Arthritis Care & Research最新文献

{"title":"Lived and care experiences of chronic musculoskeletal shoulder pain in Australian adults: A qualitative study.","authors":"Sonia Ranelli, Joanne E Jordan, Ilana N Ackerman, Alison Thorpe, Jennifer G Persaud, Linda J Woodhouse, Jason Chua, Ben Horgan, Andrew M Briggs","doi":"10.1002/acr.25614","DOIUrl":"https://doi.org/10.1002/acr.25614","url":null,"abstract":"<p><strong>Objectives: </strong>Australian evidence on lived and care experiences of chronic musculoskeletal shoulder pain (CMSP), irrespective of disorder classification or disease, is limited. However, such evidence is important for person-centred care and informing local service pathways and care guidelines or standards. To address this gap, we explored i) lived experiences of adults with CMSP across domains of the International Classification of Function, Disability and Health (ICF) Framework, and ii) their care experiences, preferences and priorities for CMSP.</p><p><strong>Methods: </strong>A qualitative study, applying a phenomenological approach and purposive sampling was conducted with adults experiencing CMSP. Individual semi-structured interviews, informed by ICF domains, explored lived and care experiences/preferences of participants. Data were analysed using an inductive approach, by objective.</p><p><strong>Results: </strong>Twenty adults (50% women) with diverse CMSP conditions/diagnoses, clinical profiles and age (21-76 years) participated. Five lived experience themes were identified: 1) impact on body functioning; 2) impact on sleep, energy and drive; 3) impact on mental well-being and evolving sense of self; 4) coping with CMSP; and 5) social support and participation. Four care experience themes included: 1) care seeking choices; 2) interactions with healthcare professionals (HCPs); and 3) values and preferences for components of CMSP care.</p><p><strong>Conclusions: </strong>Adults with CMSP experience impacts across life stages in multiple domains of functioning (ICF categories) relating to personal and social dimensions. Clinical encounters, particularly interactions with HCPs, influence an individual's confidence and engagement in their care. Discussion, education and goal setting through shared decision-making are valued attributes of clinical encounters among people with CMSP.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673815","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":"Treating lupus nephritis patients to lupus low disease activity reduces renal relapse and preserves long-term kidney function.","authors":"Chak Kwan Cheung, Desmond Yh Yap, K L Lee, Philip H Li, Iris Yk Tang, Chak Sing Lau, Shirley Cw Chan","doi":"10.1002/acr.25611","DOIUrl":"https://doi.org/10.1002/acr.25611","url":null,"abstract":"<p><strong>Objective: </strong>Lupus low disease activity state (LLDAS) is a validated treatment target in systemic lupus erythematosus (SLE) but limited studies have explored the role of LLDAS in lupus nephritis (LN). This study aims to investigate the frequency and predictors of LLDAS attainment, and its benefit on LN relapse and renal function preservation in patients with LN.</p><p><strong>Methods: </strong>Patients with LN during 2010-2020 in Queen Mary Hospital and Pamela Youde Nethersole Eastern Hospital were included in the discovery cohort and validation cohort, respectively. Complete renal response (CRR), partial renal response (PRR), LLDAS, and DORIS remission were assessed at 12 months. Regression analysis was performed to identify risk factors of LN relapse. Receiver operating characteristic (ROC) curves were used to evaluate target attainment and long-term kidney function.</p><p><strong>Results: </strong>A total of 245 LN patients (discovery cohort N=143, validation cohort N=102) were included. At 12 months, 57/143 (40%), 14/143 (10%), 70/143 (49%), 15/143 (10%) patients achieved CRR, PRR, LLDAS, and DORIS remission respectively. Attainment of both CRR/ PRR and LLDAS at 12 months was associated with best relapse-free survival (p<0.001). Multivariate analysis showed independent association of CRR/PRR and LLDAS with LN relapse risk reduction (CRR/PRR: HR=0.31, p = 0.007; LLDAS: HR=0.38, p = 0.029). LLDAS attainment predicts renal function preservation with satisfactory performance in both discovery and validation cohorts (AUC-ROC=0.71).</p><p><strong>Conclusion: </strong>LLDAS is an attainable target in LN comparable to CRR/PRR. Attainment of both targets is associated with additional benefit on relapse risk reduction. Early LLDAS attainment is associated with renal function preservation.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673816","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":"Hydroxychloroquine Associated with Lower Glomerular Filtration Rate Decline in Lupus Nephritis.","authors":"Shivani Garg, Brad Rovin, Brad C Astor, Tripti Singh, Fauzia Hollnagel, Megan Kuik, Lexie Kolton, Callie Saric, S Sam Lim, Christie M Bartels","doi":"10.1002/acr.25616","DOIUrl":"https://doi.org/10.1002/acr.25616","url":null,"abstract":"<p><strong>Background: </strong>Hydroxychloroquine (HCQ) protects kidney function in lupus nephritis (LN) by preventing flares, yet some cohort studies show no significant benefit in kidney function with HCQ. Clarifying these conflicting findings by showing early and long-term benefits of HCQ on kidney function preservation is critical. Therefore, we analyzed data from our retrospective longitudinal inception LN cohort to examine the time-varying effects of HCQ on kidney function decline in LN.