Lancet Rheumatology最新文献

{"title":"Whole-body MRI in patients with arthralgia or inflammatory arthritis after exposure to immune checkpoint inhibitors: a single-centre prospective imaging study.","authors":"Kate Harnden, Navkiran Sidhu, Emma Rowbotham, Laurence Duquenne, Sana Sharrack, Keith Howell, Dominic Bertham, Kerem Abacar, Paul Emery, Dennis McGonagle, Kulveer Mankia","doi":"10.1016/S2665-9913(25)00061-X","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00061-X","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal adverse events due to immune checkpoint inhibitors are common and can present clinically as inflammatory arthritis, polymyalgia rheumatica, or arthralgia. The pathoanatomy of musculoskeletal adverse events related to immune checkpoint inhibitors remains undefined, with a paucity of available imaging data. We aimed to investigate the whole-body imaging phenotype of arthralgia and inflammatory arthritis following exposure to immune checkpoint inhibitors, to fully characterise the pattern of inflammation in these patients and subsequently inform clinical management.</p><p><strong>Methods: </strong>In this prospective imaging study, patients aged 18 years or older with new musculoskeletal symptoms that started during or up to 6 months after receiving an immune checkpoint inhibitor and healthy controls aged 18 years or older, with no personal history of rheumatological autoimmune disease, no active cancer, and no self-reported joint pains in the 4 weeks before their MRI scan date, were recruited at the Leeds Rheumatology department of Chapel Allerton Hospital, Leeds, UK, and underwent gadolinium contrast-enhanced whole-body MRI. Joint, tendon, bursal, entheseal, and whole spinal imaging lesions were graded by two independent masked assessors and consensus reported. Inflammatory whole-body MRI patterns were analysed and patients were followed up for 6 months. People with lived experience of inflammatory arthritis and musculoskeletal toxicity related to immune checkpoint inhibitors highlighted the importance of knowing and understanding imaging findings to help inform risk versus benefit decisions about immunosuppressive treatments.</p><p><strong>Findings: </strong>Between Oct 20, 2021, and May 22, 2024, 60 patients (35 [58%] with arthralgia and 25 [42%] with inflammatory arthritis) and 20 healthy controls were recruited. The mean age of patients was 65 years (SD 11) and that of healthy controls was 62 years (7); 34 (57%) patients were men and 26 (43%) were women, and 12 (60%) healthy controls were men and eight (40%) were women. All patients and healthy controls were White. Median total joint synovitis, joint erosions, enthesitis, and tenosynovitis scores were significantly higher in patients with arthralgia or inflammatory arthritis induced by immune checkpoint inhibitors compared with healthy controls, without significant differences between the inflammatory arthritis and arthralgia subgroups. Acromioclavicular (46 [77%] of 60), glenohumeral (45 [75%] of 60), wrist (43 [73%] of 59), and metacarpophalangeal (35 [59%] of 59) joints were the most frequently affected by synovitis in all patients. There were three distinct global inflammatory patterns: peripheral inflammatory arthritis in 22 (37%) of 60 patients; polymyalgia rheumatica in seven (12%), and an overlapping phenotype of polymyalgia rheumatica and peripheral inflammatory arthritis in 12 (20%). Axial inflammation was only identified in one patient","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295154","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":"Occupational therapist-led versus rheumatologist-led care in people with hand osteoarthritis in Norway: an open-label, multicentre, randomised controlled, non-inferiority trial.","authors":"Annikka Polster, Unni Olsen, Lars Asphaug, Kjetil Bergsmark, Barbara Christensen, Ida K Haugen, Toril Hennig, Merete Hermann-Eriksen, Åshild Hove, Trine Sjøvold, Joe Sexton, Anne Therese Tveter, Ingvild Kjeken","doi":"10.1016/S2665-9913(25)00040-2","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00040-2","url":null,"abstract":"<p><strong>Background: </strong>Hand osteoarthritis is a common musculoskeletal disease with a rising prevalence due to increased life expectancy. Because the disease is diagnosed on the basis of clinical examination and the first choice of treatment is non-pharmacological, it is not a high-risk condition. We aimed to assess the non-inferiority and cost-effectiveness of occupational therapist-led care for hand osteoarthritis compared with rheumatologist-led care.