{"title":"The turning point: April 2025 marks historic shift in US animal testing policy.","authors":"Thomas Hartung","doi":"10.14573/altex.2504301","DOIUrl":"10.14573/altex.2504301","url":null,"abstract":"","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":" ","pages":"536-537"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997792","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}
Thomas Steger-Hartmann, Guillemette Duchateau-Nguyen, Frank Bringezu, Manuela Onidi, Martina Stirn
{"title":"Virtual control groups in non-clinical toxicology - A replicability challenge.","authors":"Thomas Steger-Hartmann, Guillemette Duchateau-Nguyen, Frank Bringezu, Manuela Onidi, Martina Stirn","doi":"10.14573/altex.2503061","DOIUrl":"10.14573/altex.2503061","url":null,"abstract":"","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":" ","pages":"538-542"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A path forward advancing microphysiological systems.","authors":"Thomas Hartung, Lena Smirnova","doi":"10.14573/altex.2504091","DOIUrl":"10.14573/altex.2504091","url":null,"abstract":"<p><p>Microphysiological systems (MPS), including organ-on-chip platforms and complex organoid models, represent a transformative approach to human-relevant in vitro modeling. These technol-ogies bioengineer aspects of organ architecture and functionality, revolutionizing drug development, reducing animal testing, and enabling personalized medicine approaches. Despite significant advances, several critical challenges remain before their full potential can be realized. This article examines key obstacles facing MPS adoption and implementation while proposing actionable solu-tions to accelerate their development and acceptance. Major challenges include standardization issues across terminology and protocols, validation complexities requiring robust reference com-pounds and benchmarking standards, regulatory uncertainties regarding data requirements and qualification processes, and barriers to effective data sharing among stakeholders. The paper traces the field's evolution through various international initiatives, particularly highlighting the Center for Alternatives to Animal Testing's (CAAT) contributions, including the establishment of the International MPS Society and World Summits. Proposed solutions emphasize establishing global standards through international consortia, enhancing validation frameworks through specialized validation centers, fostering collaboration through pre-competitive consortia and standardized data formats, and advancing regulatory integration through detailed case studies and clear guidance documents. Future priorities focus on overcoming technical challenges in biological complexity, addressing engineering hurdles, standardizing technologies, improving data management, increasing eco-nomic accessibility, and integrating with other emerging technologies. The path forward requires coordinated, collaborative efforts across academia, industry, regulatory agencies, and technology suppliers to systematically address these interrelated challenges.</p>","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":"42 2","pages":"183-203"},"PeriodicalIF":5.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052628","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}
Bernard Staumont, Luiz Ladeira, Alessio Gamba, Harm J Heusinkveld, Aldert Piersma, Ellen Fritsche, Rosalinde Masereeuw, Tamara Vanhaecke, Marc Teunis, Thomas H Luechtefeld, Thomas Hartung, Ramiro Jover, Mathieu Vinken, Liesbet Geris
{"title":"Mapping physiology: A systems biology approach for the development of alternative methods in toxicology.","authors":"Bernard Staumont, Luiz Ladeira, Alessio Gamba, Harm J Heusinkveld, Aldert Piersma, Ellen Fritsche, Rosalinde Masereeuw, Tamara Vanhaecke, Marc Teunis, Thomas H Luechtefeld, Thomas Hartung, Ramiro Jover, Mathieu Vinken, Liesbet Geris","doi":"10.14573/altex.2412241","DOIUrl":"10.14573/altex.2412241","url":null,"abstract":"<p><p>Chemical safety assessment still heavily relies on animal testing, which is associated with ethical dilemmas and has limited human predictive value. New approach methodologies (NAMs), including in vitro and in silico techniques, offer alternative solutions. In silico toxicology has made progress in predicting chemical effects but frequently lacks biological mechanistic foundations. Recent developments focus on the mechanistic understanding of adverse effects caused by chemicals, as embedded in (quantitative) adverse outcome pathways (AOPs). However, there is a demand for more detailed mechanistic insights at the gene and cell levels, encompassing both pathology and physiology. Drawing inspiration from the Disease Maps Project, this paper introduces physiological maps (PMs) as comprehensive graphical representations of biochemical processes related to specific organ functions. PMs are standardized using Systems Biology Graphical Notation (SBGN) and controlled vocabularies and annotations. Curation guidelines have been developed to ensure reproducibility and usability. We present the methodology used to build PMs, emphasizing the essential collaboration between domain experts and curators. PMs offer user-friendly, standardized visualization for data analysis and educational purposes. Enabling a better understanding of (patho)physiology, they also complement and support the development of AOPs by providing detailed mechanistic information at the gene and cell level. Furthermore, PMs contribute to developing in vitro test batteries and to building (dynamic) in silico models aiming to predict the toxicity of chemicals. Collaborative efforts between the toxicology and systems biology communities are crucial for creating standardized and comprehensive PMs, supporting and accelerating the development of human-relevant NAMs for next-generation risk assessment.