</p><p><strong>Methods: </strong>Retrospective data from an incident biopsy proven LN cohort. Creatinine values at LN diagnosis through the last follow-up were abstracted to estimate the glomerular filtration rate (eGFR). Using HCQ exposure as a time-dependent covariate, we examined associations between HCQ exposure and sustained eGFR decline ≥30% and ≥40%. We also calculated an annual eGFR slope decline by HCQ exposure using linear mixed effects analysis.</p><p><strong>Results: </strong>Among 209 patients, 33% & 23% experienced eGFR decline ≥30% and ≥40% over time. Time-varying HCQ exposure was associated with 60% and 62% lower risk of eGFR decline of ≥30% or ≥40%, after adjusting for propensity scores. An 77% lower risk of eGFR decline was noted in patients with CKD ≥3 with HCQ. HCQ exposure reduced the annual eGFR slope decline by 5.12 and 3.17 ml/min/1.73 m² within first 5 and 10 years of diagnosis.</p><p><strong>Conclusion: </strong>HCQ use was associated with early and long-term benefits on kidney function in LN, including those with CKD ≥3. Universal HCQ use should be encouraged in LN patients.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673814","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":"Reconsidering Race-Based Medicine in Pediatric Rheumatology: Challenges and Opportunities for Equitable Care.","authors":"Nayimisha Balmuri, Alisha Akinsete, Laura B Lewandowski, Mallet Reid, Jordan E Roberts, Jennifer M P Woo","doi":"10.1002/acr.25602","DOIUrl":"https://doi.org/10.1002/acr.25602","url":null,"abstract":"<p><p>Despite growing evidence of their limitations, race-based practices in pediatric rheumatology-those that rely on race or ethnicity to influence diagnosis and treatment-continue to shape care, often reinforcing health disparities. The assumption that biological or genetic differences exist between racial groups oversimplifies complex health issues and perpetuates health inequities. This paper examines persistent race-based practices in pediatric rheumatology, particularly in the interpretation of laboratory results and clinical decision-making, and highlights their clinical limitations. For example, the use of race-adjusted formulas in estimating glomerular filtration rate (eGFR), pulmonary function tests, and creatine kinase levels can lead to misdiagnoses and delayed interventions, particularly in Black and Asian populations. Additionally, race-based assumptions in diseases like Kawasaki disease and multisystem inflammatory syndrome in children (MIS-C) can lead to incorrect conclusions about disease severity and treatment efficacy. This article advocates for a shift toward race-conscious practices that consider the role of social determinants of health and biases in clinical care. It also emphasizes the need for more inclusive research methodologies and diverse representation in clinical trials to enhance the generalizability of findings. By moving away from race-based practices and adopting equity-oriented frameworks, pediatric rheumatologists can better address the needs of marginalized populations and improve health outcomes. This shift is crucial in dismantling systemic disparities and advancing health equity in clinical and research settings.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625225","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":"Where, how, and how much? A multicenter cohort study of the relationship between lupus decision aid modality, place of administration, interruption and viewing completeness and patient-reported outcomes.","authors":"Jasvinder A Singh, Mark Beasley, Larry R Hearld","doi":"10.1002/acr.25603","DOIUrl":"https://doi.org/10.1002/acr.25603","url":null,"abstract":"<p><strong>Objective: </strong>We assessed whether shared decision-making (SDM), and patient acceptability, feasibility, and overall satisfaction with a computerized patient decision aid (PtDA) for patients with systemic lupus erythematosus (SLE), differs by PtDA setting, modality, and the viewing experience.</p><p><strong>Methods: </strong>Patients with SLE were invited to view a self-administered computerized SLE PtDA during regular clinic visits at 15 rheumatology clinics in an implementation trial. Patients completed a survey that included SDM measures including the decision-conflict (DCS), preparation for decision-making (PDM), and CollaboRATE scales; perceived patient acceptability, feasibility, and satisfaction. Patients viewed the SLE PtDA in two settings/places, in-clinic or at home (telemedicine visits), using one of three modalities, touchpad computer, smart phone, or a computer (desktop or laptop computer). We also assessed the effects of interruptions while viewing the PtDA and incomplete viewings.