</p><p><strong>Methods: </strong>We did an open-label, multicentre, randomised controlled, non-inferiority trial at two hospitals in Norway. Participants with hand osteoarthritis aged 18 years or older were randomly assigned 1:1, stratified by centre, using a computed-generated randomisation list, to receive either standard rheumatologist-led care or occupational therapist-led care. The primary outcome was response to treatment at 6 months according to the OMERACT-OARSI criteria. Non-inferiority was tested in the intention-to-treat population using a response rate difference of 15% as a non-inferiority margin. A cost-utility analysis from the Norwegian health-care system perspective was done to assess the economic effect of occupational therapist-led care. Two patient research partners with first-hand experience of hand osteoarthritis were included in the project team from the outset and contributed to study design, development of research questions, and strategies for optimising the recruitment process. This trial was preregistered with ClinicalTrials.gov (NCT03102788) and is closed for recruitment.</p><p><strong>Findings: </strong>Between Sept 19, 2017, and Nov 11, 2020, 374 patients were randomly assigned; 186 to rheumatologist-led care and 188 to occupational therapist-led care. Mean age was 63·6 year (SD 10·0), 302 (80·7%) of 374 participants were women and 72 (19·3%) were men. At 6 months, 48 (28·4%) of 169 participants in the rheumatologist-led group and 48 (28·6%) of 168 participants in the occupational therapist-led group were responders according to the OMERACT-OARSI criteria. Occupational therapist-led care was non-inferior to rheumatologist-led care (OR 1·01, 95% CI 0·63-1·62). Economic analysis showed that occupational therapist-led care was cost-effective up to a willingness to pay per quality-adjusted life-year of £23 255. No severe adverse events were recorded.</p><p><strong>Interpretation: </strong>Occupational therapist-led care for hand osteoarthritis is non-inferior to rheumatologist-led care in terms of efficacy and safety. The economic evaluation indicates that occupational therapist-led care could offer a cost-saving approach with similar health outcomes, supporting the feasibility of task shifting to allied health professionals in the management of chronic conditions such as hand osteoarthritis. This approach aligns with global health-care recommendations to optimise resource use without compromising care quality.</p><p><strong>Funding: </strong>The Norwegian Resea","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295152","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":"What can imaging teach us about immune checkpoint inhibitor-induced arthritis?","authors":"Alice Tison, Anne R Bass","doi":"10.1016/S2665-9913(25)00077-3","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00077-3","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295153","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":"Trends in the prevalence of autoimmune diseases during pregnancy in the UK, 2000–21: a retrospective cohort study","authors":"Megha Singh PhD , Katherine Phillips PhD , Jingya Wang PhD , Anuradhaa Subramanian PhD , Kelly-Ann Eastwood PhD , Prof Krishnarajah Nirantharakumar MD , Francesca L Crowe PhD","doi":"10.1016/S2665-9913(25)00039-6","DOIUrl":"10.1016/S2665-9913(25)00039-6","url":null,"abstract":"<div><h3>Background</h3><div>Autoimmune diseases are increasingly prevalent worldwide and disproportionately affect women of reproductive age, including during pregnancy. Given the association between autoimmune diseases, comorbidities, and risk factors for adverse pregnancy outcomes, we aimed to estimate the burden of autoimmune disease in pregnancy.</div></div><div><h3>Methods</h3><div>This was a UK population-based retrospective cohort study using routinely collected data from two large databases (Clinical Practice Research Datalink Gold and Aurum) and associated pregnancy registers. Prevalence was calculated annually for 17 autoimmune diseases (Addison's disease, alopecia areata, ankylosing spondylitis, coeliac disease, inflammatory bowel disease (including Crohn's disease and ulcerative colitis), Graves' disease, Hashimoto's thyroiditis, multiple sclerosis, myasthenia gravis, psoriasis, psoriatic arthritis, rheumatoid arthritis, Sjögren's disease, SLE, systemic sclerosis, type 1 diabetes, and vitiligo) in pregnancies among women of reproductive age (15–49 years) from Jan 1, 2000, to Dec 31, 2021. Logistic regression was used to estimate odds ratios, describing the relationship between women's characteristics (age, ethnicity, deprivation, BMI, smoking status, and gravidity), comorbidities, and autoimmune diseases. Patient and public involvement and engagement representatives participated in formulating the research question. They also played key role in collaboration with clinicians and researchers to identify and consider the list of autoimmune diseases in the study, and played a key role in disseminating the results.