Journal of Rheumatology最新文献

{"title":"Development of an application for self-monitoring to empower patients with rheumatoid arthritis (MyRA).","authors":"Cheryl Roumen, Laura M Hochstenbach, Pim van den Dungen, Anouk M Knops, Maria Bj Brokken-Peters, Marieke D Spreeuwenberg, Harald E Vonkeman, Astrid van Tubergen","doi":"10.3899/jrheum.2024-1071","DOIUrl":"https://doi.org/10.3899/jrheum.2024-1071","url":null,"abstract":"<p><strong>Objective: </strong>To develop a web-based self-monitoring tool including motivational elements to improve empowerment of patients with rheumatoid arthritis.</p><p><strong>Methods: </strong>Following a design thinking approach, the development included three iterative, co-creative phases involving different stakeholders. In the 'empathise and define' phase, two focus groups gave insight into patients' wishes and needs regarding self-monitoring with an application. During the 'ideation' phase, two co-creation sessions were organised to establish the content and consider motivational elements. For the 'prototyping and testing' phase, usability was assessed through both formative (heuristics evaluation) and summative (System Usability Scale, 0-100, ≥68 is good to excellent) evaluations.</p><p><strong>Results: </strong>The focus groups resulted in a shortlist of what to monitor (physical possibilities, quality of life, pain, fatigue, mental wellbeing, and social participation) and preferences on how to monitor (single item questions, 0-10 scale, frequency not fixed). The co-creation sessions revealed preference for empathetic dialogues with an avatar for self-monitoring. Setting goals, adding notes, sharing results, and receiving tips could further increase motivation for use. Initial experiences regarding heuristics of the tool were generally positive and confirmed by a System Usability Scale score of 84.4 (SD 11.6). Points for improvement included simplifying login procedures, adding notifications, and adjusting the avatar's tone of voice.</p><p><strong>Conclusion: </strong>A web-based self-monitoring application (MyRA) was developed, with an avatar asking patients in dialogues to score six domains, showing graphical displays, a diary functionality, and practical tips. Further studies are needed to confirm its usability and effectiveness in empowering patients.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558523","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":"Epidemiology of Isolated Cutaneous Lupus Erythematosus in the Multiethnic Population of Reunion Island: A Retrospective Multicenter Study.","authors":"Mathurin Maillet, Babacar S Tounkara, Damien Vagner, Kelly Bagny, Sébastien Duquenne, Céline Lartigau-Roussin, Anne Kolbe, Yves Lauret, Andry Randrianjohany, Serge Laureau, Nicole Denat, Aude Alquier, Nathalie Sultan-Bichat, Antoine Bertolotti, Loïc Raffray","doi":"10.3899/jrheum.2024-0661","DOIUrl":"10.3899/jrheum.2024-0661","url":null,"abstract":"<p><strong>Objective: </strong>Few data are available about the epidemiology of cutaneous lupus erythematosus (CLE) in the Southern hemisphere and in multiethnic populations. We describe the prevalence, incidence, and clinical characteristics of isolated CLE in the multiethnic population of Reunion Island, France, including patients with dark skin.</p><p><strong>Methods: </strong>The study was performed in all public hospitals and private dermatology practices in Reunion Island. Cases were identified through informatics databases. Cases were defined as isolated CLE, meaning they did not fulfill the criteria for systemic lupus erythematosus (SLE). Incident cases were collected from 2008 to 2021. Prevalence was calculated on January 1, 2022. A capture-recapture analysis was performed to estimate both prevalence and incidence.</p><p><strong>Results: </strong>A total of 268 cases of CLE were identified and 218 were incident cases. The standardized prevalence of CLE was 43 out of 100,000 persons and the average annual standardized incidence was 3.1 per 100,000 person-years (PY). With a capture-recapture analysis, prevalence and annual incidence were estimated to be 99 out of 100,000 persons (95% CI 77.10-136.45) and 5.7 per 100,000 PY (95% CI 4.40-7.95), respectively. The mean age at diagnosis was 41.7 years and the ratio of female to male individuals was 4:1. Patients with dark skin had a higher rate of discoid CLE and were more likely to receive immunosuppressants. Generalized discoid CLE, panniculitis, and overlapping subtypes of CLE appeared as predictive markers of progression toward SLE.</p><p><strong>Conclusion: </strong>The prevalence and incidence of CLE in the multiethnic population of Reunion Island seem higher than in light-skinned populations. We highlight new risk factors of evolution toward SLE that should be known by practitioners to adjust follow-up.