RMD Open最新文献

{"title":"Monomeric C-reactive protein as a therapeutic target in inflammatory diseases.","authors":"Chitose Fujita, Yasuo Sakurai, Yuki Yasuda, Masaaki Fujita","doi":"10.1136/rmdopen-2024-005379","DOIUrl":"10.1136/rmdopen-2024-005379","url":null,"abstract":"","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145302954","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":"Topography of entheseal lesions on ultrasound: a comparative study between axial spondyloarthritis, psoriatic arthritis and healthy controls.","authors":"Gehad G Elsehrawy, Delphine S Courvoisier, Erik Deman, Diana Dan, Raphael Micheroli, Pascal Zufferey, Laure Brulhart, Michael J Nissen","doi":"10.1136/rmdopen-2025-006088","DOIUrl":"10.1136/rmdopen-2025-006088","url":null,"abstract":"<p><strong>Objectives: </strong>To determine which anatomical sites and which ultrasonographic entheseal lesions are best able to discriminate between spondyloarthritis (SpA) patients and healthy controls (HC).</p><p><strong>Methods: </strong>We included patients with psoriatic arthritis (PsA) and axial SpA (axSpA), from six Swiss hospital outpatient clinics, as well as HC. Participants completed quality of life and physical activity questionnaires and underwent a clinical examination of both joints and entheses, followed by a detailed musculoskeletal ultrasound examination including nine entheseal sites bilaterally. Entheses were scored according to the Outcome Measures in Rheumatology criteria, with an additional evaluation of bursae and power Doppler (PD) in the 2-5 mm zone.</p><p><strong>Results: </strong>Overall, 121 participants were included, including 41 with PsA (mean age in years (SD), percentage male: 54.5±11.0, 63.4%), 39 with axSpA (45.1±10.0, 51.3%) and 41 HC (43.9±10.9, 56.1%), with a total of 2178 entheses evaluated. The PsA and axSpA groups showed no significant differences regarding inflammatory markers or disease activity scores.In the univariable analysis, all ultrasonographic lesions at the enthesis showed a significant association with SpA vs HC. Only B-mode inflammatory lesions (OR=1.38, p=0.034) and active enthesitis (OR=4.45, p=0.030) retained this association in multivariable analyses. While 4/9 entheses were associated with SpA in univariable analyses, only the distal patellar ligament insertion remained significantly associated with SpA (OR=1.74, p=0.039) in multivariable analyses.</p><p><strong>Conclusion: </strong>To distinguish SpA patients from controls, the sonographic scoring system used should account not only for the presence of specific entheseal lesions (structural and inflammatory) but also for the individual site affected.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145302882","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":"Autoantibodies directed against the angiotensin II type 1 receptor and the endothelin-1 type A receptor in patients with systemic sclerosis.","authors":"Katherine E van der Wouden, Saad Ahmed, Wieke M van Oostveen, Eva M Hoekstra, Sophie I E Liem, Tom W J Huizinga, René E M Toes, Alexandre E Voskuyl, Gabriela Riemekasten, Cynthia M Fehres, Madelon Vonk, Jeska K de Vries-Bouwstra","doi":"10.1136/rmdopen-2025-005787","DOIUrl":"10.1136/rmdopen-2025-005787","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the clinical applicability of autoantibodies (AAbs) measured by ELISA against the angiotensin II type 1 receptor (AT₁R) and endothelin-1 type A receptor (ET_AR) in systemic sclerosis (SSc) patients.</p><p><strong>Methods: </strong>Serum samples from n=279 SSc patients from the Leiden Systemic Sclerosis cohort, n=42 patients with primary Raynaud's phenomenon, n=24 patients with rheumatoid arthritis and n=20 healthy controls were tested for anti-AT₁R- and anti-ET_AR AAbs. Levels were compared between groups with Mann-Whitney U tests or Kruskal-Wallis tests. Risk ratios and Kaplan-Meier analyses were used to determine associations between AAbs and disease manifestations or all-cause mortality. Analyses were repeated in an independent cohort with n=310 SSc patients from the Radboud University Medical Center.</p><p><strong>Results: </strong>AAbs against AT₁R and ET_AR could be detected by ELISA in the sera of all groups tested. Levels were slightly higher in the SSc group compared with the pooled non-SSc group (p=0.043). No associations could be found between anti-AT₁R AAbs or anti-ET_AR AAbs and disease manifestations or all-cause mortality. In the Radboud cohort, patients with diffuse cutaneous SSc (p=0.001) and interstitial lung disease (p=0.007) had higher median anti-ET_AR AAb levels. Patients who died during follow-up had lower levels of anti-AT₁R- (p=0.005) and anti-ET_AR AAbs (p=0.020).