American Journal of Nephrology最新文献

{"title":"Premature Aortic Stiffness in Relation to Cerebral Small-Vessel Disease, Cognitive Decline, Major Cardiovascular Events, and Mortality in Dialysis.","authors":"Lin Shi, Ke Zheng, Yujun Qian, Xixi Zheng, Haiyun Wang, Fei Han, Hui You, Bo Hou, Jing Yuan, Feng Feng, Yicheng Zhu, Xuemei Li","doi":"10.1159/000553205","DOIUrl":"10.1159/000553205","url":null,"abstract":"<p><strong>Introduction: </strong>There is a great burden of cerebral small-vessel disease (CSVD) in dialysis population. Arterial stiffness, normally assessed by pulse-wave velocity (PWV), is an important risk factor for CSVD. We aimed to investigate the effect of PWV on CSVD and related consequences, including cognitive function, cardiovascular disease (CVD), and mortality in dialysis.</p><p><strong>Methods: </strong>In a prospective cohort of maintenance dialysis adults, 3 features of CSVD including cerebral microbleed (CMB), lacunae, and white matter hyperintensity (WMH) were measured. PWV was assessed by sequential recording of electrocardiogram-gated carotid and femoral artery pressure waves. The effect of PWV on CSVD and cognitive impairment were investigated by multivariate regression analysis. Cox proportional hazards model was used to assess the risk of CVD and mortality up to 10 years follow-up.</p><p><strong>Results: </strong>In the 178 study subjects, the frequency of CMB, lacunae, and WMH was 32.6%, 25.3%, and 34.8%. PWV was related to the risk of lacunae in subcortical white matter (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.02-1.20) and WMH (OR, 1.11; 95% CI, 1.02-1.20) in crude analyses. Unadjusted associations between PWV and cognitive impairment, which were reflected in loss of global function, verbal memory, and executive function, were also detected. At follow-up, PWV was associated with CVD (hazard ratio [HR], 1.13; 95% CI, 1.08-1.18) and all-cause mortality (HR, 1.11; 95% CI, 1.06-1.16) after confounder adjustment. Restricted cubic splines depicted a linear relationship between PWV and the outcome events.</p><p><strong>Conclusion: </strong>PWV was associated with all-cause mortality and CVD, independent of age and sex. PWV was associated with CVSD and cognitive decline in unadjusted analyses. PWV is a widely available measurement and could be an early biomarker and provide predictive value in this population.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148325406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjudicating Heart Failure as an End Point in Dialysis Trials: More Signal, Less Noise.","authors":"Emma O Apos Lone, Patrick B Mark","doi":"10.1159/000553102","DOIUrl":"10.1159/000553102","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-5"},"PeriodicalIF":3.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148325357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjudicating Heart Failure Events in Participants Receiving Hemodialysis: Findings from Evaluation of Cinacalcet Hydrochloride Therapy to Lower Cardiovascular Events (EVOLVE) Trial.","authors":"Guson Kang, Safa Abdalla, Patrick S Parfrey, Renato D Lopes, Uptal D Patel, Gerard London, Glenn M Chertow, Kenneth W Mahaffey","doi":"10.1159/000553103","DOIUrl":"10.1159/000553103","url":null,"abstract":"<p><strong>Introduction: </strong>The Evaluation of Cinacalcet Hydrochloride Therapy to Lower Cardiovascular Events (EVOLVE) trial compared the effects of cinacalcet against placebo on major cardiovascular events in 3,883 hemodialysis patients with secondary hyperparathyroidism. In this manuscript, we describe heart failure events in EVOLVE and the role of centralized adjudication on heart failure reporting.</p><p><strong>Methods: </strong>A central clinical events classification committee (CEC) defined and adjudicated suspected heart failure events reported by the site investigators. The treatment effect was analyzed by intention to treat.</p><p><strong>Results: </strong>Overall, 3,883 participants were enrolled, 1,366 heart failure events were reported by site investigators, and 40 potential events were identified independently by the CEC. Among site investigator-reported events, 653 (47.8%) were adjudicated by the CEC as heart failure endpoints. Of the 40 potential events identified independently by the CEC, 17 (42.5%) were adjudicated as heart failure endpoints. The effect of cinacalcet compared with placebo on time to first heart failure event using CEC-adjudicated and site investigator-reported events (10.6% and 12.2% for CEC-adjudicated events [relative hazard 0.82, 95% CI: 0.68-0.99] and 20.3% and 22.1% for site investigator-reported events [relative hazard 0.88, 95% CI: 0.77-1.01]) was similar, although CEC data included fewer events but nominally statistically significant results.