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"251-256"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774195","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":"Characteristics of Overlap Syndrome in a Large Cohort of Brazilian Patients With Systemic Sclerosis: A Retrospective Analysis.","authors":"Cipriano R Gama, Andre S Franco, Adriana B Bortoluzzo, Renata Miossi, Ana Cristina Medeiros-Ribeiro, Ana Paula Luppino Assad, Percival D Sampaio-Barros","doi":"10.3899/jrheum.2024-0505","DOIUrl":"10.3899/jrheum.2024-0505","url":null,"abstract":"<p><strong>Objective: </strong>Systemic sclerosis (SSc) often presents alongside other connective tissue disorders, termed \"overlap syndrome (OS).\" This study aimed to characterize patients with SSc with OS compared to those without OS in a tertiary university hospital in Brazil.</p><p><strong>Methods: </strong>A retrospective analysis of demographic, clinical, and laboratory data from 787 SSc patients was performed using electronic medical records. Patients were classified based on the 2013 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for SSc and additional criteria for systemic lupus erythematosus (SLE), idiopathic inflammatory myopathy (IIM), Sjögren disease (SjD), and rheumatoid arthritis (RA). Statistical analysis, including univariate and multivariate methods, identified factors associated with OS.</p><p><strong>Results: </strong>Ninety-one patients (11.6%) had OS, mainly with SLE (29.7%), SjD (26.4%), RA (24.2%), or IIM (19.8%). Patients with OS were younger, with an earlier age at onset (<i>P</i> = 0.004) and at diagnosis (<i>P</i> = 0.003). They presented a higher prevalence of limited SSc (<i>P</i> _trend = 0.06), musculoskeletal symptoms (<i>P</i> < 0.001), neoplasia (<i>P</i> = 0.03), and sicca symptoms (<i>P</i> < 0.001); and were associated with a lower frequency of pulmonary hypertension (<i>P</i> = 0.048) and comorbidities such as diabetes mellitus (<i>P</i> = 0.02) and dyslipidemia (<i>P</i> = 0.02). A higher prevalence of anti-Ro (<i>P</i> = 0.007) and a lower prevalence of anti-Scl70 (<i>P</i> = 0.003) were also observed. Patients with OS were more frequently prescribed glucocorticoids (GCs; <i>P</i> < 0.001), methotrexate (<i>P</i> = 0.01), and leflunomide (<i>P</i> = 0.001). Multivariate analysis identified limited SSc (odds ratio [OR] 3.1), neoplasia (OR 3.4), and use of GCs (OR 8.2) and leflunomide (OR 5.5) with OS. No worse prognosis was observed.</p><p><strong>Conclusion: </strong>Overall, Brazilian patients with SSc with OS have distinct clinical characteristics but do not have a worse prognosis compared to those without OS.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426485","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":"Risk of Heart Failure in Patients With Immune-Mediated Inflammatory Diseases: A Population-Based Study.","authors":"Sahil Koppikar, Bindee Kuriya, Jacob A Udell, Bing Yu, Anna Chu, Douglas S Lee, Jessica Widdifield, Lihi Eder","doi":"10.3899/jrheum.2024-0866","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0866","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the risk of heart failure (HF) in patients with immune-mediated inflammatory diseases (IMIDs) compared to the general population with and without diabetes mellitus (DM).</p><p><strong>Methods: </strong>A population-based cohort study was conducted in patients with rheumatoid arthritis (RA), radiographic axial spondyloarthritis (r-axSpA), psoriatic arthritis, and psoriasis (PsO) in Ontario from 2011 until 2019. The study outcome was first hospitalization for HF. Incidence rates of HF were calculated for each cohort. Hazard ratios (HRs) for HF were calculated using Cox proportional hazard models. The etiology of HF was descriptively classified into mutually exclusive groups based on comorbidities during HF hospitalization.</p><p><strong>Results: </strong>A total of 243,061 patients with IMID, 748,517 with DM, and 8,278,934 non-IMID, non-DM controls were analyzed. The crude incidence rate for HF in IMID was 2.70 per 1000 person-years, with the highest rate in RA and lowest in r-axSpA. The risk of being hospitalized for HF was higher in IMID compared with non-IMID comparators (HR 1.34, 95% CI 1.30-1.38). This risk was highest among patients with RA (HR 1.61, 95% CI 1.54-1.68) and lowest in PsO (HR 1.09, 95% CI 1.03-1.15). In comparison, the risk of HF hospitalization in patients with DM was higher (HR 2.19, 95% CI 2.16-2.21). The most common antecedent comorbidity associated with HF in all patients with IMID was ischemic heart disease. In patients with IMID without DM, atrial fibrillation had a similar effect as ischemic heart disease.</p><p><strong>Conclusion: </strong>The risk of HF hospitalization is increased in patients with IMID compared to the general population.