Nephrology Dialysis Transplantation最新文献

{"title":"BK Polyomavirus-associated nephropathy - diagnostic and treatment standard.","authors":"Mohammed Al-Talib, Matthew Welberry-Smith, Andrew Macdonald, Siân Griffin","doi":"10.1093/ndt/gfaf002","DOIUrl":"https://doi.org/10.1093/ndt/gfaf002","url":null,"abstract":"<p><p>BK polyomavirus (BKPyV) is recognised as a significant viral complication of kidney transplantation. Prompt immunosuppression reduction reduces early graft failure rates due to BK polyomavirus-associated nephropathy (BKPyVAN), however modulation of immunosuppression can lead to acute rejection. Medium-to-long term graft outcomes are negatively impacted by BKPyVAN, likely due to a combination of virus-induced graft damage and host immune responses against graft alloantigens potentiated by immunosuppression reduction. Kidney biopsy remains the gold-standard diagnostic test, however false negative findings are common due to the focal nature of BKPyVAN. BKPyV DNAemia, as measured by quantitative polymerase chain reaction (qPCR), is established as a screening test but there is at present no (inter)national standardisation of these assays to allow collation and comparison of data between centres. Randomised controlled trials are lacking both in terms of optimal immunosuppression reduction strategies, and for the medications variably used to attempt treatment in clinical practice. Much of the fundamental biology of BKPyV is not yet understood, and further elucidation is required to promote rational direct-acting antiviral drug design. Insights into the role of adaptive immunity in control of BKPyV have informed the design of novel treatments such as adoptive immunotherapies and neutralizing antibodies which require evaluation in clinical studies. Here, we review the current standards of diagnosis and treatment of BKPyVAN and discuss novel developments in the pathophysiology, diagnosis, outcome prediction and management.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of two distinct clusters in membranous lupus nephritis patients: recognition of a high-risk profile based on unsupervised analysis.","authors":"Zhipeng Wang, Wang Xiang, Yiqin Wang, Jianwen Yu, Xin Wang, Hongjian Ye, Haishan Wu, Ruihan Tang, Xi Xia, Wei Chen","doi":"10.1093/ndt/gfae295","DOIUrl":"https://doi.org/10.1093/ndt/gfae295","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Membranous lupus nephritis (MLN) traditionally includes class V (alone) and may be associated with other classes (III or IV). The clinical, therapeutic and prognosis relevance of the classification remains controversial.</p><p><strong>Methods: </strong>A retrospective cohort of 412 MLN patients from the First Affiliated Hospital of Sun-Yat Sen University was followed for a median of 65.68 (IQR: 23.13-131.70) months. The primary outcomes were adverse renal events including all-cause death and end-stage renal diseases (ESRD). Phenotypes were identified and validated using unsupervised clustering analysis (K-means), Principal component analysis (PCA) and decision tree analysis.</p><p><strong>Results: </strong>Distinct clinical and pathological differences were noted for the traditional Class IV + V, the traditional Class V + III and Class V exhibited high similarities in clinical features and prognosis (P = 0.074). K-means clustering revealed high-risk (n = 180) and low-risk groups (n = 232), with significant differences in adverse renal outcomes (9.2% vs. 4.1%, P < 0.001). To recognize the high-risk profile of MLN patients, a decision tree based on Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) Score, hemoglobin, serum creatinine, traditional classification, and activity index of renal biopsy accurately clustered patients in the development (95.8% accuracy) and validation (87.1% accuracy) cohorts.</p><p><strong>Conclusions: </strong>Two novel phenotypic clusters, more predictive than traditional classifications, enhance high-risk profile identification and prognostic accuracy.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel approach to induce early remission in high-risk primary membranous nephropathy.","authors":"Zinaida Kochoyan, Vladimir A Dobronravov","doi":"10.1093/ndt/gfae138","DOIUrl":"10.1093/ndt/gfae138","url":null,"abstract":"<p><strong>Background: </strong>This prospective single-arm trial with historic controls evaluated the efficacy and safety of treatment based on a combination of rituximab, intravenous cyclophosphamide and corticosteroids (RCP) administered at lower cumulative doses for the induction of early remission in primary membranous nephropathy (PMN).</p><p><strong>Methods: </strong>We prospectively enrolled 30 high-risk PMN patients with persistent nephrotic syndrome (NS) and elevated antibodies to the phospholipase A2 receptor who underwent RCP therapy. We compared the effectiveness of RCP with that of historic controls who received rituximab-based therapy (RTX, n = 15) or cyclosporine + corticosteroids (CSA, n = 42). The primary outcomes were complete remission (CR) and overall remission (OR) by Month 12 and the time to remission.