</p><p><strong>Conclusion: </strong>Roughly half of heart failure events reported by site investigators were not adjudicated as heart failure by the CEC. Site investigators failed to report additional events that were later adjudicated as heart failure endpoints. These findings suggest that, in the hemodialysis population, identifying and classifying heart failure events is challenging and highlight the importance of centralized adjudication to ensure specificity and consistency in clinical events ascertainment.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Amount: The Selectivity of Proteinuria and Risk of Graft Failure in Kidney Transplant Recipients.","authors":"Firas F Alkaff, Wendy A Dam, Jenny E Kootstra-Ros, Eva Corpeleijn, Mohamed R Daha, Martin H de Borst, Jacob van den Born, Stephan J L Bakker, Stefan P Berger","doi":"10.1159/000552866","DOIUrl":"10.1159/000552866","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with nonselective proteinuria generally have a worse prognosis than those with selective proteinuria. However, this has never been studied in kidney transplant recipients (KTRs). This study aimed to evaluate the association between proteinuria selectivity and graft failure among KTRs.</p><p><strong>Methods: </strong>We used data from KTRs with a functioning graft ≥1 year after transplantation who enrolled in the prospective TransplantLines Food and Nutrition Biobank and Cohort Study and had urinary albumin excretion ≥30 mg/24-h and urinary protein excretion >150 mg/24-h. The selectivity of proteinuria was based on the clearance ratio of IgG to albumin (≤0.10 = highly selective; >0.10 = moderate/nonselective). Multivariable Cox regression analyses were performed to evaluate the association between proteinuria selectivity and graft failure.</p><p><strong>Results: </strong>A total of 335 KTRs (36% female, median 6 years after transplantation, mean estimated glomerular filtration rate [eGFR] 47 mL/min/1.73 m2) were included in the analyses. Of them, 107 (31.9%) had moderate/nonselective proteinuria. KTRs with moderate/nonselective proteinuria had lower eGFR, higher 24-h urinary protein excretion, and higher levels of tubular injury markers. During a median follow-up of 5.2 years after baseline measurement, 66 (19.7%) KTRs developed death-censored graft failure. Moderate/nonselective proteinuria was significantly associated with a higher risk of graft failure, independent of potential confounders, including eGFR and 24-h urinary protein excretion (adjusted hazard ratio [95% confidence interval] = 2.10 [1.12-3.94], p = 0.020).</p><p><strong>Conclusion: </strong>The independent association between proteinuria selectivity and graft failure highlights the importance of evaluating proteinuria selectivity, in addition to urinary protein, in routine clinical care for KTRs.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148154951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Body Composition Biomarkers with Survival, Cardiovascular Events, and Progression in Persons with Chronic Kidney Disease: Insights from the Renal Risk in Derby Study.","authors":"Ashveer Randhay, Nicholas M Selby, Maarten W Taal, Mohamed Tarek Eldehni","doi":"10.1159/000552844","DOIUrl":"10.1159/000552844","url":null,"abstract":"<p><strong>Introduction: </strong>Low muscle mass and increased visceral fat are associated with increased mortality and adverse health outcomes, but measurement of components of body composition is not routine. The creatinine muscle index (CMI) has been described as a novel surrogate marker for muscle mass. The waist-to-hip ratio (WHR) is a recognised surrogate marker for visceral adiposity. We sought to study the associations of CMI and WHR with survival, cardiovascular events, and chronic kidney disease (CKD) progression.</p><p><strong>Methods: </strong>This was a prospective observational cohort study of 1,732 people with CKD category G3 and followed up for 5 years. The primary outcomes were time to cardiovascular events and all-cause mortality over a 5-year period, and secondary outcome was progression of CKD.</p><p><strong>Results: </strong>Participants in the higher tertiles of CMI were younger, more likely to be male, and had higher serum albumin, lower BMI, and lower WHR. Two hundred forty-eight participants (14.3%) died prior to their visit in year 5. In the multivariable Cox proportional hazards model for mortality at 5 years, each one-standard-deviation decrease in CMI was associated with 28% higher risk in mortality (HR 1.277, 95% CI 1.086-1.502, p = 0.003). Cardiovascular events occurred in 605 (34.9%) participants. Each standard deviation increase in WHR was significantly associated with 16% higher risk of cardiovascular events at 5 years (HR 1.160, CI 1.037-1.298, p = 0.009). Three hundred six (24.8%) participants evidenced CKD progression. In a multivariable binary logistic regression analysis, lower CMI was associated with a higher risk of progression of CKD at 5 years (OR 1.230, CI 1.028-1.471, p = 0.024).