Cardiorenal Medicine最新文献

{"title":"Mechanisms of Congestion in Acute Decompensated Heart Failure.","authors":"Ashkan Karimi, Kristen Mathew, Negiin Pourafshar","doi":"10.1159/000544929","DOIUrl":"10.1159/000544929","url":null,"abstract":"<p><strong>Background: </strong>Acute decompensated heart failure (ADHF) poses a challenging paradox of renal and cardiac pathophysiology, with volume excess or \"congestion\" being a key player. Understanding the mechanisms of congestion is crucial for effectively managing fluid overload and improving patient prognosis.</p><p><strong>Summary: </strong>In this review, we evaluate the physiology of congestion and explore its implications for management in clinical practice. Mechanisms of congestion can largely be broken down under the subtext of fluid accumulation and fluid redistribution. Fluid accumulation develops as a consequence of neurohormonal dysregulation, physiologic maladaptive mechanisms, and detrimental crosstalk between the heart and the kidney. On the other hand, fluid redistribution evolves due to progressive overriding of compensatory vascular mechanisms, renal injury, and hormonal feedback.</p><p><strong>Key messages: </strong>Understanding the complex pathophysiology of congestion in ADHF is crucial for effective volume management and protection against long-term mortality and morbidity risks. By targeting both fluid accumulation and redistribution mechanisms, clinicians can optimize treatment strategies to alleviate congestion and restore hemodynamic stability in patients with ADHF.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"544-551"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiopulmonary Exercise Testing in Patients with Chronic Kidney Disease.","authors":"Nolan W Groninger, Drake E Dillman, Hunter Stafford, Monique Campos, Andrew R Coggan, Kenneth Lim","doi":"10.1159/000546201","DOIUrl":"10.1159/000546201","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary exercise testing (CPET) is an emerging tool in nephrology that has garnered significant interest among clinicians and investigators.</p><p><strong>Summary: </strong>CPET technology enables the user to accurately assess cardiovascular functional capacity using an integrative approach, to identify multi-organ reserve capacities and interrogate pathophysiological mechanisms underpinning impaired exercise tolerance in patients with chronic kidney disease (CKD). These capabilities provide rationale for accumulating studies exploring the use of this existing technology for new applications in nephrology and to solve current clinical practice barriers. Examples of current clinical interest areas include its potential to help transform diagnostic approaches to cardiovascular complications in patients with CKD, to offer superior cardiovascular risk stratification and to provide a solution to current limitations of traditional resting endpoints in cardiorenal clinical trials.</p><p><strong>Key messages: </strong>This article reviews the foundational principles, methodologic, and operational implementation of CPET in patients with CKD and those on dialysis.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"510-525"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12224200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polishing the Core: Refining VExUS for Venous Congestion Assessment.","authors":"Rogerio da Hora Passos,Pedro Guadix Zulian Teixeira,Carolina de Moraes Pellegrino,Vinicius Barbosa Galindo,Renan Sandoval de Almeida,Thais Dias Midega,Uri Adrian Prync Flato","doi":"10.1159/000541382","DOIUrl":"https://doi.org/10.1159/000541382","url":null,"abstract":"","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":"211 1","pages":"1-4"},"PeriodicalIF":3.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261357","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":"Telomere length is associated with increased risk of cardiovascular events in patients with end-stage kidney disease on hemodialysis.","authors":"Rafaela Vostatek,Philipp Hohensinner,Sabine Schmaldienst,Matthias Lorenz,Renate Klauser-Braun,Ingrid Pabinger,Marcus Säemann,Cihan Ay,Oliver Königsbrügge","doi":"10.1159/000541112","DOIUrl":"https://doi.org/10.1159/000541112","url":null,"abstract":"INTRODUCTIONPatients with chronic kidney disease (CKD), especially those with end-stage kidney disease (ESKD) on hemodialysis (HD), are at increased risk for cardiovascular disease (CVD), including myocardial infarction and ischemic stroke. A shortening in telomere length, as a parameter for accelerated vascular aging, is an established biomarker for CVD in the general population. We aimed to elucidate the role of telomere length in ESKD patient on HD and its association with cardiovascular outcomes.METHODSTelomere length was measured in a prospective