Acta Clinica Belgica最新文献

{"title":"Impact of the COVID-19 pandemic on <i>Clostridioides difficile</i> infection in a tertiary healthcare institution in Belgium.","authors":"Bastien Tossens,&nbsp;Philippe Barthelme,&nbsp;Caroline Briquet,&nbsp;Leila Belkhir,&nbsp;Eléonore Ngyuvula,&nbsp;Kate Soumillion,&nbsp;Alexia Verroken,&nbsp;Hector Rodriguez-Villalobos,&nbsp;Michel Delmée,&nbsp;Ahalieyah Anantharajah","doi":"10.1080/17843286.2023.2250624","DOIUrl":"10.1080/17843286.2023.2250624","url":null,"abstract":"<p><strong>Objectives: </strong>Clostridioides difficile infection (CDI) causes the greatest number of healthcare-associated infectious diarrhoea. CDIs are transmitted by direct and indirect patient-to-patient contact and risk increases with the use of antibiotics. Since early 2020, the COVID-19 pandemic has affected healthcare systems in many ways including substantial changes in hygiene behaviour. The aim of this study was to assess whether CDI incidence differed during the COVID-19 pandemic compared to a year before.</p><p><strong>Methods: </strong>All tests for suspected CDI cases were recorded for a hospital in Brussels, Belgium. The percentage of CDI-positive results and incidences (total and healthcare-associated (HA)-CDI)) for years 2019, 2020, 2021, and 2022 were calculated. Antibiotic consumption was analysed for years 2019 and 2020.</p><p><strong>Results: </strong>Since the COVID-19 pandemic struck, a significant reduction of up to 39% was observed in the number of <i>Clostridioides difficile</i> stool tests in our hospital. A significant decrease in the percentage of positive tests and a 50% decrease in the incidence of CDI (total and HA-CDI) was found for 2020 compared with 2019 and confirmed for years 2021 and 2022. The decrease in CDI incidence was mostly marked in haematology, nephrology, and gastroenterology units. No significant change in the use of antibiotics was found.</p><p><strong>Conclusion: </strong>The global decrease in CDI incidence observed in our hospital was not associated with a change in the use of antibiotics. The control measures implemented to prevent COVID-19 transmission may explain a reduction in CDI incidence. An underdiagnosis of CDI cannot be excluded.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10051381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visceral leishmaniasis and potential role of vitamin D.","authors":"Vitorino Modesto Dos Santos,&nbsp;Taciana Arruda Modesto Sugai","doi":"10.1080/17843286.2023.2233235","DOIUrl":"10.1080/17843286.2023.2233235","url":null,"abstract":"We read with special interest the recent article published in this Journal by Zaghi I et al. describing their case study of visceral leishmaniasis confirmed by liver biopsy [1]. The 59-year-old female had the initial hypothesis of hepatic and splenic metastases, based on her symptoms besides the nodular images revealed by the abdominal ultrasonography. Worthy of note was the hypercalcemia due to an excess of vitamin D, which was properly managed and led to successful control of her longstanding asthenia and loss of appetite. After the correct diagnosis was established by histopathologic studies, she underwent the specific anti-parasitic treatment resulting in complete regression of the nodular lesions. The authors emphasized that this was the first case report of several unsuspected foci of visceral leishmaniasis related to the antiinflammatory effect of hypervitaminosis D [1]. In this setting, with base on the literature data, the important role of proteases and micronutrient levels on the evolution of clinical manifestations, treatment responses, and outcomes of patients with Leishmania infections have merited a crescent interest [1–6]. Feleke BE et al. checked serum levels of micronutrients, just before and in the four initial weeks of treatment of leishmaniasis, to compare the patient profile with success rate [2]. The study included dosages of iodine, iron, selenium, zinc, and the vitamins A and D. They found lower levels of vitamin D in those patients with visceral leishmaniasis, a condition that persisted in spite of the adequate specific anti-leishmaniasis management. Gogulamudi VR et al. studied the effects of vitamins A and D3 to treat mice experimentally infected by L. donovani, and there was control of the parasite growth and infectivity [3]. The authors concluded that the utilization of the vitamins can reduce the parasitism and modulate the pro-inflammatory immune response to the anti-inflammatory activation, and the immune stimulation can have usefulness to control the visceral leishmaniasis [3]. Kumar VU et al. stressed the role of serum levels of the vitamins A, B, C, D, besides calcium, iron, and zinc on the responses to treatment and outcomes of leishmaniasis [4]. Defense mechanisms related to vitamin D can include the induction of antimicrobial peptides such as cathelicidin and the binding and killing of promastigotes in macrophages. The macrophage capacity of killing promastigotes (IFNactivated) may be reduced by vitamin D3, being