Yong Feng Tang, Yong Tian Su, Li Juan Liang, Yong Feng, Xiang Jiao Huang, Xue Lian Xiang, Zhi Hai Liang
Objectives
Gallstones affect a significant proportion of U.S. adults and can cause serious complications. We aimed to investigate the association between gallstone disease and common metabolic disorders in a nationally representative sample in the United States.
Methods
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected from 2017 to 2020. We included 6164 participants meeting the eligibility criteria, which represented 171 407 370 participants. The associations between gallstone disease and six metabolic disorders were analyzed using multivariate logistic regression analyses, accounting for potential confounding factors. Subgroup analyses were conducted by age, gender, and race.
Results
Altogether 10.9% of participants had gallstone disease, with prevalence increasing with age (mean age with vs. without gallstones: 56.435 years vs. 46.896 years, p < 0.001) and a female predominance (75.1% vs. 24.9%, p < 0.001). Non-alcoholic fatty liver disease (NAFLD), obesity, hypertension, and diabetes mellitus were significantly associated with an increased risk of gallstone formation, with adjusted odds ratios (OR) of 1.523 (95% confidence interval [CI] 1.180–1.965, p = 0.002), 1.733 (95% CI 1.265–2.374, p = 0.001), 1.466 (95% CI 1.203–1.785, p = 0.001), and 1.522 (95% CI 1.165–1.989, p = 0.003), respectively. These associations were more pronounced in individuals under 60 years of age and in females. No significant associations were observed with hyperlipidemia or hyperuricemia.
Conclusions
Gallstone disease is significantly associated with obesity, NAFLD, diabetes mellitus, and hypertension, with stronger associations found in younger individuals and females. Sensitivity analyses confirmed the robustness of these findings.
{"title":"Association Between Metabolic Dysfunction and Gallstone Disease in U.S. Adults: An Analysis of the National Health and Nutrition Examination Survey","authors":"Yong Feng Tang, Yong Tian Su, Li Juan Liang, Yong Feng, Xiang Jiao Huang, Xue Lian Xiang, Zhi Hai Liang","doi":"10.1111/1751-2980.13349","DOIUrl":"10.1111/1751-2980.13349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Gallstones affect a significant proportion of U.S. adults and can cause serious complications. We aimed to investigate the association between gallstone disease and common metabolic disorders in a nationally representative sample in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected from 2017 to 2020. We included 6164 participants meeting the eligibility criteria, which represented 171 407 370 participants. The associations between gallstone disease and six metabolic disorders were analyzed using multivariate logistic regression analyses, accounting for potential confounding factors. Subgroup analyses were conducted by age, gender, and race.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 10.9% of participants had gallstone disease, with prevalence increasing with age (mean age with vs. without gallstones: 56.435 years vs. 46.896 years, <i>p</i> < 0.001) and a female predominance (75.1% vs. 24.9%, <i>p</i> < 0.001). Non-alcoholic fatty liver disease (NAFLD), obesity, hypertension, and diabetes mellitus were significantly associated with an increased risk of gallstone formation, with adjusted odds ratios (OR) of 1.523 (95% confidence interval [CI] 1.180–1.965, <i>p</i> = 0.002), 1.733 (95% CI 1.265–2.374, <i>p</i> = 0.001), 1.466 (95% CI 1.203–1.785, <i>p</i> = 0.001), and 1.522 (95% CI 1.165–1.989, <i>p</i> = 0.003), respectively. These associations were more pronounced in individuals under 60 years of age and in females. No significant associations were observed with hyperlipidemia or hyperuricemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Gallstone disease is significantly associated with obesity, NAFLD, diabetes mellitus, and hypertension, with stronger associations found in younger individuals and females. Sensitivity analyses confirmed the robustness of these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 3-4","pages":"158-169"},"PeriodicalIF":2.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150576","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}
Muhammad Tayyab Anwar, Muhammad Shahzil, Taha Bin Arif, Muhammad Ali Khaqan, Edzel Lorraine Co, Fariha Hasan, Rameez Tarar, Hamza Naeem, Sibgha Farooq, Ali Jaan, Ammad Javaid Chaudhary, Vinay Jahagirdar, Reena Salgia
Objectives
Autoimmune Hepatitis (AIH) is a chronic inflammatory liver disease with significant morbidity and mortality if untreated. Current first-line treatment involves corticosteroids and azathioprine (AZA), which are effective but are associated with significant adverse effects and treatment intolerance. Mycophenolate mofetil (MMF), an immunosuppressive agent with a potentially better safety profile, has emerged as an alternative. This meta-analysis evaluated the efficacy and safety of MMF compared to AZA in treatment-naïve AIH patients.