population-based cohort study of prevalent HD patients. DNA was isolated from whole blood, sampled at baseline, and analyzed for telomere length via a qPCR-based approach. The risk for the occurrence of the independently adjudicated 3P-MACE outcome (myocardial infarction, ischemic stroke, and cardiovascular death) was statistically analyzed considering the competing risk of non-cardiovascular death.RESULTSIn the cohort of 308 patients with ESKD (115 (37.3%) women, median (25th-75th percentile) age: 67.0 (56.8 - 76.0), the median telomere length was 1.51 kb (25th-75th percentile 0.6-3.2 kb). The 3P-MACE outcome occurred with an incidence rate of 9.4 per 100 patient-years. Patients with longer telomere length more frequently had vascular nephropathy compared to patients with shorter telomere length. Interestingly, patients in the highest quartile of telomere length had a 1.8-fold increased risk for 3P-MACE (95%CI 1.051-3.201, p=0.033), after multivariable adjustment for age, history of stroke, myocardial infarction, venous thromboembolism, presence of heart valve replacement, atrial fibrillation, smoking, anticoagulation, or immunosuppressive use.CONCLUSIONSurprisingly, in this high-risk cohort of patients with ESKD on HD, longer telomere lengths were associated with increased risk of cardiovascular events.","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":"250 1","pages":"1-16"},"PeriodicalIF":3.8,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207082","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":"Erratum.","authors":"","doi":"10.1159/000539832","DOIUrl":"10.1159/000539832","url":null,"abstract":"","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":2.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Heart Failure and Acute Kidney Injury: Emerging Concepts and Controversial Dimensions.","authors":"Wisit Cheungpasitporn, Charat Thongprayoon, Kianoush B Kashani","doi":"10.1159/000537751","DOIUrl":"10.1159/000537751","url":null,"abstract":"<p><strong>Background: </strong>The growing complexity of patient data and the intricate relationship between heart failure (HF) and acute kidney injury (AKI) underscore the potential benefits of integrating artificial intelligence (AI) and machine learning into healthcare. These advanced analytical tools aim to improve the understanding of the pathophysiological relationship between kidney and heart, provide optimized, individualized, and timely care, and improve outcomes of HF with AKI patients.</p><p><strong>Summary: </strong>This comprehensive review article examines the transformative potential of AI and machine-learning solutions in addressing the challenges within this domain. The article explores a range of methodologies, including supervised and unsupervised learning, reinforcement learning, and AI-driven tools like chatbots and large language models. We highlight how these technologies can be tailored to tackle the complex issues prevalent among HF patients with AKI. The potential applications identified span predictive modeling, personalized interventions, real-time monitoring, and collaborative treatment planning. Additionally, we emphasize the necessity of thorough validation, the importance of collaborative efforts between cardiologists and nephrologists, and the consideration of ethical aspects. These factors are critical for the effective application of AI in this area.</p><p><strong>Key messages: </strong>As the healthcare field evolves, the synergy of advanced analytical tools and clinical expertise holds significant promise to enhance the care and outcomes of individuals who deal with the combined challenges of HF and AKI.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"147-159"},"PeriodicalIF":3.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139729083","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":"Evaluation of the Renal and Cardiovascular Effects of Long-Term Tolvaptan Treatment in Autosomal Dominant Polycystic Kidney Disease.","authors":"Alparslan Demiray, Ramazan Ozan, Salih Güntuğ Özaytürk, Hakan İmamoğlu, Gökmen Zararsız, Murat Hayri Sipahioğlu, Bülent Tokgöz, Deniz Elçik, İsmail Koçyiğit","doi":"10.1159/000538098","DOIUrl":"10.1159/000538098","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular diseases constitute a significant cause of morbidity and mortality in individuals with autosomal dominant polycystic kidney disease (ADPKD). This study aimed to assess the long-term effects of tolvaptan on the kidneys and heart in rapidly progressing ADPKD.</p><p><strong>Methods: </strong>Among 354 patients diagnosed with ADPKD, 58 meeting the eligibility criteria for tolvaptan were included in the study. The study comprised two groups with similar demographic and clinical characteristics: 29 patients receiving tolvaptan treatment and 29 in the control group. Several included genetic analysis, magnetic resonance imaging, and echocardiography. Clinical and cardiac changes were recorded in both groups after a 3-year follow-up.