Thorax最新文献

{"title":"Periodic hemidiaphragmatic paresis: a puzzling diaphragm","authors":"Miguel Jiménez-Gómez, Carlos Pablo de Fuenmayor-Fernández de la Hoz, Ana Hernández-Voth","doi":"10.1136/thorax-2025-223288","DOIUrl":"https://doi.org/10.1136/thorax-2025-223288","url":null,"abstract":"Diaphragmatic dysfunction is an uncommon and often overlooked cause of dyspnoea, particularly when symptoms progress insidiously. We present the case of a 50-year-old man with a history of a bicycle accident, without associated thoracic trauma. A routine chest X-ray revealed an elevated left hemidiaphragm (figure 1A,B), initially presumed to be trauma-related. Despite this finding, the patient remained asymptomatic, and the condition resolved spontaneously within a year (figure 1C). Figure 1 Radiographic evolution: (A) Baseline chest X-ray. (B) Asymptomatic left diaphragmatic paresis. (C) Complete resolution of the left hemidiaphragm elevation. (D) Symptomatic right diaphragmatic involvement. For nearly a decade, he remained asymptomatic until presenting with right shoulder pain, initially diagnosed as bursitis. This was followed by exertional dyspnoea, orthopnoea, and trepopnoea. A chest X-ray showed right hemidiaphragm elevation (figure 1D). Spirometry demonstrated a marked reduction in forced vital capacity (53% of the predicted value) with a significant decline …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"59 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144202144","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":"Smoke and mirrors: uncovering sex differences in COPD","authors":"Georgie May Massen, Hannah Whittaker","doi":"10.1136/thorax-2025-223451","DOIUrl":"https://doi.org/10.1136/thorax-2025-223451","url":null,"abstract":"Recent years have seen an increase in recognition of women’s health and the importance of understanding how disease presentation, progression and management differ by sex and gender. Growing evidence has demonstrated the impact of hormone fluctuations, including puberty and menopause, on health-related outcomes.1 2 Organisations and policies including the European Medicines Agency, the National Institute for Health and Care Research, the UK government’s Women’s Health Strategy and the MESSAGE (Medical Science Sex and Gender Equity) framework encourage the integration and reporting of sex and gender-specific findings in health research to help improve the lives of females, women and girls across the life course.3–6 Chronic obstructive pulmonary disease (COPD) has historically been seen as a male-dominant disease; however, data suggest that the differences in COPD prevalence between males and females have narrowed in recent years. Between 2000 and 2019, the difference in COPD prevalence between males and females fell from 0.46% to 0.26%.7 Similarly, the literature suggests that differences in COPD development and presentation exist, whereby females are more likely to have higher lung function, experience more exacerbations and have worse dyspnoea.8 Smoking is a common cause of COPD, and previous studies have investigated possible sex differences in the relationship between smoking and COPD …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"136 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144202152","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":"Comparison of volume-based and diameter-based assessment of solid nodules in lung cancer screening","authors":"Mark M Hammer","doi":"10.1136/thorax-2025-223295","DOIUrl":"https://doi.org/10.1136/thorax-2025-223295","url":null,"abstract":"Lung cancer screening (LCS) with low-dose CT has been proven to reduce lung cancer-specific mortality in high-risk individuals. However, there has been a lot of concern regarding false-positive scans requiring additional imaging follow-up or even biopsies. Reporting guidelines, such as those developed by the American College of Radiology (ACR Lung-RADS)1 or the British Thoracic Society (BTS),2 aim to reduce false positives and standardise nodule management. Among these guidelines, there is disagreement about how best to measure pulmonary nodules; some, such as the ACR, favour linear diameter measurement, while others, such as the BTS, favour volume measurement. Recently, Creamer et al have compared these two measures as part of a prospective, longitudinal LCS study.3 Through analysis of more than 11 000 baseline LCS CTs, they show that a volume threshold (100 mm3) to ‘rule out’ lung cancer yielded similar sensitivity for cancer as a 6 mm diameter threshold (malignancy risk in negative scans of 0.88% vs 0.81%, respectively). However, the …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"20 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144202153","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":"Performance of volume and diameter thresholds in malignancy prediction of solid nodules in lung cancer screening","authors":"Andrew W Creamer, Carolyn Horst, Ruth Prendecki, Priyam Verghese, Amyn Bhamani, Helen Hall, Sophie Tisi, Jennifer L Dickson, Chuen R Khaw, John McCabe, Tanita Limani, Kylie Gyertson, Anne-Marie Hacker, Jonathan Teague, Laura Farrelly, Shrinkhala Dawadi, Neal Navani, Allan Hackshaw, Anand Devaraj, Arjun Nair, The SUMMIT Consortium, Sam M