</div></div><div><h3>Findings</h3><div>5 165 960 pregnancies in 2 831 472 women were included. In 2000–21, there were 185 208 pregnancies in 100 655 women who had a coded diagnosis of autoimmune disease. There was an increase in prevalence of the combination of 17 autoimmune diseases, from 6058 (3·5%) of 172 430 in 2000 to 8429 (4·7%) of 181 532 in 2021. Of the 17 autoimmune diseases studied, psoriasis had the highest prevalence throughout the study period. The prevalence of most of the autoimmune diseases increased from 2000 to 2021. The steepest rise was Hashimoto's thyroiditis, followed by coeliac disease, Grave's disease, and type 1 diabetes. Women in less deprived areas had higher odds of an autoimmune disease during pregnancy (adjusted odds ratio 1·10 [95% CI 1·07–1·14]), whereas minority ethnic groups had lower prevalence rates compared with White women (Black women 0·48 [0·45–0·51]; Asian women 0·81 [0·77–0·85]). Ex-smokers had significantly higher odds of autoimmune disease than non-smokers (1·20 [1·18–1·23]). When compared with women with a single pregnancy, the odds of having an autoimmune disease were significantly higher for women with five or more pregnancies (1·12 [1·10–1·15]). Women with metabolic and mental health conditions had significantly higher odds of having an autoimmune disease during pregnancy (type 2 d","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 7","pages":"Pages e495-e504"},"PeriodicalIF":15.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235585","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":"Autoimmune disease in pregnancy: strengthening research and care","authors":"Hilary K Brown , Natalie V Scime","doi":"10.1016/S2665-9913(25)00067-0","DOIUrl":"10.1016/S2665-9913(25)00067-0","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 7","pages":"Pages e457-e458"},"PeriodicalIF":15.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235584","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":"Long-term effectiveness of non-surgical interventions for chronic low back pain: a systematic review and meta-analysis.","authors":"Hazel J Jenkins, Leticia Corrêa, Benjamin T Brown, Giovanni E Ferreira, Casper Nim, Sasha L Aspinall, Deborah Wareham, Junghyun Choi, Christopher G Maher, Mark J Hancock","doi":"10.1016/S2665-9913(25)00064-5","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00064-5","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain is a long-term recurrent condition. Interventions with sustained benefits are needed to reduce the associated personal and societal burden. We aimed to assess the long-term effectiveness of non-surgical interventions for reducing pain intensity and disability in adults with chronic low back pain.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis. MEDLINE, EMBASE, and CINAHL were searched from inception until May 22, 2024, for randomised controlled trials assessing non-surgical interventions in adults with chronic low back pain. Studies assessing pain intensity outcomes, disability outcomes, or both at long-term (1-2 years) and very long-term (≥2 years) follow-up were included. Comparators included placebo, adjuvant intervention, no intervention, or usual care. Study characteristics and outcome measures were extracted and risk of bias assessed. Random effects meta-analysis was performed for studies with similar populations, interventions, and outcome measures. We involved people with experience living with or treating chronic low back pain in the design and interpretation of this review. The review protocol was prospectively registered in PROSPERO (CRD42023408537).</p><p><strong>Findings: </strong>75 trials (15 395 participants) were included. Risk of bias was rated high for the majority of studies (51 [68%] of 75). In people with non-specific chronic low back pain at long-term follow-up, there was moderate certainty evidence that cognitive behavioural therapy and mindfulness probably result in reductions in pain intensity (mean difference -7·2 [95% CI -9·8 to -4·6]; I² =0·0 for cognitive behavioural therapy and -10·0 [-14·4 to -5·6]; I² =0·1 for mindfulness) and disability (-5·7 [-7·7 to -3·7]; I² =0·0 and -9·3 [-14·4 to -4·1]; I² =11·1). Goal setting (-8·3 [-12·8 to -3·9]; I² =4·8) and needling (-4·8 [-8·1 to -1·5]; I² =0·0) probably reduce disability at long-term follow-up. There was low certainty evidence that multidisciplinary care could reduce pain intensity (-10·1 [-16·6 to -3·7; I² =0·0) and exercise might reduce disability (-10·2 [-17·5 to -2·9]; I² =33·5) at very long-term follow-up. Heterogeneity was evident in several of the meta-analyses, and results should be interpreted with caution.</p><p><strong>Interpretation: </strong>Some interventions, including cognitive behavioural therapy, mindfulness, exercise, and multidisciplinary care could produce the long-term benefits required to reduce the global burden due to non-specific chronic low back pain; however, the effects are mostly small, and the strength of evidence is relatively uncertain. Greater attention is needed on developing and testing interventions with long-term effects for chronic low back pain.