</p><p><strong>Results: </strong>Tolvaptan treatment demonstrated a significant reduction in the rate of eGFR decline compared to the control group. Furthermore, it was observed that tolvaptan could prevent the development of cardiac arrhythmias by inhibiting an increase in QTc interval and heart rate.</p><p><strong>Conclusion: </strong>These findings suggest that, in addition to slowing kidney progression in ADPKD management, tolvaptan may potentially benefit in preventing cardiac complications.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"167-177"},"PeriodicalIF":3.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995660","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":"Prognostic Value of Shock Index Creatinine in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement.","authors":"Bangyuan Yang, Changjin Wang, Ting Zhou, Yinghao Sun, Shengneng Zheng, Jiaohua Chen, Songyuan Luo, Jianfang Luo, Jie Li","doi":"10.1159/000541323","DOIUrl":"10.1159/000541323","url":null,"abstract":"<p><strong>Introduction: </strong>Shock index (SI) and its derivatives have been reported to have prognostic value in various cardiovascular diseases. This study aims to ascertain the utility of shock index creatinine (SIC) in predicting mid-term mortality among patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 555 patients with severe AS who underwent TAVR from April 2016 to March 2023. SIC was calculated as (SI × 100) - estimated creatinine clearance (CCr). The primary endpoint was all-cause mortality during the follow-up period, and secondary endpoints included in-hospital complications as defined by the Valve Academic Research Consortium-3 (VARC-3) criteria. Patients were stratified into two groups based on the optimal cutoff value determined by the receiver-operating characteristic (ROC) curve. Cox regression analysis was employed to identify independent predictors of all-cause mortality. Additionally, restricted cubic spline (RCS) was deployed to illustrate the relationship between SIC and mortality risk. The predictive performance of risk scores was evaluated using the area under the ROC curve (AUC).</p><p><strong>Results: </strong>Over a mean follow-up period of 21.5 months, there were 51 cases of all-cause mortality. Patients with a high SIC, identified by a cutoff of 16.5, exhibited a significantly higher cumulative all-cause mortality compared to those with a low SIC (18.3% vs. 5.2%, p &lt; 0.001; adjusted HR = 2.188; 95% CI 1.103-4.341, p = 0.025). Patients with a high SIC were older (p = 0.002) and exhibited a higher prevalence of frailty (p &lt; 0.001). Furthermore, they exhibited a heightened probability of moderate or severe mitral regurgitation (p &lt; 0.001), tricuspid regurgitation (p &lt; 0.001), and pulmonary hypertension (p &lt; 0.001) compared to those with a low SIC. In terms of perioperative complications, acute kidney injury (10.1% vs. 3.9%, p = 0.008) and bleeding (13.6% vs. 6.7%, p = 0.014) were more prevalent in patients with a high SIC. The RCS demonstrated a positive correlation between SIC and all-cause mortality rate. Furthermore, incorporating high SIC into the STS score improved its predictive value for 1-year all-cause mortality (AUC: 0.731 vs. 0.649, p = 0.01).</p><p><strong>Conclusion: </strong>Patients with a high SIC are more likely to experience frailty and cardiac damage and exhibit an increased in-hospital and mid-term mortality rate. SIC may provide additional information for risk stratification of patients undergoing TAVR.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"556-569"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280640","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":"Treatment of Chronic Heart Failure in Advanced Chronic Kidney Disease: The HAKA Multicenter Retrospective Real-World Study.","authors":"Borja Quiroga, Alberto Ortiz, Sara Núñez, Maria Kislikova, Silvia González Sanchidrián, José Jesús Broseta, Zoila Stany Albines, Beatriz Escamilla Cabrera, Yaiza Rivero Viera, David Rodriguez Santarelli, Laura Salanova Villanueva, Francisca Lopez Rodriguez, Barbara Cancho Castellano, María Ibáñez Cerezon, Carmen Patricia Gutierrez Rivas, Nuria Aresté, Belén Campos Gutiérrez, Ana Ródenas Gálvez, Maria Constanza Glucksmann Pizá, Sagrario Balda Manzanos, Amparo Soldevila, Lucía Rodríguez Gayo, Esperanza Moral Berrio, Mayra Ortega Diaz, Sandra Beltrán Catalán, Adriana Puente García, Miguel Ángel Rojas, R Haridian Sosa Barrios, Henar Santana Zapatero, Gema Rangel Hidalgo, Ana Maria Martinez Canet, Javier Díez","doi":"10.1159/000538030","DOIUrl":"10.1159/000538030","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic heart failure (HF) has high rates of mortality and hospitalization in patients with advanced chronic kidney disease (aCKD). However, randomized clinical trials have systematically excluded aCKD population. We have investigated current HF therapy in patients receiving clinical care in specialized aCKD units.