</p><p><strong>Results: </strong>In the RCP group, the OR and CR rates by 12 months (97% and 60%) were higher than those in the RTX group (60% and 7%, P ≤ .009) and the CSA group (50% and 24%, P ≤ .003). The median time to OR [2.8 (1.6-3.9) months] was shorter compared with RTX [7.1 (3.4-17.5) months, P = .008] and CSA [7.3 (6.0-13.6) months, P < .001]. In adjusted Cox regression, hazard ratios for OR and CR attainment for RCP versus other treatments were 5.2 (95% CI 2.8-9.6) and 4.8 (95% CI 2.2-10.3), respectively. Propensity score-matched group analyses confirmed these results. One serious adverse event occurred in the RCP group in the follow-up of 56 patient-years.</p><p><strong>Conclusions: </strong>RCP therapy is considered effective and safe for inducing early remission in high-risk PMN patients.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"60-70"},"PeriodicalIF":4.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher skeletal muscle mass associates with higher measured glomerular filtration rate in healthy individuals.","authors":"Lisa B Westenberg, Marco van Londen, Marcel Zorgdrager, Martin H de Borst, Alain R Viddeleer, Stephan J L Bakker, Robert A Pol","doi":"10.1093/ndt/gfae217","DOIUrl":"10.1093/ndt/gfae217","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"212-214"},"PeriodicalIF":4.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Light-chain (AL) amyloidosis for nephrologists-treatment standard.","authors":"Shankara Anand, Maggie O'Neill-Dee, Vaishali Sanchorawala, Ashish Verma","doi":"10.1093/ndt/gfae224","DOIUrl":"10.1093/ndt/gfae224","url":null,"abstract":"<p><p>Amyloidosis is a group of complex diseases caused by the misfolding and aggregation of proteins into amyloid fibrils. Light-chain (AL) amyloidosis is one of the most prevalent forms of amyloidosis, characterized by the gradual proliferation of light chains from plasma cell clones. A growing body of evidence has contributed to our understanding of its pathogenesis, presentation and clinical course. Increased recognition of its clinical sequelae has increased the prevalence of AL amyloidosis. Renal involvement, seen in up to 70% of cases, is particularly challenging due to its impact on quality of life and access to treatment options. Thus, early recognition of its unique sequelae, appropriate staging and a comprehensive understanding of treatment options balanced by their organ toxicities are crucial to managing this disease. We review the current treatment standards and discuss novel developments in the pathophysiology, diagnosis, outcome prediction and management of AL amyloidosis for the Nephrologist.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"34-47"},"PeriodicalIF":4.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significance of eGFR and proteinuria for cardiovascular disease in individuals beyond 85 years of age.","authors":"Tatsuhiko Azegami, Hidehiro Kaneko, Akira Okada, Yuta Suzuki, Katsuhito Fujiu, Hiroyuki Morita, Norifumi Takeda, Norihiko Takeda, Akira Fukui, Takashi Yokoo, Koichi Node, Hideo Yasunaga, Masaomi Nangaku, Kaori Hayashi","doi":"10.1093/ndt/gfae124","DOIUrl":"10.1093/ndt/gfae124","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on how advancing age influences prediction of cardiovascular disease (CVD) risk based on the estimated glomerular filtration rate (eGFR) and proteinuria, especially in older adults, including those aged ≥85 years old. This study aimed to clarify the association of eGFR and proteinuria with CVD outcomes and the impact of age on this association.</p><p><strong>Methods: </strong>The distribution of eGFR and urine protein in Japan was assessed retrospectively using real-world administrative claims and health checkup data collected between April 2014 and November 2022. We investigated the associations of these two parameters with the incidence of CVD, with an emphasis on the impact of aging.</p><p><strong>Results: </strong>We assessed 1 829 020 individuals for distribution of eGFR and proteinuria; after excluding those with known CVD, their association with CVD risk was examined in 1 040 101 individuals aged ≥40 years. The prevalence of impaired kidney function (eGFR <60 mL/min/1.73 m2) increased with age, being 0.7%, 9.2%, 21.9%, 40.2% and 60.2% at the ages of 18-39, 40-64, 65-74, 75-84 and ≥85 years, respectively (P for trend <.001); similarly, the proportion with positive proteinuria increased with age, being 2.7%, 4.3%, 5.6%, 9.2% and 15.8%, respectively (P for trend <.001). Both eGFR and urine protein were identified to be independent risk factors for CVD. Hazard ratios for CVD increased significantly when eGFR was <45 mL/min/1.73 m2 at the ages of 40-64, 65-74 and 75-84 years and <30 mL/min/1.73 m2 at ≥85 years, while proteinuria remained significantly associated with a high CVD risk regardless of age. These findings were consistent even when analyzed separately by sex.