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192389","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":"Long-term outcomes in chronic low back pain: costs, comorbidities, and clinical importance.","authors":"Jo Nijs, Elin Johansson","doi":"10.1016/S2665-9913(25)00104-3","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00104-3","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192390","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":"ERN ReCONNET–SLICC–SLEuro expert consensus on the therapeutic management of rare systemic lupus erythematosus manifestations","authors":"Prof Laurent Arnaud MD PhD ,&nbsp;Prof Guillermo Ruiz-Irastorza MD PhD ,&nbsp;Prof Cynthia Aranow MD PhD ,&nbsp;Prof Sasha Bernatsky MD PhD ,&nbsp;Prof Maria Dall'Era MD ,&nbsp;Prof Olufemi Adelowo MD MACR ,&nbsp;Prof Sang-Cheol Bae MD PhD ,&nbsp;Lorenzo Beretta MD ,&nbsp;Prof Eloisa Bonfa MD PhD ,&nbsp;Prof Ricard Cervera MD PhD ,&nbsp;François Chasset MD PhD ,&nbsp;Ann E Clarke MD MSc ,&nbsp;Prof Nathalie Costedoat-Chalumeau MD PhD ,&nbsp;Prof Andrea Doria MD ,&nbsp;Gerard Espinosa MD PhD ,&nbsp;Prof Antonis Fanouriakis PhD ,&nbsp;Micaela Fredi MD PhD ,&nbsp;Prof Mariele Gatto MD PhD ,&nbsp;Prof Dafna D Gladman MD ,&nbsp;José A Gomez-Puerta MD PhD ,&nbsp;Julija Zepa","doi":"10.1016/S2665-9913(25)00063-3","DOIUrl":"10.1016/S2665-9913(25)00063-3","url":null,"abstract":"<div><div>Existing guidelines for systemic lupus erythematosus (SLE) predominantly focus on common and major organ involvements. An international taskforce involving experts from three SLE expert groups (ie, the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases, the Systemic Lupus Erythematosus International Collaborating Clinics group, and the European Lupus Society) was established. A total of 119 participants contributed to the development of consensus therapeutic strategies for 24 rare SLE manifestations, using a multistep process. For SLE enteritis and pancreatitis, experts recommended hydroxychloroquine, glucocorticoids, and cyclophosphamide or mycophenolate mofetil. Rare lung conditions such as pneumonitis were also managed with cyclophosphamide if severe or with mycophenolate mofetil if not severe. SLE for myocarditis with hydroxychloroquine, glucocorticoids, and cyclophosphamide or mycophenolate mofetil, are recommended based on severity. For CNS manifestations, hydroxychloroquine, glucocorticoids, and cyclophosphamide or mycophenolate mofetil were common choices for treatment. For rare skin manifestations, the preferred strategy was a combination of hydroxychloroquine and glucocorticoids with anifrolumab or mycophenolate mofetil. This expert-based consensus provides a valuable framework for guiding therapeutic decisions where the available recommendations might be insufficient or inapplicable.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 7","pages":"Pages e505-e518"},"PeriodicalIF":15.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209952","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":"Towards precision medicine in antiphospholipid syndrome.","authors":"Chary Lopez-Pedrera, Carlos Pérez-Sánchez, Maria G Tektonidou","doi":"10.1016/S2665-9913(25)00094-3","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00094-3","url":null,"abstract":"<p><p>Antiphospholipid syndrome is a rare systemic autoimmune disorder with complex pathophysiology and high heterogeneity in clinical presentation and treatment responses. The core idea of precision medicine is that the varying treatment responses among patients with the same clinical diagnosis are due to differences in their underlying pathogenetic mechanisms and genetic makeup. A better understanding of the pathophysiology and multiple clinical subtypes of antiphospholipid syndrome has led to better classification and subphenotyping of the syndrome. Advances in microarray analysis, cytometry, and omic technologies have helped to identify genes, epigenetic variations, and pathway-informed biomarkers and identified new factors in disease development. By stratifying patients with antiphospholipid syndrome based on clinical or laboratory phenotypes and cellular and molecular profiles in the blood and affected tissues, treatments can be more effectively tailored, improving efficacy and reducing toxicity. This Review explores the current evidence on clinical, genetic, and biomolecular stratification in antiphospholipid syndrome and how artificial intelligence algorithms from clinical and molecular profiles can guide precision medicine in antiphospholipid syndrome.</p>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152234","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":"One step closer to predicting autoimmune congenital heart block?","authors":"Grégoire Martin de Frémont, Nathalie Morel, Nathalie Costedoat-Chalumeau","doi":"10.1016/S2665-9913(25)00129-8","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00129-8","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144072","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}