</p><p><strong>Methods: </strong>The Heart And Kidney Audit (HAKA) was a cross-sectional and retrospective real-world study including outpatients with aCKD and HF from 29 Spanish centers. The objective was to evaluate how the treatment of HF in patients with aCKD complied with the recommendations of the European Society of Cardiology Guidelines for the diagnosis and treatment of HF, especially regarding the foundational drugs: renin-angiotensin system inhibitors (RASi), angiotensin receptor blocker/neprilysin inhibitors (ARNI), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i).</p><p><strong>Results: </strong>Among 5,012 aCKD patients, 532 (13%) had a diagnosis of HF. Of them, 20% had reduced ejection fraction (HFrEF), 13% mildly reduced EF (HFmrEF), and 67% preserved EF (HFpEF). Only 9.3% of patients with HFrEF were receiving quadruple therapy with RASi/ARNI, BB, MRA, and SGLT2i, but the majority were not on the maximum recommended doses. None of the patients with HFrEF and CKD G5 received quadruple therapy. Among HFmrEF patients, approximately half and two-thirds were receiving RASi and/or BB, respectively, while less than 15% received ARNI, MRA, or SGLT2i. Less than 10% of patients with HFpEF were receiving SGLT2i.</p><p><strong>Conclusions: </strong>Under real-world conditions, HF in aCKD patients is sub-optimally treated. Increased awareness of current guidelines and pragmatic trials specifically enrolling these patients represent unmet medical needs.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"202-214"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140183853","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":"Efficacy of Modern Therapies for Heart Failure with Reduced Ejection Fraction in Specific Population Subgroups: A Systematic Review and Network Meta-Analysis.","authors":"Carlo Lavalle, Marco Valerio Mariani, Paolo Severino, Marta Palombi, Sara Trivigno, Andrea D'Amato, Giacomo Silvetti, Nicola Pierucci, Luca Di Lullo, Cristina Chimenti, Francesco Summaria, Claudio Ronco, Roberto Badagliacca, Fabio Miraldi, Carmine Dario Vizza","doi":"10.1159/000541393","DOIUrl":"10.1159/000541393","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy and safety of emerging therapies for heart failure with reduced ejection fraction (HFrEF) have never been compared in specific subgroups of patients.</p><p><strong>Methods: </strong>PubMed, Cochrane Registry, Web of Science, Scopus, and EMBASE libraries were used to extract data. We used the following keywords: (heart failure with reduced ejection fraction OR HFrEF) AND (treatment OR therapy) OR (cardiovascular death) OR (hospitalization for heart failure). We compared randomized clinical trials for HFrEF emerging therapies focusing on the elderly (patients &gt;65 years old and &gt;75 years old), chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) &lt; 60 mL/min), patients with diabetes mellitus (DM), coronary heart disease (CAD), New York Heart Association (NYHA) class III/IV, women, patients on sacubitril/valsartan (S/V). The primary outcome was the efficacy composite endpoint of cardiovascular death (CVD) and HF hospitalization (HFH).</p><p><strong>Results: </strong>S/V significantly reduced the primary outcome in patients &gt;65 years old (RR: 0.80; 95% CI: 0.68-0.94) and with CKD (RR: 0.79; 95% CI: 0.69-0.90); dapagliflozin in patients &gt;65 (RR: 0.72; 95% CI: 0.60-0.86) and &gt;75 years old (RR: 0.68; 95% CI: 0.53-0.87), in those with CKD (RR: 0.72; 95% CI: 0.59-0.88), DM (RR: 0.75; 95% CI: 0.63-0.89), and CAD (RR: 0.77; 95% CI: 0.65-0.92); empagliflozin in patients &gt;65 years old (RR: 0.78; 95% CI: 0.66-0.93), those with DM (RR: 0.72; 95% CI: 0.60-0.86), CAD (RR: 0.82; 95% CI: 0.68-0.99), women (RR: 0.59; 95% CI: 0.44-0.79), and in patients on S/V (RR: 0.64; 95% CI: 0.45-0.91); vericiguat in patients with CKD (RR: 0.84; 95% CI: 0.73-0.97) and NYHA class III/IV (RR: 0.87; 95% CI: 0.77-0.98); omecamtiv mecarbil in patients with CAD (RR: 0.90; 95% CI: 0.82-0.99) and NYHA III/IV (RR: 0.88; 95% CI: 0.80-0.97).</p><p><strong>Conclusion: </strong>Emerging HFrEF therapies show a clinical benefit with the reduction of the primary composite endpoint of CVD and HFH, with each drug being more effective in specific patient population.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"570-580"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280639","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}