</p><p><strong>Conclusion: </strong>Lower CMI was independently associated with higher mortality and CKD progression, whereas higher WHR was independently associated with increased risk of cardiovascular events. These simple and inexpensive surrogate biomarkers of sarcopenia and visceral adiposity can be easily incorporated into daily practice to enhance risk stratification in people with CKD and inform therapeutic interventions to improve their clinical outcomes.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Variability in Urine Albumin-to-Creatinine Ratio in the General US Adult Population.","authors":"Sophie E Claudel, Sushrut S Waikar, Insa M Schmidt, Ashish Verma","doi":"10.1159/000552774","DOIUrl":"10.1159/000552774","url":null,"abstract":"<p><strong>Introduction: </strong>Measured urine albumin-to-creatinine ratio (ACR) is known to be variable between measurements from the same individual with chronic kidney disease or diabetes, but the factors predisposing to increased variability remain unclear. Our objective was to quantify and identify predictors of short-term, within-person variability in albuminuria in a generalizable population.</p><p><strong>Methods: </strong>This is a cross-sectional analysis of 4,829 adults in the 2009-2010 United States National Health and Nutrition Examination Survey who provided two urine samples within 10 days. We calculated the absolute percentage change, within-person coefficient of variation, and 95% reference change values for the overall population and within clinically meaningful subgroups. We then performed linear regression modeling to assess for a priori selected predictors of variability and examined nonlinear relationships using restricted cubic splines.</p><p><strong>Results: </strong>The mean age was 47.8 (SD 16.5) years, the mean eGFR was 95.8 (SD 20.4) mL/min per 1.73 m2, 11.3% had diabetes, and 51.5% of the participants were women. Factors associated with greater variability in temporally proximate repeat urine ACR samples included age, sex, and severity of initial urine ACR. Overall, albuminuria varied by approximately 28%, but there was heterogeneity within clinical subgroups. Reclassification into alternative albuminuria category following the second collection was low.</p><p><strong>Conclusion: </strong>Patients' urine ACR can fluctuate roughly ±30% on average and confirmatory testing is wise in those with borderline values. Reviewing longitudinal trends in urine ACR or averaging several collections is likely more clinically meaningful than any single value.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-8"},"PeriodicalIF":3.8,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forecasting Urgent Dialysis Needs: From Predictive Accuracy to Clinical Actionability.","authors":"Fariha Shahid Tanveer, Muhammad Hassan Saeed","doi":"10.1159/000551551","DOIUrl":"https://doi.org/10.1159/000551551","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-2"},"PeriodicalIF":3.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Sacubitril/Valsartan versus Irbesartan on Urine Tubular Biomarkers in Chronic Kidney Disease: Findings from the UK HARP-III Trial.","authors":"Michelle A Goonasekera, Greco B Malijan, Rebecca J Sardell, Natalie Staplin, Benjamin S Storey, Daniel Chapman, Michael Hill, Stewart Moffat, Abdulrahman Al-Mohammad, Doreen Zhu, Nigel J Brunskill, John J V McMurray, Maarten W Taal, William G Herrington, Martin J Landray, Colin Baigent, Richard Haynes, Parminder K Judge","doi":"10.1159/000552348","DOIUrl":"10.1159/000552348","url":null,"abstract":"<p><strong>Introduction: </strong>Sacubitril/valsartan shows benefits in heart failure and may have kidney protective effects. Its impact on kidney tubular health in chronic kidney disease (CKD) remains unclear. We evaluated the effects of sacubitril/valsartan on urinary markers of tubular dysfunction and injury in UK Heart and Renal Protection-III (HARP III, ISRCTN:11958993).</p><p><strong>Methods: </strong>Urine tubular biomarkers were measured at baseline, 3 and 6 months using first morning void or spot urine samples among 411 participants from UK HARP III. A mixed model repeated measures approach was used to quantify the study average effect of treatment on the urine biomarkers.</p><p><strong>Results: </strong>Compared to allocation to irbesartan, allocation to sacubitril/valsartan reduced neutrophil gelatinase-associated lipocalin (NGAL), a marker secreted in the distal tubules after ischemia and reperfusion, by 18% (95% CI: -32% to -1%). No significant changes were observed for the other biomarkers, and there was no evidence of effect modification by key baseline characteristics across all biomarkers studied.