Methods
We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Databases were searched for articles published up to May 2024. Statistical analysis was performed using RevMan, employing a random-effects model.
Results
Five studies involving 621 patients were included. MMF showed significantly higher rates of complete biochemical response compared to AZA (odds ratio [OR] 3.64, 95% confidence interval [CI] 2.07–6.40, p < 0.00001) and lower non-response rates (OR 0.45, 95% CI 0.24–0.85, p = 0.01). Corticosteroid withdrawal rates were also higher in the MMF group (OR 2.89, 95% CI 1.69–4.94, p = 0.0001). Relapse rate and cumulative prednisolone dose were comparable between the two groups. MMF demonstrated a better safety profile, with significantly lower rates of gastrointestinal symptoms (OR 0.46, 95% CI 0.27–0.79, p = 0.005).
Conclusions
MMF shows superior efficacy and tolerability compared to AZA in treatment-naïve AIH patients and may serve as a preferred first-line therapy, offering improved patient adherence and clinical outcomes. Further randomized controlled trials are warranted to confirm these findings.
{"title":"MMF Is an Effective and Safer Treatment Options for Treatment-Naïve Patients With Autoimmune Hepatitis Compared to Azathioprine: A Systematic Review and Meta-Analysis","authors":"Muhammad Tayyab Anwar, Muhammad Shahzil, Taha Bin Arif, Muhammad Ali Khaqan, Edzel Lorraine Co, Fariha Hasan, Rameez Tarar, Hamza Naeem, Sibgha Farooq, Ali Jaan, Ammad Javaid Chaudhary, Vinay Jahagirdar, Reena Salgia","doi":"10.1111/1751-2980.13348","DOIUrl":"10.1111/1751-2980.13348","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Autoimmune Hepatitis (AIH) is a chronic inflammatory liver disease with significant morbidity and mortality if untreated. Current first-line treatment involves corticosteroids and azathioprine (AZA), which are effective but are associated with significant adverse effects and treatment intolerance. Mycophenolate mofetil (MMF), an immunosuppressive agent with a potentially better safety profile, has emerged as an alternative. This meta-analysis evaluated the efficacy and safety of MMF compared to AZA in treatment-naïve AIH patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Databases were searched for articles published up to May 2024. Statistical analysis was performed using RevMan, employing a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five studies involving 621 patients were included. MMF showed significantly higher rates of complete biochemical response compared to AZA (odds ratio [OR] 3.64, 95% confidence interval [CI] 2.07–6.40, <i>p</i> < 0.00001) and lower non-response rates (OR 0.45, 95% CI 0.24–0.85, <i>p</i> = 0.01). Corticosteroid withdrawal rates were also higher in the MMF group (OR 2.89, 95% CI 1.69–4.94, <i>p</i> = 0.0001). Relapse rate and cumulative prednisolone dose were comparable between the two groups. MMF demonstrated a better safety profile, with significantly lower rates of gastrointestinal symptoms (OR 0.46, 95% CI 0.27–0.79, <i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>\u0000 MMF shows superior efficacy and tolerability compared to AZA in treatment-naïve AIH patients and may serve as a preferred first-line therapy, offering improved patient adherence and clinical outcomes. Further randomized controlled trials are warranted to confirm these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 3-4","pages":"113-128"},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093932","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}
We aimed to evaluate the consistency between endoscopic grading of gastric intestinal metaplasia (EGGIM) and the operative link on gastric intestinal metaplasia assessment (OLGIM) staging, as well as the value of endoscopic grading of gastric intestinal metaplasia (GIM) in early gastric cancer (EGC) risk.