associated with the cellular reduction of nitrous oxide production [4]. The authors concluded that the potential role of the cited micronutrients should be better evaluated for the public health management of leishmaniasis in the endemic regions [4]. Ribeiro-Dias F et al. reviewed the literature about the IL-32 in Leishmania infections, besides the role of vitamin D-dependent microbicidal pathway for parasite control [5]. They focused on the production of vitamin D-dependent peptides by human monocy","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9754647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators for physical activity on acute geriatric and rehabilitation wards: a survey study.","authors":"Ine Mols,&nbsp;Margreet van Dijk,&nbsp;Maaike L De Roo,&nbsp;Jos Tournoy,&nbsp;Bastiaan Van Grootven","doi":"10.1080/17843286.2023.2239546","DOIUrl":"10.1080/17843286.2023.2239546","url":null,"abstract":"<p><strong>Objectives: </strong>During hospitalisation, physical inactivity is common among older patients and is associated with adverse outcomes, e.g. functional decline. This study identified barriers and facilitators of physical activity with geriatric patients during hospital admission.</p><p><strong>Methods: </strong>This is a cross-sectional descriptive study, on two acute geriatric units and one rehabilitation unit, using a researcher-administered survey methodology in patients 70 years or older. A new questionnaire was developed based on a literature review, and was administered bedside and face-to-face with the older patients.</p><p><strong>Results: </strong>72 patients, mean age 83.6 years, completed the questionnaire. 88.9% of the participants found physical activity important during hospitalisation. The main patient-related determinants were fear of falling and symptoms of current illness (e.g. pain). The main environmental-related determinants were the presence of medical devices, and the availability of walking aids. Half of the patients felt motivated by the hospital staff, and one out of six participants felt discouraged. Receiving more assistance for walking and having access to other types of physical activity was expected to increase physical activity. Additionally, motivation from family would be a facilitator for 44.4% of the participants.</p><p><strong>Conclusion: </strong>Promoting physical activity on acute geriatric units will require interventions at different levels. Most importantly, focusing on interpersonal motivators and positive reinforcement by hospital staff could be beneficial strategies to increase the physical activity of older hospitalised patients.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10255612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skeletal response to teriparatide in real-life setting: effects of age, baseline bone density and prior denosumab use.","authors":"Valerie Konings,&nbsp;Michaël R Laurent,&nbsp;Sigrid Janssens,&nbsp;Jolan Dupont,&nbsp;Evelien Gielen,&nbsp;Marian Dejaeger","doi":"10.1080/17843286.2023.2238375","DOIUrl":"10.1080/17843286.2023.2238375","url":null,"abstract":"<p><strong>Objectives: </strong>Teriparatide (TPD) is an osteoanabolic agent used in patients with high osteoporotic fracture risk. Predictors of therapeutic response to TPD in real-life setting are not well characterised. This study investigated the influence of previous antiresorptive therapy, age and other patient characteristics on the skeletal response to TPD.</p><p><strong>Methods: </strong>Retrospective study at the metabolic bone clinic, University Hospitals Leuven, Belgium. Patients with osteoporosis and a high fracture burden received TPD for 9-18 months. Bone mineral density (BMD) was measured at baseline, 9 and 18 months at lumbar spine (LS), femoral neck (FN) and total hip (TH).</p><p><strong>Results: </strong>BMD at LS increased at 9 months (change mean (standard error) 6.8 % (0.7) <i>p</i> < 0.001) and at 18 months (8.0 % (0.9) <i>p</i> < 0.001), while BMD at FN and TH did not change significantly. Non-response in BMD change at the LS was seen with prior denosumab use (odds ratio 0.21, 95% confidence interval (CI) 0.049-0.912, <i>p</i> = 0.037). Changes in BMD at TH were significantly greater in younger patients and in patients with a lower baseline BMD.</p><p><strong>Conclusion: </strong>TPD-induced changes in BMD at TH might depend on age and baseline BMD and at LS on prior denosumab use. The results suggest that these factors may be relevant for clinical decision making when initiating TPD treatment, although larger studies are needed to confirm these findings.