</p>","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":" ","pages":"301-307"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371373","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":"Animal pilot studies should not be used to estimate sample size if effect size and population variance are unknown.","authors":"Alexander D Bird, Peter Jedlicka, Jochen Wilhelm","doi":"10.14573/altex.2408141","DOIUrl":"10.14573/altex.2408141","url":null,"abstract":"<p><p>Reducing the number of animals required for a given experiment is part of the 3Rs strategies for animal welfare. Sample size estimation is a critical step in efficient and ethical experimental design. It is generally believed that pilot studies can be used to estimate sample sizes, which could lead to an overall reduction in the number of animals used. As part of the standard approach to ensuring that a planned animal experiment has sufficient statistical power, estimates of effect size and population variance are required. Here we derive the distribution of the sample size estimator when both effect size and variance are unknown. We show that, in this case, it is not feasible to conduct a preliminary pilot study to estimate the required sample size. Our analysis indicates that the sample size of a useful pilot study will often be much larger than that of the main study itself when the effect size is unknown. Therefore, we conclude that performing pilot studies with the aim of estimating sample size will not help to minimize the overall number of animal experiments in basic or pre-clinical research. A practical example is given, and alternative approaches are proposed and discussed.</p>","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":" ","pages":"531-535"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026011","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}
Hans A Raabe, Anna J van der Zalm, Amy J Clippinger, Gertrude-Emilia Costin
{"title":"Organizing shipping studies to evaluate the transferability of cell- and tissue-based test systems and reagents: An end user perspective.","authors":"Hans A Raabe, Anna J van der Zalm, Amy J Clippinger, Gertrude-Emilia Costin","doi":"10.14573/altex.2503131","DOIUrl":"10.14573/altex.2503131","url":null,"abstract":"<p><p>Cell- and tissue-based test systems and reagents (e.g., cells, tissues, organs, reconstructed tissue models, or cell/tissue culture reagents) are increasingly being used in regulatory and non-regulatory testing applications due to their ability to reflect human biology. These test systems and reagents may be shipped long distances, including across international borders, from the vendor to the testing laboratory. To ensure confidence in the data obtained from testing involving these systems and reagents, it is important for the testing laboratory to confirm that quality is maintained during the shipping process and that the materials can be used for their intended application (i.e., that the test method associated with the test system and/or reagent can be effectively transferred between laboratories). This paper describes various types of shipping studies that might be conducted when transferring a method to a new laboratory and key considerations for their design that can help maintain the quality of the test systems and reagents during the shipment process. Furthermore, emphasis is placed on the need for good communication between vendors, shipping agents, and end users to ensure efficient transferability of test methods.</p>","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":" ","pages":"556-560"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042762","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}
Jonathan Blum, Markus Brüll, Jan G Hengstler, Daniel R Dietrich, Andreas J Gruber, Michele Dipalo, Udo Kraushaar, Iris Mangas, Andrea Terron, Ellen Fritsche, Philip Marx-Stoelting, Barry Hardy, Andreas Schepky, Sylvia Escher, Thomas Hartung, Robert Landsiedel, Alex Odermatt, Magdalini Sachana, Katharina Koch, Arif Dönmez, Stefan Masjosthusmann, Kathrin Bothe, Stefan Schildknecht, Mario Beilmann, Joost B Beltman, Suzanne Fitzpatrick, Aswin Mangerich, Markus Rehm, Silvia Tangianu, Franziska M Zickgraf, Hennicke Kamp, Gerhard Burger, Bob van de Water, Nicole Kleinstreuer, Andrew White, Marcel Leist