</p><p><strong>Results: </strong>We had a cohort of 813 (43% of 1,895 total) patients with SLE who completed the PtDA modality and setting questions, which were added mid-way after the COVID-19 pandemic started. In a multivariable-adjusted logistic regression analysis, the setting or modality of viewing the SLE PtDA were not associated with SDM or patient outcomes except the association of place of viewing with feasibility. We noted important significant association of interruption while viewing SLE PtDA with lower feasibility, acceptability and PDM and DCS scores; and incomplete viewing of the SLE PtDA with worse PDM and DCS scores.</p><p><strong>Conclusion: </strong>The SLE PtDA was effective regardless of setting and modality of delivery. Uninterrupted and complete viewing of the SLE PtDA is desirable for better SDM and higher acceptability.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625229","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":"Development of a personalized visualization and analysis tool to improve clinical care in complex multisystem diseases with application to scleroderma.","authors":"Ji Soo Kim, John Scott, Lauren Fisher, Lauren N Smith, Willie Stewart, Adrianne Woods, Rob Smithwright, Diane Koher, Parastoo Aslanbeik, Aalok B Shah, Brad Tibbils, Samantha I Pitts, Ayse P Gurses, Yushi Yang, Ana-Maria Orbai, Antony Rosen, Laura K Hummers, Scott L Zeger, Ami A Shah","doi":"10.1002/acr.25613","DOIUrl":"https://doi.org/10.1002/acr.25613","url":null,"abstract":"<p><strong>Background: </strong>In complex diseases, it is challenging to assess a patient's disease state, trajectory, treatment exposures, and risk of multiple outcomes simultaneously, efficiently and at the point of care.</p><p><strong>Methods: </strong>We developed an interactive patient-level data visualization and analysis tool (VAT) that automates illustration of a scleroderma patient's trajectory across multiple organs and illustrates this relative to a reference population, including patient subgroups who share risk factors with the index patient, to improve estimation of disease state. We conducted VAT usability testing with patients and clinicians. We then embedded results from internally cross-validated, Bayesian multivariate mixed models that calculate an individual's risk of critical events, utilizing baseline risk factors, patient-level information in past trajectories in multiple dimensions, and known outcomes from the entire population and relevant subgroups.</p><p><strong>Results: </strong>The web-based application aggregates complex, longitudinal data to illustrate patient-, subgroup- and population-level health trajectories across multiple organ systems. Patients (N=7) exposed to the VAT reported increased knowledge about their disease and confidence in medical decision-making. Rheumatologists (N=4) were able to access 8.6-times more data in 81.5% of the time using 2/3 fewer clicks using the VAT compared to the EMR. Statistical modeling was successfully embedded in the VAT, enabling real-time estimation of a patient's risks of multiple complications.</p><p><strong>Conclusions: </strong>Systematic analysis and visualization of individual- and population-level data in a complex disease has potential to improve medical decision-making and warrants further study. Individualized risk estimation disseminated at the point of care may enable targeted screening and early intervention in high-risk patients.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625223","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":"Beyond the Bloodstream: Rethinking Colchicine Monitoring Through a Clinical Lens.","authors":"Yadi Li, Zheng Wei, Jianlong Zhou","doi":"10.1002/acr.25605","DOIUrl":"https://doi.org/10.1002/acr.25605","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625222","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 Scoping Review on AI-Supported Interventions for Non-Pharmacological Management of Chronic Rheumatic Diseases.","authors":"Nirali Shah, Alexis Castellanos, Yen T Chen, John D Piette, Amy Bucher, Susan L Murphy","doi":"10.1002/acr.25612","DOIUrl":"10.1002/acr.25612","url":null,"abstract":"<p><p>This review summarizes AI-supported non-pharmacological interventions for adults with chronic rheumatic diseases, detailing their components, purpose, and current evidence base. We searched Embase, PubMed, Cochrane, and Scopus databases for studies describing AI-supported interventions for adults with chronic rheumatic diseases. Eligible interventions targeted clinical outcomes (pain, function, disability, fatigue), psychological measures (depression, anxiety), or behavioral outcomes (physical activity, nutrition). All publication types (journal articles, conference abstracts, protocols) published in English language until January 19, 2025, were considered, and interventions of any duration, frequency, country of origin, or setting (inpatient, outpatient, community, and home setting) were included. Two reviewers independently screened studies and one extracted data on study characteristics, intervention components, AI methodologies, and outcomes. Fifteen AI-supported interventions were identified, primarily targeting osteoarthritis (OA) (73%) and focusing on education and exercise advice (67%). The most common AI tool was rule-based expert systems (40%), followed by natural language processing systems (33%) and machine learning algorithms (27%). The interventions ranged from 3 weeks to 12 months, while sample sizes ranged from 7 to 427 participants reflecting huge variability across studies. Most interventions demonstrated high usability, engagement, and adherence. Improvements in exercise compliance, physical activity, and symptoms such as pain and physical function were reported, though effects varied across studies and were sometimes not sustained long-term. AI-supported interventions show promise in promoting education, exercise, and behavioral guidance for adults with chronic rheumatic diseases. There is evidence for high usability and engagement but the clinical impact on long-term symptom management is uncertain.