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 2023 Belgian clinical guidance on anticoagulation management in hospitalized and ambulatory COVID-19 patients.","authors":"Thomas Vanassche,&nbsp;Matthias M Engelen,&nbsp;Christelle Orlando,&nbsp;Kristel Vandenbosch,&nbsp;Alain Gadisseur,&nbsp;Cedric Hermans,&nbsp;Kristin Jochmans,&nbsp;Jean-Marc Minon,&nbsp;Serge Motte,&nbsp;Harlinde Peperstraete,&nbsp;Pierre Péters,&nbsp;Muriel Sprynger,&nbsp;Patrizio Lancellotti,&nbsp;Isabelle Dehaene,&nbsp;Patrick Emonts,&nbsp;Christophe Vandenbriele,&nbsp;Peter Verhamme,&nbsp;Cecile Oury","doi":"10.1080/17843286.2023.2241692","DOIUrl":"10.1080/17843286.2023.2241692","url":null,"abstract":"<p><p>COVID-19 is associated with an increased risk for thrombotic complications. The trials investigating the optimal thromboprophylactic dose are performed in challenging times and seemingly produce conflicting evidence. The burdensome circumstances, divergent endpoints, and different analytical approaches hamper comparison and extrapolation of available evidence. Most importantly, clinicians should provide thromboprophylaxis in hospitalized COVID-19 patients while (re)assessing bleeding and thrombotic risk frequently. The COVID-19 Thromboprophylaxis Working Group of the BSTH updated its guidance document. It aims to summarize the available evidence critically and to guide clinicians in providing the best possible thromboprophylaxis.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10303555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical practice of hereditary angioedema in Belgium: opportunities for optimized care.","authors":"D G Ebo,&nbsp;M M Van der Poorten,&nbsp;A L Van Gasse,&nbsp;R Schrijvers,&nbsp;C Hermans,&nbsp;M Bartiaux,&nbsp;F Haerynck,&nbsp;J Willekens,&nbsp;H Lapeere,&nbsp;M Moutschen,&nbsp;O Michel,&nbsp;V Sabato","doi":"10.1080/17843286.2023.2213491","DOIUrl":"10.1080/17843286.2023.2213491","url":null,"abstract":"<p><strong>Introduction: </strong>Hereditary angioedema (HAE) is a rare disorder characterized by unpredictable painful and potentially life-threatening swelling episodes. The international WAO/EAACI guideline on the diagnosis and management of HAE was recently updated and provides up-to-date guidance for the management of. In this paper, we assessed to what extent the Belgian clinical practice was aligned with the revised guideline, and whether there were opportunities to optimise Belgian clinical practice in HAE.</p><p><strong>Methods: </strong>We compared the updated international guideline for HAE with information we acquired on Belgian clinical practice, a Belgian patient registry and expert opinion analysis. The Belgian patient registry was developed with the involvement of eight Belgian reference centers for HAE patients. Eight Belgian experts, physicians in the participating centers, included patients in the patient registry and participated in the expert opinion analysis.</p><p><strong>Results: </strong>The main action points to further optimise the Belgian clinical practice of HAE are Work towards total disease control and normalize patients' life by considering the use of new and innovative long-term prophylactic treatment options; (2) inform C1-INH-HAE patients about new long-term prophylactic therapies; (3) assure the availability of on-demand therapy for all C1-INH-HAE patients; (4) implement a more universally used assessment including multiple aspects of the disease (e.g. quality of life assessment) in daily clinical practice; and (5) continue and expand an existing patient registry to assure continued data availability on C1-INH-HAE in Belgium.</p><p><strong>Conclusions: </strong>In light of the updated WAO/EAACI guideline, five action points were identified and several other suggestions were made to optimise the Belgian clinical practice in C1-INH-HAE.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9520346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The concomitant use of paracetamol and flucloxacillin. A rare cause of high anion gap metabolic acidosis in the frail oldest old.","authors":"Sarah Billet,&nbsp;Philippe Vanbiervliet,&nbsp;Mark Remery,&nbsp;Julien Dekoninck,&nbsp;Wim Janssens","doi":"10.1080/17843286.2023.2246226","DOIUrl":"10.1080/17843286.2023.2246226","url":null,"abstract":"ABSTRACT Objectives This article describes the occurrence of a high anion gap metabolic acidosis (HAGMA) in two older, female patients with a methicillin sensitive staphylococcus aureus (MSSA) infection. Both patients received flucloxacillin and paracetamol. Both of them initially improved but declined rapidly after two to three weeks of treatment. They developed a severe HAGMA resulting in their death. The objective of this article is to determine whether old age is a major risk factor for developing HAGMA when combining paracetamol with flucloxacillin. Methods A literature study was conducted using the MEDLINE database, PubMed. The used MeSH terms were ‘flucloxacillin, acetaminophen, glutathione synthetase deficiency and acidosis’. Furthermore, we used two cases to illustrate our findings. Results The origin of the high anion gap metabolic acidosis is the accumulation of 5-oxoproline which is known to occur when combining flucloxacillin with paracetamol due to their interaction with different enzymes of the gamma glutamyl cycle. This leads to the depletion of glutathione and the formation of 5-oxoproline. This phenomenon has a higher risk of occurring in frail older adults as most of them have several