</p><p><strong>Conclusions: </strong>This study identified eGFR and urine dipstick proteinuria to be independent risk factors for CVD, even among individuals aged ≥85 years. However, the contribution of eGFR to the CVD risk was attenuated by aging, whereas proteinuria remained less affected by advancing age.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"164-172"},"PeriodicalIF":4.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary team approach for CKD-associated osteoporosis.","authors":"Ditte Hansen, Hanne Skou Jørgensen, Thomas Levin Andersen, Ana Carina Ferreira, Aníbal Ferreira, Renate de Jongh, Satu Keronen, Heikki Kröger, Marie Hélène Lafage-Proust, Leena Martola, Kenneth E S Poole, Xiaoyu Tong, Pieter Evenepoel, Mathias Haarhaus","doi":"10.1093/ndt/gfae197","DOIUrl":"10.1093/ndt/gfae197","url":null,"abstract":"<p><p>Chronic kidney disease-mineral and bone disorder (CKD-MBD) contributes substantially to the burden of cardiovascular disease and fractures in patients with CKD. An increasing arsenal of diagnostic tools, including bone turnover markers and bone imaging, is available to support clinicians in the management of CKD-associated osteoporosis. Although not mandatory, a bone biopsy remains useful in the diagnostic workup of complex cases. In this special report, the European Renal Osteodystrophy (EUROD) initiative introduces the concept of a kidney-bone multidisciplinary team (MDT) for the diagnosis and clinical management of challenging cases of CKD-associated osteoporosis. In 2021, the EUROD initiative launched virtual clinical-pathological case conferences to discuss challenging cases of patients with CKD-associated osteoporosis, in whom a bone biopsy was useful in the diagnostic workup. Out of these, we selected four representative cases and asked a kidney-bone MDT consisting of a nephrologist, an endocrinologist and a rheumatologist to provide comments on the diagnostic and therapeutic choices. These cases covered a broad spectrum of CKD-associated osteoporosis, including bone fracture in CKD G5D, post-transplant bone disease, disturbed bone mineralization, severely suppressed bone turnover and severe hyperparathyroidism. Comments from the MDT were, in most cases, complementary to each other and additive to the presented approach in the cases. The MDT approach may thus set the stage for improved diagnostics and tailored therapies in the field of CKD-associated osteoporosis. We demonstrate the clinical utility of a kidney-bone MDT for the management of patients with CKD-MBD and recommend their establishment at local, national, and international levels.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"48-59"},"PeriodicalIF":4.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological phenotype and outcomes of NCAM-1+ membranous lupus nephritis.","authors":"Xi Xia, Suchun Li, Xiuzhi Jia, Siyang Ye, Yuting Fan, Wang Xiang, Xiaohui Lu, Wenxing Peng, Wenfang Chen, Fengxian Huang, Ruihan Tang, Wei Chen","doi":"10.1093/ndt/gfae148","DOIUrl":"10.1093/ndt/gfae148","url":null,"abstract":"<p><strong>Background: </strong>No studies have explored the long-term outcomes of neural cell adhesion molecule 1 (NCAM1)-associated membranous lupus nephritis (MLN) patients.</p><p><strong>Method: </strong>We performed immunohistochemical studies on kidney biopsy specimens against NCAM1 in consecutive MLN patients. The clinical and histopathological characteristics and outcomes of cases of NCAM1-associated MLN patients are described and compared with NCAM1-negative patients. In addition, we detected serum circulating anti-NCAM1 antibodies through western blotting and indirect immunofluorescence assays.</p><p><strong>Results: </strong>Among 361 MLN cases, 18 (5.0%) were glomerular NCAM1-positive. NCAM1-positive MLN patients were older [35 years (interquartile range, IQR 27-43) versus 28 (22-37); P = .050] and had lower systemic lupus erythematosus disease activity index [11 (IQR 8-12) versus 14 (10-18); P = .007], serum creatinine [60 μmol/L (IQR 50-70) versus 70 (54-114); P = .029] and activity index [3 (IQR 2-6) versus 6 (3-9); P = .045] at kidney biopsy compared with NCAM1-negative patients. The percentage of positive anti-Sjögren's syndrome-related antigen A antibodies in NCAM1-positive patients was significantly greater (83.3% versus 58.2%; P = .035) than in the NCAM1-negative patients. However, no evidence of neuropsychiatric disorders was found in these 18 patients. There were no significant differences in the treatment response and the risk of end-stage renal diseases between NCAM1-positive and -negative groups (P = .668 and P = .318, respectively). However, the risk of death was much higher in the NCAM1-positive group than the NCAM1-negative group (27.8% vs 8.1%; P = .007). Moreover, the risk of death was also much higher in the NCAM1-positive group than the matched NCAM1-negative group (Log-rank P = .013). Additionally, circulating anti-NCAM1 antibodies can be detected in 1/5 (20%) patients who had serum available.