Janes","doi":"10.1136/thorax-2024-222086","DOIUrl":"https://doi.org/10.1136/thorax-2024-222086","url":null,"abstract":"Background Prospective validation and comparison of the performance of nodule management protocols is limited. The aim of this study was to examine the performance of size and risk thresholds for assessing malignancy in solid nodules at baseline low-dose CT (LDCT) in a lung cancer screening (LCS) programme. Methods This was an observational study using data from the SUMMIT Study, a prospective longitudinal study investigating LDCT for LCS. Participants were 55–77 years old and met either the United States Preventative Services Task Force (2013) criteria or had a PLCOm2012 risk of ≥1.3%. LDCTs were reported using computer-aided detection software (Veolity, MeVIS) with semiautomated volumetry. Cancer outcomes were reported for solid nodules reported at baseline CT, with participants represented by the single largest solid nodule where more than one was present. Malignancy risk was stratified by long-axis diameter and volume using predefined size thresholds taken from British Thoracic Society and European Position statement guidelines: a 5/6 mm long axis diameter or 80/100 mm3 volume ‘rule out’ thresholds for low-risk nodules and ≥300 mm3 or ≥8 mm diameter with or without Brock score ≥10% ‘Rule in’ thresholds for high-risk nodules. Pearson’s χ2 test was used to calculate statistical significance for nominal variables, McNemar’s test for comparison of sensitivity/specificity and DeLong’ test for comparison of areas under the receiver operating characteristic curve (AUROC). Optimal thresholds were determined with Youden’s J statistic. Net benefit calculations were undertaken to compare the existing thresholds with 95% CIs calculated by bootstrap sampling. Results 11 355 participants were included. Crude risk of malignancy in solid nodules at baseline LDCT was 3.8% (228/5929). Risk of malignancy in solid nodules <6 mm long-axis diameter or <100 mm3 volume was equivalent to that in participants with no nodules at baseline LDCT (0.88% and 0.84% vs 0.77%, p=0.4600 and p=0.7932, respectively). A <80 mm3 volume and <5 mm diameter ‘rule out’ threshold achieved sensitivity 86.8% and 93.4%, specificity 65.4% and 24.64%, and negative predictive value (NPV) 99.2% and 98.9%, respectively. The <80 mm3 volume threshold encompassed 63.3% of participants with a baseline solid nodule compared with 24.0% by the <5 mm diameter threshold. For nodules ≥8 mm diameter, the addition of a risk score (Brock ≥10%) was associated with a significant net benefit when compared with using size threshold alone by net effect analysis (31.24; 95% CI 26.19 to 35.89). Conclusions Solid nodules <100 mm3 or <6 mm diameter are not associated with increased risk of lung cancer compared with participants with no nodules at baseline LDCT. Volumetric rule-out thresholds achieve equivalent NPV to long-axis diameter thresholds while encompassing significantly more participants, reducing the number of interval scans required. Data are available upon reasonable request. Relevant individual de-ident","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"19 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144202154","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":"Randomised, placebo-controlled trial of oral hymecromone in adults with pulmonary hypertension","authors":"Kathryn Czepiel, Nadine Nagy, Tamera Panjalingam, Anissa Kalinowski, Adam R Frymoyer, Harry Karmouty-Quintana, Bo Gu, Haley Hedlin, Gernot Kaber, Sylvie Dobrota Lai, Joelle I Rosser, Paul L Bollyky, Vinicio de Jesus Perez, Roham T Zamanian","doi":"10.1136/thorax-2024-222725","DOIUrl":"https://doi.org/10.1136/thorax-2024-222725","url":null,"abstract":"Background Pulmonary hypertension (PH) is a progressive cardiopulmonary condition associated with increased morbidity and mortality. The extracellular matrix component hyaluronan (HA) is linked to vascular remodelling and interstitial fibrosis in PH. We hypothesised that inhibition of HA synthesis with hymecromone could serve as a reverse-remodelling therapy in PH. Methods We performed a proof-of-concept phase IIa randomised, double-blind, placebo-controlled study in adults with pulmonary arterial hypertension and PH associated with interstitial lung disease (PH-ILD). Patients were randomised to a 5:3 ratio and stratified by PH group to receive oral hymecromone or placebo two times per day over 24 weeks. The primary endpoint was change in pulmonary vascular resistance (PVR). Results We enrolled 16 patients with PH with a median age of 62.0 years. There were no treatment-related adverse events leading to hymecromone discontinuation. No statistically significant difference in PVR was observed at 24 weeks for the experimental group compared with the placebo group (mean difference 0.61 Wood unit, 95% CI −1.5 to 2.7). Five patients with PH-ILD treated with hymecromone demonstrated an unadjusted absolute mean increase in 6 min walk distance of 66 m (SD 69.6) from baseline to 24 weeks and improvements in quality-of-life measures. Conclusion Our exploratory analyses suggest that treatment with hymecromone could lead to improvements in clinically meaningful functional parameters in patients with PH-ILD. Further investigations in larger patient cohorts are warranted. Trial registration number ClinicalTrials.gov: [NCT05128929][1]. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05128929&atom=%2Fthoraxjnl%2Fearly%2F2025%2F05%2F31%2Fthorax-2024-222725.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"5 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144193152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early phase clinical trials in pulmonary hypertension: how small is big enough?","authors":"Steven D Nathan","doi":"10.1136/thorax-2025-223535","DOIUrl":"https://doi.org/10.1136/thorax-2025-223535","url":null,"abstract":"In this issue of Thorax , Czepiel et al report the results of a double-blind randomised controlled trial of an oral agent, hymecromone, in patients with pulmonary hypertension (PH).1 The authors provide a sound biological rationale as to why hyaluronan, a constituent of the extracellular matrix, may have an important role in vascular biology. The agent subjected to study is hymecromone, an inhibitor of hyaluronan, which is approved in Europe and Asia for the treatment of biliary dyskinesia. There is certainly attraction in repurposing an approved agent, with a known track record of safety for potential use in a relatively rare disease state. This small single-centre trial included patients with both group 1 pulmonary arterial hypertension (PAH) and PH associated with interstitial lung disease (ILD-PH). The subgroups, therefore, were very small with five patients receiving active drug and three assigned to placebo in each of the two groups. While the inclusion of group 1 and group 3 patients together in one trial can cloud the results, …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"16 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144193151","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":"Journal club","authors":"Kostas A Papavassiliou, Athanasios G Papavassiliou","doi":"10.1136/thorax-2025-223353","DOIUrl":"https://doi.org/10.1136/thorax-2025-223353","url":null,"abstract":"There are ongoing efforts to develop a precision medicine approach in small cell lung cancer (SCLC) where patients can be stratified based on their tumour molecular profile and treated with optimal targeted therapies. In this regard, Umemura et-al attempted to classify SCLC into clinically-relevant subtypes based on genetic profiling of a large sample size of tumour tissues via next-generation sequencing testing ( J Thoracic Oncol 2025;doi: 10.1016/j.jtho.2024.10.004). According to their findings, patients with SCLC can be classified into five molecular subtypes: NSCLC (genetic alterations associated with non-small cell lung cancer (NSCLC)), PI3K (phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathway mutations), HME (mutations in the histone-modifying enzymes), MYC ( MYC family amplifications), and Hotspot (targetable hotspot mutations common in tumours). These subtypes were associated with distinct clinical data, with the NSCLC and MYC subtypes exhibiting poorer prognosis in response to chemotherapy while the HME subtype patients displayed improved outcomes under treatment with chemo-immunotherapy. Umemura et-al also conducted a phase II clinical trial of gedatolisib (a potent inhibitor of all class I PI3K isoforms, mTORC1, and mTORC2) for SCLC which exhibited therapeutic efficacy only in SCLC patients categorised in the PI3K subgroup. Overall, the findings of this study provide important molecular insights into the heterogeneity of the biology of SCLCs, represent a step forward towards reaching precision medicine in SCLC, and …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"8 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144104693","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":"Smart steps forward: the role of wearables in long-term rehabilitation after lung transplantation","authors":"Miguel Jiménez-Gómez, Javier Sayas Catalan","doi":"10.1136/thorax-2025-223541","DOIUrl":"https://doi.org/10.1136/thorax-2025-223541","url":null,"abstract":"Physical inactivity is a modifiable and widespread risk factor in chronic disease populations, including those with obstructive pulmonary disease and recipients of lung transplantation (LT). While LT restores respiratory function, full physical recovery remains elusive. Muscle weakness and reduced exercise tolerance are common and often worsened by immunosuppressive therapies, immobility and nutritional deficits.1 Notably, prolonged sedentary behaviour is independently associated with long-term morbidity and mortality,1 2 even among patients meeting activity recommendations.3 The COVID-19 pandemic accelerated telemedicine integration into clinical practice, expanding opportunities for telerehabilitation and digital health interventions. In this context, consumer-grade wearable devices, like Fitbit wristbands (Fitbit, Google Alphabet, California, USA), originally designed for fitness tracking, are increasingly being evaluated as therapeutic tools in chronic disease populations.4 Against this backdrop, the randomised controlled trial by Breuls et al ,5 recently published in Thorax, is timely. It explores the use of wearable-based, long-term telecoaching in a high-risk, deconditioned post-LT population with low baseline activity levels. This marks a crucial shift from traditional