{"title":"The long way from raw data to NAM-based information: Overview on data layers and processing steps.","authors":"Jonathan Blum, Markus Brüll, Jan G Hengstler, Daniel R Dietrich, Andreas J Gruber, Michele Dipalo, Udo Kraushaar, Iris Mangas, Andrea Terron, Ellen Fritsche, Philip Marx-Stoelting, Barry Hardy, Andreas Schepky, Sylvia Escher, Thomas Hartung, Robert Landsiedel, Alex Odermatt, Magdalini Sachana, Katharina Koch, Arif Dönmez, Stefan Masjosthusmann, Kathrin Bothe, Stefan Schildknecht, Mario Beilmann, Joost B Beltman, Suzanne Fitzpatrick, Aswin Mangerich, Markus Rehm, Silvia Tangianu, Franziska M Zickgraf, Hennicke Kamp, Gerhard Burger, Bob van de Water, Nicole Kleinstreuer, Andrew White, Marcel Leist","doi":"10.14573/altex.2412171","DOIUrl":"10.14573/altex.2412171","url":null,"abstract":"<p><p>Toxicological test methods generate raw data and provide instructions on how to use these to determine a final outcome such as a classification of test compounds as hits or non-hits. The data processing pipeline provided in the test method description is often highly complex. Usually, multiple layers of data, ranging from a machine-generated output to the final hit definition, are considered. Transition between each of these layers often requires several data processing steps. As changes in any of these processing steps can impact the final output of new approach methods (NAMs), the processing pipeline is an essential part of a NAM description and should be included in reporting templates such as the ToxTemp. The same raw data, processed in different ways, may result in different final outcomes that may affect the readiness status and regulatory acceptance of the NAM, as an altered output can affect robustness, performance, and relevance. Data management, processing, and interpretation are therefore important elements of a comprehensive NAM definition. We aim to give an overview of the most important data levels to be considered during the development and application of a NAM. In addition, we illustrate data processing and evaluation steps between these data levels. As NAMs are increasingly standard components of the spectrum of toxicological test methods used for risk assessment, awareness of the significance of data processing steps in NAMs is crucial for building trust, ensuring acceptance, and fostering the reproducibility of NAM outcomes.</p>","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":"42 1","pages":"167-180"},"PeriodicalIF":5.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015790","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}
Patrick J Devine, Manti Guha, Jason E Ekert, Anna K Kopec, James R Gosset, May S Freag, Matthew P Wagoner, Philip Hewitt, Kate Harris, Myriam Lemmens, Nakissa Sadrieh, Donna Mendrick, David M Stresser, Leslie Valencia, Paul C Brown, Ronald L Wange, Amy Avila, Kevin Ford, Robert Geiger, Martha Garcia, Jessica A Bonzo, John P Gleeson, Christine C Orozco, Qun Li, Chris Hinckley, Reiner Class, Josephine M McAuliffe, Amy Tran-Guzman, Francesco Nevelli, Gonçalo Gamboa da Costa, Dayton Petibone, Tomomi Kiyota, Qiang Shi, Rhiannon N Hardwick
{"title":"Considerations from the pharmaceutical industry (IQ MPS Affiliate) workshop on animal microphysiological systems and 3Rs in drug development.","authors":"Patrick J Devine, Manti Guha, Jason E Ekert, Anna K Kopec, James R Gosset, May S Freag, Matthew P Wagoner, Philip Hewitt, Kate Harris, Myriam Lemmens, Nakissa Sadrieh, Donna Mendrick, David M Stresser, Leslie Valencia, Paul C Brown, Ronald L Wange, Amy Avila, Kevin Ford, Robert Geiger, Martha Garcia, Jessica A Bonzo, John P Gleeson, Christine C Orozco, Qun Li, Chris Hinckley, Reiner Class, Josephine M McAuliffe, Amy Tran-Guzman, Francesco Nevelli, Gonçalo Gamboa da Costa, Dayton Petibone, Tomomi Kiyota, Qiang Shi, Rhiannon N Hardwick","doi":"10.14573/altex.2503261","DOIUrl":"10.14573/altex.2503261","url":null,"abstract":"<p><p>Most complex in vitro models (CIVM) and microphysiological systems (MPS) are composed of human cells, with the goal of evaluating diseases, efficacy, safety, and pharmacokinetic questions specifically for humans. The hope with CIVM/MPS is that they will eventually improve our predictivity of clinical responses and reduce or replace animal use in research, supporting the 3Rs concept of only using animals in research when necessary. Given the potential of animal-based models to advance this field by comparing existing in vivo animal data with new animal-based MPS responses, there are currently few CIVM and MPS utilizing animal tissues. Animal-based MPS may also have specific utility for cross-species comparisons or species-specific mechanistic questions on zoonotic diseases, and therapies for animals. Animal-based MPS may help expand in-vitro-to-in-vivo correlations, advance the field, and establish confidence in the predictive nature of such platforms. The IQ MPS-FDA workshop provided an interactive venue for pharmaceutical companies and regulatory agencies such as the U.S. Food and Drug Administration (FDA), NC3Rs (UK), Health Canada, NIH/NCATS, NIHS and PMDA (Japan), Danish Medicines Agency, European Commission, NIEHS/NICEATM, HHS, NIST, EURL ECVAM, and the IQ MPS Affiliate, a collaboration of pharmaceutical companies, to jointly discuss considerations of animal-based MPS and applications where animal-based MPS are of potential value.