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558041","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":"East Meets West: A Canadian Rheumatology Resident's Experience in Hong Kong.","authors":"Alan L Zhou, Shirley C W Chan","doi":"10.3899/jrheum.2025-0093","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0093","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558546","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":"Tocilizumab (TCZ) for Giant Cell Arteritis: Clinical Outcomes Following Relapses and TCZ Discontinuation Due to Adverse Events.","authors":"Fumika N Nagase, Sho Fukui, Naoho Takizawa, Toshihiro Yamaguchi, Nobuhiro Oda, Hajime Inokuchi, Takanori Ito, Mitsuru Watanabe, Masei Suda, Yoichiro Haji, Yasuhiro Suyama, Ryo Rokutanda, Masahiro Minoda, Atsushi Nomura, Eishi Uechi, Hiromichi Tamaki","doi":"10.3899/jrheum.2024-0612","DOIUrl":"10.3899/jrheum.2024-0612","url":null,"abstract":"<p><strong>Objective: </strong>Tocilizumab (TCZ) is effective for giant cell arteritis (GCA). However, little is known regarding treatment modification and clinical outcomes after unfavorable events such as GCA relapses or TCZ discontinuation due to adverse events (AEs).</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with GCA who initiated TCZ from 2008 to 2021 at 5 Japanese hospitals. GCA relapses and TCZ-related AEs were monitored for 2 years after TCZ initiation. In patients with GCA relapses, subsequent clinical courses, including relapse symptoms and treatment modification, were followed for 90 days after the relapses. Similarly, patients who discontinued TCZ because of AEs were additionally followed until 1 year after the TCZ discontinuation to evaluate AEs, relapses, and treatment changes.</p><p><strong>Results: </strong>Of 62 eligible patients, 10 patients (16%) relapsed after initiating TCZ therapy. Most relapses (8 of 10) occurred after extending TCZ intervals or discontinuing TCZ. Combinations of adjusting TCZ intervals, adjusting glucocorticoid (GC) dose, and/or adding or increasing methotrexate (MTX) therapy could manage the relapses without serious complications. In the entire cohort, AEs occurred in 28 patients (45%), and 8 patients (13%) discontinued TCZ because of AEs. After AE-related TCZ discontinuation, 6 patients attempted to taper GCs without other immunosuppressive therapy (IST), and 4 subsequently relapsed. In contrast, 2 patients who used other IST or biologic therapy could decrease GCs without relapses.</p><p><strong>Conclusion: </strong>Although GCA relapses can occur after initiating TCZ therapy, most relapses can be safely managed by adjusting TCZ, GC, and/or MTX doses. Adding IST or biologic treatments may potentially be related to preventing relapses when patients discontinue TCZ because of AEs.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"270-279"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640142","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":"Cancer Incidence and Outcome for Patients With Rheumatoid Arthritis: A Long-term Population Study in Western Australia.","authors":"Johannes Nossent, Helen I Keen, David B Preen, Charles A Inderjeeth","doi":"10.3899/jrheum.2024-0724","DOIUrl":"10.3899/jrheum.2024-0724","url":null,"abstract":"<p><strong>Objective: </strong>Our aim was to compare the incidence of malignancy and its effect on mortality between hospitalized patients with rheumatoid arthritis (RA) and controls.</p><p><strong>Methods: </strong>We conducted a population-level observational study of patients with RA (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9-CM] code 714 and International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification [ICD-10-AM] codes M05-M06) in the Hospital Morbidity Data Collection (HMDC) in Western Australia (WA) between 1985 and 2015, as well as nonexposed hospitalized controls matched on sex, age, and year of index admission. HMDC data were linked to the WA Cancer Registry and the WA Death Registry data, and cancer incidence rates (CIRs) per 1000 person-years, incidence rate ratios (IRR) with 95% CIs, and Kaplan Meier survival were estimated.</p><p><strong>Results: </strong>Among 14,041 patients with RA (67.56% female, median age 65.1 years) and 33,785 controls (65.16% female, median age 65.3 years), preexisting cancer in patients with RA was less prevalent than in controls (7.6% vs 14.2%; <i>P</i> < 0.01). In participants without prior cancer, the overall post index CIR was lower in those with RA (CIR 19.68 vs 24.77; IRR 0.79, 95% CI 0.76-0.83) and stable over 3 study decades. CIR was higher in patients with RA for lung (CIR 1.17, 95% CI 1.04-1.34) and hematological cancer (CIR 1.21, 95% CI 1.03-1.43) but lower for most other cancer types. Overall median survival was lower for patients with RA than controls (3.3 vs 5.3 years; <i>P</i> < 0.001) with increased mortality rates observed for most cancer subtypes.