Methods
The sample size was estimated to be at least 210 patients. To evaluate GIM, EGGIM staging was used during magnifying endoscopy with narrow-band imaging, while the OLGIM staging was carried out according to the updated Sydney system. The consistency between the two scoring systems and the accuracy of EGGIM in diagnosing OLGIM III/IV cases were evaluated. EGC risk was evaluated using the Kimura–Takemoto classification, the operative link on gastritis assessment (OLGA)/OLGIM, and EGGIM.
Results
Among the 210 patients, 68 (32.4%) had (previous) EGC and 142 (67.6%) had chronic atrophic gastritis (CAG). EGGIM and OLGIM staging showed good consistency (κ = 0.805, U = 12.620, p < 0.001) in diagnosing OLGIM III/IV GIM, with an area under the receiver operating characteristic curve for EGGIM of 0.95. Using a cut-off value of > 4, the sensitivity and specificity were 95.7% and 91.4%, respectively. The EGGIM score was higher in the EGC group than in the CAG group (4.93 vs. 3.92, p < 0.001).
Conclusions
EGGIM shows good diagnostic performance and consistency with OLGIM, which can simplify endoscopic surveillance by reducing the need for biopsy. The EGGIM score is associated with EGC risk, and endoscopic surveillance is recommended for patients with EGGIM score > 4.
目的：评价内镜下胃肠化生分级（EGGIM）与手术环节对胃肠化生分级（OLGIM）分期的一致性，以及内镜下胃肠化生分级（GIM）在早期胃癌（EGC）风险中的价值。方法：样本量估计至少为210例患者。为了评估GIM，在窄带放大内镜下使用EGGIM分期，而OLGIM分期根据更新的Sydney系统进行。评价两种评分系统的一致性及EGGIM诊断OLGIM III/IV型病例的准确性。采用Kimura-Takemoto分级、胃炎手术环节评估(OLGA)/OLGIM和EGGIM评估EGC风险。结果：210例患者中有（既往）EGC 68例（32.4%），慢性萎缩性胃炎142例（67.6%）。EGGIM与OLGIM分期一致性较好（κ = 0.805, U = 12.620, p = 4），敏感性95.7%，特异性91.4%。EGC组EGGIM评分高于CAG组（4.93比3.92,p）结论：EGGIM与OLGIM具有良好的诊断性能和一致性，可以通过减少活检来简化内镜监测。EGGIM评分与EGC风险相关，建议对EGGIM评分为bb40的患者进行内镜监测。
{"title":"The Role of Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) in Assessing the Extent and Degree of Gastric Intestinal Metaplasia","authors":"Dong Lyu, Jing Zhao, Hai Feng Jin, Bin Lyu","doi":"10.1111/1751-2980.13346","DOIUrl":"10.1111/1751-2980.13346","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to evaluate the consistency between endoscopic grading of gastric intestinal metaplasia (EGGIM) and the operative link on gastric intestinal metaplasia assessment (OLGIM) staging, as well as the value of endoscopic grading of gastric intestinal metaplasia (GIM) in early gastric cancer (EGC) risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample size was estimated to be at least 210 patients. To evaluate GIM, EGGIM staging was used during magnifying endoscopy with narrow-band imaging, while the OLGIM staging was carried out according to the updated Sydney system. The consistency between the two scoring systems and the accuracy of EGGIM in diagnosing OLGIM III/IV cases were evaluated. EGC risk was evaluated using the Kimura–Takemoto classification, the operative link on gastritis assessment (OLGA)/OLGIM, and EGGIM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 210 patients, 68 (32.4%) had (previous) EGC and 142 (67.6%) had chronic atrophic gastritis (CAG). EGGIM and OLGIM staging showed good consistency (<i>κ</i> = 0.805, <i>U</i> = 12.620, <i>p</i> < 0.001) in diagnosing OLGIM III/IV GIM, with an area under the receiver operating characteristic curve for EGGIM of 0.95. Using a cut-off value of > 4, the sensitivity and specificity were 95.7% and 91.4%, respectively. The EGGIM score was higher in the EGC group than in the CAG group (4.93 vs. 3.92, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EGGIM shows good diagnostic performance and consistency with OLGIM, which can simplify endoscopic surveillance by reducing the need for biopsy. The EGGIM score is associated with EGC risk, and endoscopic surveillance is recommended for patients with EGGIM score > 4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 3-4","pages":"129-134"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995591","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}
Li Li Zhang, Feng Zhang, Kai Wang, Yu Hu Song, Ying Zhang, Zhen Yu Zhou, Wei Jie Dai, Lei Wang, Huan Chen, Qin Yin, Yu Zheng Zhuge, Wei Zhang
Objectives