</p>","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":" ","pages":"451-467"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038505","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":"Comparative evaluation of rat and human in vitro assays for evaluation of thyroid toxicity.","authors":"Laure Asselin, Audrey Baze, Betty Ory, Lucille Wiss, Amélie Schäfer, Liliia Horbal, Larry Higgins, Lysiane Richert","doi":"10.14573/altex.2405072","DOIUrl":"10.14573/altex.2405072","url":null,"abstract":"<p><p>The effects of ten test chemicals on thyroid sodium-iodide symporter (NIS), thyroid peroxidase (TPO), and deiodinases (DIOs) type I, II, and III were evaluated and compared in in vitro rat and human systems. Test chemicals known to directly affect TH levels in vivo were confirmed to effectively inhibit at least one of the tested in vitro endpoints, without significant disparities between species, and the test compounds known to not affect thyroid function were found ineffective. Interestingly, iodide transport blocker 5, a potent non-competitive iodine uptake inhibitor, exhibited effects beyond direct NIS inhibition, impacting NIS function through ATP depletion, and also inhibited TPO and DIO1/ 2 enzymes, although to a lesser extent. Finally, of the four hepatic inducers known to affect thyroid function indirectly in rats through increased TH metabolism in the liver, dexamethasone, phenobarbital, and pregnenolone 16α-carbonitrile were found ineffective in the herein described inhibition tests, while rifampicin decreased rat and human TPO activities, suggesting a direct effect on thyroid function. This study demonstrates the usefulness of comparative data generated by rat and human in vitro NIS, TPO and DIOs test systems to support risk-based decisions.</p>","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":" ","pages":"278-300"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774605","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}
Laurence Walder, Giorgia Pallocca, Luísa F Bastos, Manon Beekhuijzen, Francois Busquet, Helder Constantino, Marco Corvaro, Lilas Courtot, Beate Escher, Rebeca Fernandez, Emeline Gougeon, Love Hansell, Matthias Herzler, Laura Holden, Romana Hornek-Gausterer, Amaia Irizar, Helena Kandarova, Petra Kern, Susanne Kolle, Katia Lacasse, Isabelle Lee, Donna S Macmillan, Gavin Maxwell, Orla Moriarty, Stephanie Nadzialek, Julia Pochat, Kirsty Reid, Marion Revel, Merel Ritskes-Hoitinga, Tomasz Sobanski, Gilly Stoddart, Dylan Underhill, Mandy Veillette, Jelle Vriend, Carl Westmoreland, Julia Baines
{"title":"EU roadmap for phasing out animal testing for chemical safety assessments: Recommendations from a multi-stakeholder roundtable.","authors":"Laurence Walder, Giorgia Pallocca, Luísa F Bastos, Manon Beekhuijzen, Francois Busquet, Helder Constantino, Marco Corvaro, Lilas Courtot, Beate Escher, Rebeca Fernandez, Emeline Gougeon, Love Hansell, Matthias Herzler, Laura Holden, Romana Hornek-Gausterer, Amaia Irizar, Helena Kandarova, Petra Kern, Susanne Kolle, Katia Lacasse, Isabelle Lee, Donna S Macmillan, Gavin Maxwell, Orla Moriarty, Stephanie Nadzialek, Julia Pochat, Kirsty Reid, Marion Revel, Merel Ritskes-Hoitinga, Tomasz Sobanski, Gilly Stoddart, Dylan Underhill, Mandy Veillette, Jelle Vriend, Carl Westmoreland, Julia Baines","doi":"10.14573/altex.2503241","DOIUrl":"10.14573/altex.2503241","url":null,"abstract":"<p><p>The commitment to develop a roadmap for phasing out the use of animals for chemical safety assessments was part of the European Commission’s response to the European Citizens’ Initiative “Save Cruelty-Free Cosmetics – Commit to a Europe Without Animal Testing”. The roadmap aims to outline milestones and specific actions to be implemented in the short to long term to ultimately phase out animal testing for chemical safety assessments. To advance this goal and help define a structure of the roadmap, a multi-stakeholder roundtable workshop was organized by five animal protection non-governmental organizations in June 2024. The roundtable aimed to explore and define key elements and organizational structures for shaping the roadmap and identify pathways to facilitate the transition to a non-animal testing regulatory framework. Participants discussed a range of critical issues such as revising legislation and guidance, facilitating validation/qualification and regulatory acceptance, strengthening coordination, providing education and training in non-animal approaches, transparency and accessibility to data, establishing metrics to measure progress, and securing funding. The importance of a multi-faceted approach integrating scientific, regulatory, policy, ethical, societal, and practical dimensions was emphasized, along with the critical role of transdisciplinary collaboration and combining diverse knowledge, ideas, and technologies to achieve optimal outcomes. This report summarizes the main findings and discussion points and provides concrete recommendations. These are intended to facilitate the Commission’s work to develop the roadmap and may serve as a valuable resource for similar initiatives worldwide.</p>","PeriodicalId":51231,"journal":{"name":"Altex-Alternatives To Animal Experimentation","volume":" ","pages":"435-450"},"PeriodicalIF":5.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997791","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}