</p><p><strong>Conclusion: </strong>The prevalence of NCAM1 positivity was 5.0% in our cohort of MLN and the high mortality in these subgroup patients are needed to validate in future studies.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"193-205"},"PeriodicalIF":4.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton pump inhibitor use and bone fractures in patients with chronic kidney disease.","authors":"Andreas Kommer, Karel Kostev, Eva Maria Schleicher, Julia Weinmann-Menke, Christian Labenz","doi":"10.1093/ndt/gfae135","DOIUrl":"10.1093/ndt/gfae135","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) are at high risk for bone fractures, which are associated with high morbidity and mortality. Proton pump inhibitors (PPI) have been linked to an increased risk for fractures in the general population as well as in patients with need for hemodialysis, but studies in patients with CKD are currently missing.</p><p><strong>Methods: </strong>We performed a population-based observational case-control study exploring a sample of patients with CKD derived from the IQVIATM Disease Analyzer database. Patients with and without fractures were matched using the 1:1 nearest neighbor propensity score matching method. To investigate the association between PPI use and fractures, multivariable logistic regression analyses were performed adjusting for confounding factors.</p><p><strong>Results: </strong>In total, 6076 patients with and 6076 patients without fractures were matched and subsequently available for analyses. In the total cohort, PPI use was associated with an increased risk for fractures [odds ratio (OR) 1.68; 95% confidence interval (95% CI) 1.55-1.83]. This association was noted for nearly all types of fractures. The strongest association between PPI use and fractures was found in patients below the age of 60 years with a PPI prescription for longer than 2 years (OR 6.85; 95% CI 1.85-25.38). The same was true when analyzing cumulative PPI doses. Here, patients below the age of 60 years with a cumulative PPI dose above 16 000 mg (highest quartile) had the highest risk for fractures (OR 4.62; 95% CI 1.87-11.44). There was no difference between men or women regarding the association between PPI use and fractures.</p><p><strong>Conclusions: </strong>This study provides evidence that PPI use is associated with fractures in patients with CKD. Deprescription of PPI in patients without an indication for treatment could be a modifiable risk factor to reduce fracture risk in this high-risk group.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"173-181"},"PeriodicalIF":4.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Glucocorticoid Therapy in Lupus Nephritis.","authors":"Gabriel Figueroa-Parra, Mario Bautista-Vargas, Erika Navarro-Mendoza, Alí Duarte-García","doi":"10.1093/ndt/gfae294","DOIUrl":"https://doi.org/10.1093/ndt/gfae294","url":null,"abstract":"<p><p>This review provides an in-depth analysis of glucocorticoid therapy for lupus nephritis (LN), a severe manifestation of systemic lupus erythematosus that affects up to 51.7% of patients. LN significantly increases the risk of mortality and progression to end-stage kidney disease. Glucocorticoids have been central to LN treatment for decades due to their anti-inflammatory properties, but optimal dosing strategies remain uncertain. The review discusses the historical evolution of glucocorticoid use, highlighting the shift from high-dose regimens to combined approaches with immunosuppressants and lower glucocorticoid doses to minimize adverse effects. Mechanistically, glucocorticoids exert effects through genomic and non-genomic pathways, modulating immune responses and metabolism. Long-term use is associated with risks such as infection, osteoporosis, hyperglycemia, and cardiovascular disease. The review examines different dosing strategies, including intravenous pulse therapy and oral regimens, and presents evidence of their efficacy and safety. It also explores alternative approaches, such as low-dose and glucocorticoid-free regimens, which show promise but require further study. The review concludes by emphasizing the need for future research to optimize glucocorticoid regimens, refine tapering protocols, and identify safer therapeutic combinations, as glucocorticoids remain a cornerstone in LN management despite their challenges.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}