The Drum Tower Severity Scoring (DTSS) system is a novel tool designed for assessing the outcome of anticoagulation therapy and disease severity in patients with pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS). The aim of this study was to validate the predictive performance of the DTSS system in PA-HSOS patient outcome.
Methods
We conducted a retrospective analysis of 111 PA-HSOS patients who received standard anticoagulation–transjugular intrahepatic portosystemic shunt (TIPS) stepwise therapy from six hospitals in China. Patients were categorized into two groups based on whether they responded to anticoagulation therapy. The predictive performance of the DTSS system was evaluated through the efficacy of anticoagulation therapy, the area under the receiver operating characteristic curve (AUROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) analysis.
Results
The response rates to anticoagulation therapy varied among patients with DTSS of different severity, being 94.12% for mild, 57.81% for moderate, and 13.33% for severe cases. The DTSS system demonstrated a robust predictive performance, with an AUROC of 0.864. The calibration curve indicated a close match between the predicted and observed effects of the DTSS system. Good calibration was confirmed by the Hosmer–Lemeshow test (p = 0.704), and both the DCA and CIC analysis indicated high clinical utility of the DTSS system.
Conclusion
The DTSS system is a practical tool that uses easily accessible data to predict the initial response to anticoagulation therapy in PA-HSOS patients, showing robust predictive performance and significant clinical benefit in guiding personalized management strategies.
{"title":"Validation of Drum Tower Severity Scoring (DTSS) System for Pyrrolizidine Alkaloid-Induced Hepatic Sinusoidal Obstruction Syndrome","authors":"Li Li Zhang, Feng Zhang, Kai Wang, Yu Hu Song, Ying Zhang, Zhen Yu Zhou, Wei Jie Dai, Lei Wang, Huan Chen, Qin Yin, Yu Zheng Zhuge, Wei Zhang","doi":"10.1111/1751-2980.13347","DOIUrl":"10.1111/1751-2980.13347","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The Drum Tower Severity Scoring (DTSS) system is a novel tool designed for assessing the outcome of anticoagulation therapy and disease severity in patients with pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS). The aim of this study was to validate the predictive performance of the DTSS system in PA-HSOS patient outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of 111 PA-HSOS patients who received standard anticoagulation–transjugular intrahepatic portosystemic shunt (TIPS) stepwise therapy from six hospitals in China. Patients were categorized into two groups based on whether they responded to anticoagulation therapy. The predictive performance of the DTSS system was evaluated through the efficacy of anticoagulation therapy, the area under the receiver operating characteristic curve (AUROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The response rates to anticoagulation therapy varied among patients with DTSS of different severity, being 94.12% for mild, 57.81% for moderate, and 13.33% for severe cases. The DTSS system demonstrated a robust predictive performance, with an AUROC of 0.864. The calibration curve indicated a close match between the predicted and observed effects of the DTSS system. Good calibration was confirmed by the Hosmer–Lemeshow test (<i>p</i> = 0.704), and both the DCA and CIC analysis indicated high clinical utility of the DTSS system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The DTSS system is a practical tool that uses easily accessible data to predict the initial response to anticoagulation therapy in PA-HSOS patients, showing robust predictive performance and significant clinical benefit in guiding personalized management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 3-4","pages":"150-157"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995019","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}
Ying Zhou, Bai Sheng Chen, Qi Jiang, Na Shan Li, Pei Hong Zhang, Dan Feng Zhang, Yuan Ling Ruan, Ping Li, Xia Wu, Ping Hong Zhou, Wei Feng Chen
Objectives
In this study, we aimed to evaluate the effectiveness of a novel endoscopic purse-string suture auxiliary instrument compared with traditional methods for closure of a full-thickness defect of the stomach in an ex vivo model.
