC). Here we report the prespecified final analysis of the secondary endpoints with 3 years’ follow-up, together with exploratory analyses of circulating tumor (ct)DNA. Patients with previously untreated stage II/III TNBC enrolled in 75 academic and community sites in 13 countries were randomized 1:1 to receive neoadjuvant chemotherapy with either peri-operative atezolizumab (<i>n</i> = 165) or preoperative placebo (<i>n</i> = 168). Descriptive secondary endpoints included event-free, disease-free and overall survival. Long-term outcomes favored the atezolizumab group (event-free survival hazard ratio (HR), 0.76; 95% confidence interval (CI), 0.47–1.21; disease-free survival HR, 0.76; 95% CI, 0.44–1.30; overall survival HR, 0.56; 95% CI, 0.30–1.04). Among patients without pCR, 14 of 70 (20%) atezolizumab-treated and 33 of 99 (33%) placebo-treated patients received additional adjuvant therapy, frequently capecitabine. In exploratory biomarker analyses, patients with baseline ctDNA-negative status (6%) had excellent long-term outcomes. Most patients (87%) had cleared ctDNA at surgery. ctDNA-positive status at surgery identified a subset of non-pCR patients with poorest prognosis. Long-term safety was consistent with primary results. These data show that adding atezolizumab to chemotherapy for stage II/III TNBC is associated with favorable long-term outcomes, and ctDNA dynamics provide prognostic value beyond pCR. ClinicalTrials.gov identifier: NCT03197935.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"313 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144211490","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}