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625221","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":"Trends in Dermato-polymyositis Mortality, 1999-2022: A Nationwide Population-based Study, United States.","authors":"Elizabeth Matz, Ram R Singh","doi":"10.1002/acr.25609","DOIUrl":"https://doi.org/10.1002/acr.25609","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated trends in dermato-polymyositis (DPM) mortality relative to all-cause mortality in the United States, 1999-2022.</p><p><strong>Methods: </strong>We used the Center for Disease Control and Prevention's databases (Multiple Causes of Death for 1999-2020 and Provisional Mortality Statistics for 2021 and 2022) to obtain death counts for DPM and non-DPM (all causes other than DPM). We calculated age-standardized mortality rates (ASMR) for both groups and computed the ratio of DPM-ASMR to non-DPM-ASMR for each of the 24 years. We performed joinpoint regression analysis to estimate annual percent change (APC) in DPM and non-DPM ASMRs and in the DPM-ASMR:non-DPM-ASMR ratios, overall and by sex, age, and race/ethnicity.</p><p><strong>Results: </strong>There were 12,882 DPM and 63,549,485 non-DPM deaths during 1999-2022. Mortality decreased at a higher APC (-3.8% [95% CI, -4.3%, -3.4%]) for DPM than non-DPM (-1.2% [95% CI, -1.5%, -0.9%]) until the start of the COVID-19 pandemic, when it increased for both at similar APCs. Consequently, the ratios of DPM-ASMRs to non-DPM-ASMRs decreased over these 24 years in all subgroups. The DPM-ASMR to non-DPM-ASMR ratios were higher in females than males, and in younger individuals (≤64 years) than those ≥65 years. The odds of premature death were higher for DPM than non-DPM. Non-Hispanic Black, Hispanic, and non-Hispanic others had higher DPM-ASMR to non-DPM-ASMR ratios than White individuals.</p><p><strong>Conclusion: </strong>DPM mortality decreased at a higher rate than all-cause mortality until the pandemic, when it proportionately increased for both DPM and all causes. Females, younger, Black, Hispanic, and non-Hispanic other individuals had higher DPM mortality relative to all-cause mortality. Findings highlight the need for improved screening, earlier intervention, and targeted efforts to address racial/ethnic disparities in DPM outcomes.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625227","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":"Late-Onset Scleroderma Renal Crisis Does Occur - A Multi-Center Study.","authors":"Swati Mehta, Sumbal Wajid, Isam Albaba, Virginia Steen, Robyn T Domsic-Degazio, Alexa Luta, Paul J Feustel, Loay Salman, Lee Shapiro","doi":"10.1002/acr.25608","DOIUrl":"https://doi.org/10.1002/acr.25608","url":null,"abstract":"<p><strong>Objective: </strong>Scleroderma renal crisis (SRC) is historically described to occur within first 5 years of SSc diagnosis. However, it has been observed to occur beyond 5 years. In this analysis, we aim to describe the prevalence, clinical features and outcomes of late onset SRC and compare them to early onset SRC.</p><p><strong>Methods: </strong>This retrospective observational study included patients diagnosed with SRC between 1995 to 2018 at three university-affiliated hospitals. Late onset SRC was defined as SRC occurring 5 years after SSc diagnosis. After obtaining IRB approval, data including demographics, SRC onset, clinical characteristics, laboratory data, and outcomes were extracted. Continuous data were expressed as mean/median, and categorical as frequencies/percentages. Differences were analyzed via Pearson's chi-square.</p><p><strong>Results: </strong>A total of 223 SRC patients were identified, with 169 (75.8%) classified as early onset and 54 (24.2%) as late onset. Late onset group had a mean SRC onset at 12.2 years after SSc diagnosis. Male predominance was observed in late compared to early group (59% vs 9%). Steroid exposure was more common in late vs early group (56% vs 29%). There was no evidence of difference in autoantibodies profile and outcomes between early and late onset groups.</p><p><strong>Conclusions: </strong>Late onset SRC was seen in up to 25% of SRC patients, with a mean of 12 years after SSc diagnosis. Our findings reveal comparable clinical characteristics and outcomes between early and late onset SRC, underlying the importance of recognizing SRC regardless of disease duration to optimize outcomes.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625224","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}