predisposing risk factors which result in lower baseline glutathione reserve. These risk factors include old age, malnutrition, assigned female at birth, pre-existing kidney and/or liver dysfunction, uncontrolled diabetes and sepsis. Conclusion The purpose of this article is to raise awareness of this phenomenon and its higher occurrence in frail older adults, which hopefully will lead to an earlier diagnosis with a better outcome for the patient.","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10362155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inverse association between caffeine intake and albuminuria in US adults: an analysis of NHANES 2005-2016.","authors":"Qiqi Ma,&nbsp;Shuaihua Song,&nbsp;Gaosi Xu","doi":"10.1080/17843286.2023.2222243","DOIUrl":"10.1080/17843286.2023.2222243","url":null,"abstract":"<p><strong>Objectives: </strong>Albuminuria is a significant biomarker of various kidney diseases and is associated with renal outcome. Recently, caffeine intake has shown potential renoprotective effects. However, the relationship between caffeine intake and albuminuria remains profoundly elusive.</p><p><strong>Methods: </strong>We conducted a cross-sectional study aimed to explore the association between caffeine intake and albuminuria in the American adult population using the data acquired from the National Health and Nutrition Examination Survey (NHANES) 2005-2016. Caffeine intake was assessed by 24-h dietary recalls, and albuminuria was assessed by albumin-to-creatinine ratio. Multivariate logistic regression was performed to explore the independent association between caffeine intake and albuminuria. Subgroup analysis and interaction tests were also conducted.</p><p><strong>Results: </strong>Among 23,060 participants, 11.8% of the individuals exhibited albuminuria, and the prevalence of albuminuria decreased with higher caffeine intake tertiles (Tertile 1: 13%; Tertile 2: 11.9%; Tertile 3: 10.5%; <i>P</i> < 0.001). After adjusted potential confounders, the results of logistic regression indicated that a higher caffeine intake was associated with a decreased risk of albuminuria (OR = 0.903; 95% CI: 0.84, 0.97; <i>P</i> = 0.007), especially in females and the participants aged <60 years and chronic kidney disease stage II.</p><p><strong>Conclusion: </strong>The present study first indicated an inverse correlation between caffeine intake and albuminuria, which further confirmed the potentially protective effects of caffeine on the kidney.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9571181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CPAP adherence after ambulatory and in-hospital management in patients aged 65 years and older.","authors":"Charlène Collard,&nbsp;Maxime Regnier,&nbsp;Gisèle Maury","doi":"10.1080/17843286.2023.2260137","DOIUrl":"10.1080/17843286.2023.2260137","url":null,"abstract":"<p><strong>Objectives: </strong>The aims of this study are to evaluate the early adherence to CPAP treatment in patients aged 65 years and older and to compare ambulatory (ACPAP) and in-hospital (HCPAP) management in starting CPAP treatment.</p><p><strong>Methods: </strong>Adherence to CPAP therapy at 3 months was retrospectively studied in patients on whom CPAP therapy was initiated between 1 January 2020 and 31 December 2021. Patients in the ACPAP group were selected based on the current Belgian reimbursement criteria (OAHI ≥30/h and few comorbidities).</p><p><strong>Results: </strong>146 patients were studied (median OAHI 43.35/h [32.02; 57.40]; median age 69 [67.0; 73.0]): 116 (79.5%) patients in the HCPAP and 30 (20.5%) in the ACPAP group. Based on an adherence threshold of average CPAP use of ≥ 4 hours per day, 120 (82%) patients were adherent to the treatment; 94 (81%) patients in the HCPAP and 26 (86.7%) in the ACPAP group. The median CPAP use for the total population was 6.4 h/day [4.89; 7.34], reaching 6.3 h/d [4.79; 7.15] for the HCPAP group and 6.8 h/d [6.21; 8.06] for the ACPAP group (<i>p</i> = 0.019). Insomnia was a significant risk factor for non-adherence (OR 5.16 [1.64; 16.08], <i>p</i> = 0.0043) but the ACPAP method was not (OR 0.66 [0.18; 1.91], <i>p</i> = 0.4748).</p><p><strong>Conclusion: </strong>Early CPAP adherence in patients ≥ 65 years old was good in terms of average use per day and proportion of adherent patients. ACPAP method was not a risk factor for lower CPAP adherence in patients presenting severe OSAS (OAHI ≥30/h) and few comorbidities.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10311154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts presented at the 27th Annual Congress of the Belgian Society of Internal Medicine, 1-2 December 2023, Dolce La Hulpe, La Hulpe, Belgium","authors":"","doi":"10.1080/17843286.2023.2278952","DOIUrl":"https://doi.org/10.1080/17843286.2023.2278952","url":null,"abstract":"Published in Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine (Vol. 78, No. sup1, 2023)","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138529533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}