</p><p><strong>Conclusion: </strong>Overall CIR in patients with RA was consistently lower over time than in matched controls. CIR was only increased for lung and hematological cancer. Despite the overall lower CIR, post cancer mortality was higher for patients with RA in most cancer subtypes.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"219-225"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840026","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":"Historical Perspective on Antinuclear Antibody Testing.","authors":"Gyorgy Abel, M Qasim Ansari, Melissa R Snyder, Anne E Tebo, Mark H Wener, Stanley J Naides","doi":"10.3899/jrheum.2023-1121","DOIUrl":"10.3899/jrheum.2023-1121","url":null,"abstract":"<p><p>Serum factors binding to cell nuclei were first described in the 1940s, and the antibodies responsible for the binding to self (autoantibodies) were discovered in the late 1950s. Routine standardized testing using a cell line (HEp-2) started in the 1980s and continues to evolve. In addition to the classic immunofluorescence assay (IFA), various immunochemical techniques have been developed for the measurement of antinuclear antibodies (ANAs). The complexity of ANA IFA pattern reading and the varying sensitivities, specificities, and overall clinical performance of the alternative methods have often generated controversies and sometimes even confusion among healthcare providers and laboratorians. A better understanding of the historical roots of ANA testing can aid in understanding these controversies and assist with selecting the best-performing methods. In this review, we present historic and contemporary ANA testing methods, highlighting the pros and cons of each. We also provide an overview of the current practice of ANA testing based on several recent large laboratory surveys. For optimal patient care, it is critical that clinicians and laboratorians using ANA testing understand the performance and limitations of the methods used by their institutions, as well as the meaning of the test results. Recently published surveys and standardization efforts initiated by several stakeholder scientific organizations will likely lead to new ANA diagnostic guidelines, to be followed by an improvement in testing practices, management, and outcomes for patients with autoimmune disorders.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076096","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":"Zebra Bodies in Kidney Biopsy: Drug-Induced Phospholipidosis in a Patient With Systemic Lupus Erythematosus.","authors":"Tania Aguila, Riya Madan, Matthew B Palmer, Chris T Derk","doi":"10.3899/jrheum.2024-1312","DOIUrl":"https://doi.org/10.3899/jrheum.2024-1312","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558552","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":"Tight Control and Radiological Progression: The Radiographic Outcomes of the TICOPA Study.","authors":"Lija James, Philip S Helliwell, Elizabeth M A Hensor, Philip G Conaghan, Paul Emery, Laura C Coates","doi":"10.3899/jrheum.2024-1035","DOIUrl":"10.3899/jrheum.2024-1035","url":null,"abstract":"<p><strong>Objective: </strong>The Tight Control of Psoriatic Arthritis (TICOPA) study was the first to undertake the treat-to-target approach in psoriatic arthritis (PsA). Our aim was to further investigate the radiographic changes in the TICOPA study.</p><p><strong>Methods: </strong>The TICOPA trial recruited patients with early treatment-naïve PsA. Plain radiographs of the hands and feet were taken at weeks 0 and 48. Clinical outcomes were recorded by a blinded assessor every 12 weeks. In post hoc analysis, bootstrapped quantile regression, adjusting for baseline values and minimization factors, was used to compare radiographic scores (modified Sharp/van der Heijde [mSvdH]), defined according to treatment arm or disease activity states.</p><p><strong>Results: </strong>Paired baseline and week 48 radiographs were available for 169/206 (82%) at week 48 (84 tight control [TC] arm, 85 standard care [StdC] arm). There was no difference in change in total mSvdH score seen with TC compared to StdC (median [IQR] 0.0 [-2.0 to 0.5] vs 0.0 [-2.0 to 0.0]; difference 0.0 [95% CI 0.0-0.0]). Median total mSvdH score change was lower in those achieving minimal disease activity, Disease Activity in Psoriatic Arthritis remission, and very low disease activity. The number of people with radiographic progression (an increase in total erosion score of ≥ 2 at week 48) was numerically lower in the TC group (5/84 [5.9%] vs 12/85 [14.1%]). Patients with radiographical progression presented with polyarticular disease and high C-reactive protein, and had poorer clinical outcomes at weeks 12 and 24.</p><p><strong>Conclusion: </strong>These data confirm the benefit of achieving low disease activity states on subsequent radiographic outcomes but did not show a significant impact related to a TC management approach.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076093","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}