</p><p><strong>Conclusions: </strong>We confirm positive ELISAs for anti-AT₁R AAbs and anti-ET_AR AAbs in the sera of several patient groups and healthy controls. Previously described associations with disease manifestations and all-cause mortality could not be confirmed in our cohorts. Based on the current study, the determination of these AAbs is of limited predictive value in clinical practice.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308985","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":"Rheumatic and musculoskeletal disorders in musicians: risks, adaptations and management.","authors":"Lou Autret, Émilie Shipley, Brice Lodde, Andrea Hinojosa-Azaola, Alain Saraux","doi":"10.1136/rmdopen-2025-006149","DOIUrl":"10.1136/rmdopen-2025-006149","url":null,"abstract":"<p><p>Music therapy is recognised as a complementary or alternative therapy for osteoarthritis and fibromyalgia, but playing music can have health repercussions for musicians in the field of rheumatology.Limited articles exist on artists developing rheumatic diseases before 1900, possibly due to underestimation, poor understanding or a lack of awareness. Conditions like Marfan syndrome may confer hypermobility-enhancing virtuosity, as seen in Paganini and Rachmaninov.Among contemporary musicians, Edith Piaf, Lady Gaga, Selena Gomez and Céline Dion suffered from rheumatic diseases, and it was true obstacles for their careers.Repetitive movements, inadequate posture and instrument-specific physical demands contribute to musculoskeletal disorders in musicians, particularly tendinopathies and entrapment syndromes affecting the upper limbs. These conditions result in chronic pain, reduced mobility and performance decline. String and wind instrument players face heightened vulnerability due to the unique constraints of their instruments.Given the longevity of musical careers compared with athletic ones, specialised medical management and targeted prevention strategies are crucial. Minimising the impact of these conditions is paramount to ensuring musicians can maintain optimal performance and extend their careers under the best possible conditions, enabling a preventive approach, follow-up and specialised care for as long as needed. Therefore, further exploration of rheumatic diseases in musicians is warranted, particularly with an emphasis on the evolution of medical knowledge and clinical practices. These pathologies are complex and require specific treatment. Some European health professionals and musicians are training in the practice of 'arts medicine'.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286894","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":"Cross-validation and sensitivity to change of EULAR ScleroID as a measure of function and impact of disease in patients with systemic sclerosis.","authors":"Seda Yurumez Colak, Stefano Di Donato, Riccardo Bixio, Lesley-Anne Bissell, Theresa Barnes, Muhammad Nisar, Vishal Kakkar, Chris Denton, Francesco Del Galdo","doi":"10.1136/rmdopen-2025-005999","DOIUrl":"10.1136/rmdopen-2025-005999","url":null,"abstract":"<p><strong>Objective: </strong>To determine the distribution of the EULAR SSc Impact of Disease (ScleroID) and its domain questions in very early (Ve), limited (lc) and diffuse cutaneous (dc) subsets, its value in reflecting clinical severity, and to assess its sensitivity to change and minimal clinically important difference (MCID) in a 12-month interval.</p><p><strong>Methods: </strong>Patients with ScleroID questionnaires from the observational cohort STRIKE were included in the study. Changes (Δ) were calculated as the difference between 12-month follow-up and compared MCIDs of the other measures.</p><p><strong>Results: </strong>Data were available for 271 patients, 69 with Ve, 139 lc and 63 dc systemic sclerosis (SSc). Median (IQR) ScleroID scores were progressively higher in the 3 subsets with 2.1 (3.6) for VeSSc, 3.4 (4.4) for lcSSc and 4.7 (4) for dcSSc (p<0.001). ScleroID showed strong content validity against clinical measures. Patients with high disease activity had significantly higher ScleroID scores than low ones (p=0.003). Presence of digital ulcers, pulmonary disease or small intestinal bacterial overgrowth was all reflected in higher scores in their relative domains (p<0.005 for all). Accordingly, ScleroID scores and its relative domains showed high correlations with all other patient-reported outcomes (PROs) (p<0.05). Changes in ScleroID strongly correlated with changes in clinical measures and other PROs with specific thresholds identified for MCID changes in Health Assessment Questionnaire Disability Index, the University of California Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 and Cochin Hand Function Scale.