</p><p><strong>Conclusion: </strong>In UK HARP-III, sacubitril/valsartan reduced urinary NGAL compared with irbesartan but did not affect other tubular biomarkers of injury, ischemia, and fibrosis, suggesting limited tubular benefits, consistent with no observed effect on kidney function.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-4"},"PeriodicalIF":3.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13363103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Rurality and Evaluation Start among Referred Patients with End-Stage Kidney Disease.","authors":"Angelitta M Britt-Spells, Jade Buford, Catherine Kelty, Parneet Manjal, Katie Ross-Driscoll, Jonathan A Fridell, Stephen Pastan, Rachel E Patzer, Adam S Wilk","doi":"10.1159/000552281","DOIUrl":"10.1159/000552281","url":null,"abstract":"<p><strong>Introduction: </strong>Rural residents with end-stage kidney disease have lower access to kidney transplantation, especially in later stages. We examined the impact of rurality on initiation of transplant evaluation and whether this varies by region.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 86,839 adults (18-80 years) referred for kidney transplantation between 2015 and 2023 in the Early Steps to Transplant Access Registry, linked to United States Renal Data System (USRDS). Rurality was defined using the USRDS variable based on the ZIP code using rural-urban commuting area codes. The primary outcome was evaluation initiation within 6 months of referral. Fine and Gray competing risk models estimated the time to evaluation start, accounting for death as a competing event, with multivariable adjustment and interaction by geographic region; sub-analyses were stratified by the end-stage renal disease (ESRD) network.</p><p><strong>Results: </strong>Median time to evaluation was longer for rural patients (166 days) than urban patients (106 days), a pattern consistent across all ESRD networks. The largest rural-urban time gaps were observed in New York and the Ohio River Valley. Rural residence was associated with an 11% lower likelihood of evaluation initiation (adjusted subdistribution hazard ratio [aSHR] [95% CI]: 0.89 [0.86, 0.92]). The strongest disparities were in New York (aSHR [95% CI]: 0.56 [0.50, 0.62]) and New England (aSHR [95% CI]: 0.76 [0.69, 0.83]). The Southeast (aSHR [95% CI]: 0.90 [0.87, 0.94]) and Ohio River Valley (aSHR [95% CI]: 0.92 [0.85, 0.99]) showed similar associations.</p><p><strong>Conclusion: </strong>Rural residents were less likely to initiate transplant evaluation compared to urban residents. These findings suggest that rural disparities exist in the early steps of the transplant process, highlighting the need for targeted interventions, especially in regions with lowest access.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glomerular Hyperfiltration as an Independent Predictor of All-Cause Mortality in Healthy Adults: A Nationally Representative Cohort Study.","authors":"Lu Zhang, Yiming Zhao, Fucong He, Yanqiu Wang, Baihuan Feng, Shengjun Wu","doi":"10.1159/000552329","DOIUrl":"10.1159/000552329","url":null,"abstract":"<p><strong>Introduction: </strong>Glomerular hyperfiltration (GHF) is a marker of systemic dysfunction, but its link to long-term mortality in healthy adults remains unclear.</p><p><strong>Methods: </strong>This nationally representative cohort study included 14,309 healthy adults from the National Health and Nutrition Examination Survey. GHF was defined as age- and sex-specific estimated glomerular filtration rate (eGFR) indexed for individual body surface area (BSA) exceeding the 95th percentile. Normal filtration was defined as the 25th-75th percentile. All-cause mortality risk was assessed using Cox proportional hazards models, propensity score matching, and restricted cubic spline regression.</p><p><strong>Results: </strong>Among participants, 722 exhibited GHF (median eGFR: 168 mL/min/BSA m2) and 7,153 had normal filtration (median eGFR: 115 mL/min/BSA m2). Over a median follow-up of 123 months, GHF was associated with increased mortality risk (fully adjusted hazard ratio [HR]: 1.86; 95% confidence interval [CI]: 1.33, 2.60). Propensity score-matched analysis yielded consistent results (HR: 2.60; 95% CI: 1.25, 5.39). Restricted cubic splines revealed a U-shaped eGFR-mortality relationship, with risk progressively increasing above the 60th eGFR percentile. Sensitivity analyses confirmed the robustness of these findings across various stratification methods and exclusion criteria.</p><p><strong>Conclusions: </strong>GHF independently predicts increased mortality in healthy adults, suggesting its potential role as a systemic risk marker and highlighting the potential value of revisiting kidney health assessment frameworks.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}