short-term, centre-based rehabilitation to sustained, behaviourally driven, patient-centred care, addressing the persistent deconditioning that often characterises long-term recovery.1 6 Wearable technologies are emerging as scalable,7 low-cost tools that support behavioural interventions4 through real-time feedback,7 individualised coaching, social connectivity and remote monitoring (figure …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"36 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176510","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":"Combining tuberculin skin test with follow-on interferon gamma release assay markedly improves screening of household contacts","authors":"Chi Kuen Chan, Chi Chiu Leung, Shan Shan Huang, Shuk Nor Maria Lee, Lai Bun Tai","doi":"10.1136/thorax-2024-222400","DOIUrl":"https://doi.org/10.1136/thorax-2024-222400","url":null,"abstract":"Introduction In Hong Kong, tuberculin skin test (TST) with a 15 mm cut-off was used at 0 and 3 months for contact screening, but half of future tuberculosis cases might be missed. Follow-on interferon-gamma release assay (IGRA) was added for those with tuberculin reaction of 5–14 mm in a pilot programme. Methods This was a prospective cohort study. All household contacts of smear-positive tuberculosis aged 12–64 registered in Hong Kong Tuberculosis and Chest Service from 1 July 2018 to 30 June 2022 were prospectively tracked through medical records and the territory-wide tuberculosis notification registry for active tuberculosis till 31 December 2022. Results Among untreated contacts with tuberculin reaction of 5–14 mm in either the initial test or second test at 3 months, the tuberculosis rate among those with a follow-on reactive IGRA was significantly higher than those with a non-reactive IGRA (12.44 vs 0.75 per 1000 person-years, relative risk: 16.52, p=0.003). After adjustment for the efficacy of preventive treatment among all treated cases, the estimated proportions of tuberculosis cases captured by the pilot programme criterion of TST≥15 mm/TST 5–14 mm and IGRA reactive/TST conversion were similar to those captured by TST cut-offs of 5 mm or 10 mm, despite consistently lower positive rates. With an overall test-positive rate of 54.5%, the pilot programme captured 95.8% of estimated future tuberculosis cases at a relative risk between test-positive and test-negative cases of 19. Conclusion Combining TST with follow-on IGRA for those with tuberculin reaction of 5–14 mm markedly improves screening of household contacts in an intermediate burden setting. Data are available upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"23 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176511","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":"Effect of elexacaftor/tezacaftor/ivacaftor on systemic inflammation in cystic fibrosis","authors":"Rosemary E Maher, Urszula M Cytlak-Chaudhuri, Saad Aleem, Peter Barry, Daniel Paul Brice, Eva Caamaño Gutiérrez, Kimberley Driver, Edward Emmott, Alexander Rothwell, Emily Smith, Mark Travis, Dave Lee, Paul Stephen McNamara, Ian Waller, Jaclyn Ann Smith, Andrew Jones, Robert W Lord","doi":"10.1136/thorax-2024-222242","DOIUrl":"https://doi.org/10.1136/thorax-2024-222242","url":null,"abstract":"Background Despite significant clinical improvements, there is evidence of persisting airway inflammation in people with cystic fibrosis (CF) established on elexacaftor/tezacaftor/ivacaftor (ETI) therapy. As CF is a multi-system disease, systemic immune profiles can reflect local inflammation within the lungs and other organs. Understanding systemic inflammation after ETI therapy may reveal important translational insights. This study aims to profile systemic inflammatory changes and relate these to the well-documented improvements observed with ETI therapy. Methods We conducted a single-centre longitudinal study with 57 CF subjects initiating ETI therapy. All participants were Phe508del homozygous or Phe508del/minimal function. Blood samples were collected pre-ETI and 3–12 months post-therapy initiation. Analyses included mass spectrometry-based proteomics, a multiplex immunoassay, and flow cytometry for peripheral immune cell counts and phenotype. Controls samples were provided by 29 age-matched healthy controls. Results Systemic inflammation reduced with ETI therapy; however, the immune profile remained distinct from healthy controls. ETI reduced neutrophil counts and was associated with a more mature, less inflammatory phenotype, as well as a shift towards an immune resolving state associated with increased CD206 expression. Cytokines known to influence neutrophil levels reduced with therapy. Despite ETI therapy, neutrophil and monocyte counts remained elevated compared with healthy controls. There was no obvious association between the ETI-related improvements in systemic inflammation and lung function. Conclusions Patients with CF showed evidence of persisting systemic inflammation despite ETI therapy, which may have long-term potentially adverse effects on respiratory and other organ systems. Data are available on reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"82 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176512","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}