</p><p><strong>Conclusion: </strong>ScleroID demonstrates strong correlation with validated clinical measures and responsiveness to changes in standard of care, supporting its use in both clinical practice and trials. ScleroID captures the multidimensional burden of SSc regardless of disease subsets.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275606","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":"Correction: Distribution of nailfold videocapillaroscopy parameters in systemic lupus erythematosus and their association with disease activity: an international blinded case-control analysis on behalf of the EULAR study group on microcirculation in rheumatic diseasesEffectiveness of ixekizumab in 709 real-world patients with axial spondyloarthritis and psoriatic arthritis: a nationwide cohort study.","authors":"","doi":"10.1136/rmdopen-2025-005772corr1","DOIUrl":"10.1136/rmdopen-2025-005772corr1","url":null,"abstract":"","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259082","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":"Correction: Hydroxychloroquine and pregnancy outcomes in patients with anti-phospholipid syndrome: a systematic review and meta-analysis.","authors":"","doi":"10.1136/rmdopen-2025-005825corr1","DOIUrl":"10.1136/rmdopen-2025-005825corr1","url":null,"abstract":"","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259030","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":"Unveiling the clinical and genetic impact of neuropsychiatric involvement in systemic lupus erythematosus.","authors":"Soojin Cha, Ga Young Ahn, Kwangwoo Kim, Hye-Soon Lee, Sang-Cheol Bae, So-Young Bang","doi":"10.1136/rmdopen-2025-006033","DOIUrl":"10.1136/rmdopen-2025-006033","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the clinical significance of neuropsychiatric systemic lupus erythematosus (NPSLE), which is a severe complication of SLE, clinical and genetic studies on NPSLE remain limited. This study aimed to identify the clinical features of NPSLE and explore genetic factors associated with NPSLE in a prospective lupus cohort.</p><p><strong>Methods: </strong>The clinical features, disease activity and organ damage of 1205 Korean patients with SLE were assessed at least annually, and genome-wide genotyping with imputation was performed. The clinical and genetic associations of NPSLE, excluding minor events, and its specific subsets (seizure or psychosis) compared with those of non-NPSLE were analysed using genome-wide association studies (GWASs). The biological relevance of the identified loci was investigated through functional analyses.</p><p><strong>Results: </strong>A total of 271 patients with NPSLE exhibited more clinically diverse manifestations (p=2.40×10^-4), especially in patients with seizure (N=84, p=4.86×10^-14) and psychosis (N=26, p=8.29×10^-5), compared with 934 patients with non-NPSLE. Notably, NPSLE patients significantly had greater organ damage (total Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score: OR 1.49, p=3.28×10^-17; non-NP SDI score: OR 1.22, p=7.61×10^-5) than patients with non-NPSLE, adjusting for age, sex, hypertension, disease duration and antiphospholipid antibodies. GWAS revealed nine NPSLE-associated loci at a suggestive significance level (p<5×10⁻⁶). The nine nearest mapped genes were exclusively expressed in the brain (adjusted p=5.28×10^-4), particularly in the basal ganglia, cortex and hippocampus (adjusted p<0.05).</p><p><strong>Conclusions: </strong>Neuropsychiatric involvement in SLE increases clinical manifestations and extends organ damage beyond the nervous system, with NPSLE-related genetic variants highlighting their potential functional roles in various brain regions.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252432","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":"Seventeen-year reassessment of diagnostic transitions, biologic therapy initiation and mortality in spondyloarthritis: results from the REGISPON-3 study.","authors":"María Ángeles Puche-Larrubia, Lourdes Ladehesa-Pineda, María Carmen Ábalos-Aguilera, Desirée Ruiz-Vílchez, Laura Berbel-Arcobé, Xavier Juanola-Roura, Marta Arévalo-Salaet, Mireia Moreno, Raquel Almodóvar-González, Cristina Pijoan-Moratalla, Beatriz Joven-Ibáñez, Marta Valero-Expósito, Verónica García-García, Manuel Moreno-Ramos, Enrique Ornilla, Raquel Ena María Granados, Diana Maria Margareta Moldovan, Carlos M Collantes-Sánchez, Alejandro Escudero-Contreras, Eduardo Collantes-Estévez, Clementina López-Medina","doi":"10.1136/rmdopen-2025-006031","DOIUrl":"10.1136/rmdopen-2025-006031","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate disease evolution, diagnostic transitions, time to biologic treatment initiation and mortality in patients with spondyloarthritis (SpA) after 17 years from the original Spanish Registry of Spondyloarthritis (REGISPONSER).</p><p><strong>Methods: </strong>Spondyloarthritis Registry 3 (REGISPON-3) is a two-timepoint longitudinal study with patients fulfilling the European Spondyloarthropathy Study Group criteria participating in the REGISPONSER study and re-evaluated after 17 years. Clinical, laboratory, radiological and treatment data were collected and compared with baseline. Diagnostic changes according to the rheumatologist's judgement and their associated factors were analysed using multivariable logistic regression. Time to initiation of biologic therapy was evaluated using Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>A total of 536 patients from the REGISPONSER study conducted in 2004 were contacted in 2021 for the REGISPON-3 visit. Of these, 411 were physically re-evaluated, while 125 were confirmed deceased. Among the 411 patients, 31.6% experienced a change in diagnosis in the REGISPON-3 visit, mainly from undifferentiated SpA to axial SpA or psoriatic arthritis. In multivariable analysis, dactylitis, younger age and lower Bath Ankylosing Spondylitis Radiology Index scores were associated with diagnostic change. The use of biologic disease-modifying antirheumatic drugs (bDMARDs) increased from 13.1% to 52.1%. However, the median time to first bDMARD from symptom onset was 32 years (95% CI 30 to 35) and 28 years from diagnosis (95% CI 26 to 32). Among the 125 patients who died, the leading causes were infections (21.6%), cardiovascular (CV) events (20.0%) and cancer (19.2%).</p><p><strong>Conclusions: </strong>This long-term reassessment reveals significant diagnostic changes in SpA and a mortality burden mainly attributed to infections and CV diseases.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239206","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":"Preterm birth in women with psoriatic arthritis: what are the risks and risk factors? A collaborative cohort study from Sweden, Denmark and Norway.","authors":"Anne Emilie Pape Secher, Fredrik Granath, Katarina Remaeus, Bente Glintborg, Ane Lilleøre Rom, Brigitte Michelsen, Merete Lund Hetland, Karin Hellgren","doi":"10.1136/rmdopen-2025-005614","DOIUrl":"10.1136/rmdopen-2025-005614","url":null,"abstract":"<p><strong>Objective: </strong>To estimate risk and to identify risk factors for preterm birth in pregnant women with psoriatic arthritis (PsA) in relation to maternal characteristics, treatment and disease activity, both before and during pregnancy.</p><p><strong>Methods: </strong>We linked clinical rheumatology registers to medical birth registers in Sweden, Denmark and Norway and identified PsA pregnancies and control pregnancies 2006-2021, matched 1:10 on age, parity, country and birth year. Adjusted ORs (aORs) for preterm birth in PsA pregnancies vs control pregnancies were calculated overall and stratified by maternal characteristics, antirheumatic treatment and disease load (9 months before and during pregnancy).</p><p><strong>Results: </strong>We observed 54 preterm births among 688 PsA pregnancies (7.8%) versus 312 among 6880 control pregnancies (4.5%); aOR, 95% CI: 1.80, 1.29 to 2.51. The risk estimate was largely unaffected by parity, smoking and body mass index. PsA pregnancies exposed to a combination of biologic and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and/or glucocorticoids during pregnancy had a markedly increased risk of preterm birth compared with control pregnancies (4.44, 2.07 to 9.50), whereas exposure to biological DMARD (bDMARD) monotherapy (primarily tumour necrosis factor inhibitors) had not (0.73, 0.22 to 2.42). High disease load before pregnancy was associated with increased risk. The proportion of preterm birth was higher in those stopping bDMARD during the first trimester (21%) opposed to those continuing past the first trimester (10%) based on few events.</p><p><strong>Conclusion: </strong>We identified an 80% increased risk of preterm birth in PsA pregnancies compared with control pregnancies. Antirheumatic combination therapy during and high disease load before pregnancy constituted risk factors. Discontinuing bDMARD treatment in early pregnancy further increased the risk. Our findings support that a subgroup of PsA pregnancies should be considered high-risk pregnancies.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239586","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}