Methods
Twelve perforation sites (10–20 mm in diameter) were created in the ex vivo porcine stomach models. Two physicians (A and B had performed endoscopic surgery for 6 and 3 years) performed suturing using both the experimental and traditional (control) instruments. Operation time, success rate, and number of attempts for successful suture required were recorded.
Results
For physician A, the median suturing time was 56.50 s (interquartile range [IQR] 40.50 s, 134.50 s) and 215.50 s (IQR 63.75 s, 254.75 s) in the experimental and control groups. For physician B, they were 53.00 s (IQR 38.50 s, 87.75 s) and 174.00 s (IQR 104.50 s, 279.25 s), respectively. The differences between experimental and control groups were statistically significant for both physicians A (p = 0.010) and B (p = 0.004). The median number of attempts required for successful suturing in the experimental and control groups was 1 (IQR 1, 2) and 2 (IQR 1, 3) for physician A, and 1 (IQR 1, 1) and 3 (IQR 2, 3) for physician B, which were statistically significant for both physicians (p = 0.026 and 0.006). The overall success rate was significantly higher in the experimental group (100% vs. 75.0%, p = 0.022).
Conclusion
This novel purse-string suture auxiliary instrument may assist in single-channel endoscopic suturing operations, improve the suture success rate, reduce the number of operations required, and shorten the operation time.
在本研究中，我们旨在评估一种新型内镜下荷包缝合辅助器械与传统方法在离体胃全层缺损闭合中的有效性。方法在离体猪胃模型上建立12个直径为10 ~ 20mm的穿孔部位。两名医生（A和B分别进行了6年和3年的内窥镜手术）使用实验和传统（对照）器械进行缝合。记录手术时间、成功率及成功缝合次数。结果A医生的缝合时间中位数分别为56.50 s（四分位差[IQR] 40.50 s、134.50 s）和215.50 s（四分位差[IQR] 63.75 s、254.75 s）。B医师分别为53.00 s （IQR 38.50 s, 87.75 s）和174.00 s （IQR 104.50 s, 279.25 s）。A医生和B医生在实验组和对照组之间的差异均有统计学意义（p = 0.010）和（p = 0.004）。实验组和对照组缝合成功所需尝试次数中位数A医师为1次（IQR 1,2）和2次（IQR 1,3）， B医师为1次（IQR 1,1）和3次（IQR 2,3），两种医师的差异均有统计学意义（p = 0.026和0.006）。实验组的总成功率明显高于对照组（100% vs. 75.0%, p = 0.022）。结论新型荷包缝合辅助器械可辅助单通道内镜缝合手术，提高缝合成功率，减少手术次数，缩短手术时间。
{"title":"A Study of a Novel Disposable Endoscopic Purse-String Suture Auxiliary Instrument for the Treatment of Full-Thickness Gastric Wall Defects","authors":"Ying Zhou, Bai Sheng Chen, Qi Jiang, Na Shan Li, Pei Hong Zhang, Dan Feng Zhang, Yuan Ling Ruan, Ping Li, Xia Wu, Ping Hong Zhou, Wei Feng Chen","doi":"10.1111/1751-2980.13338","DOIUrl":"https://doi.org/10.1111/1751-2980.13338","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In this study, we aimed to evaluate the effectiveness of a novel endoscopic purse-string suture auxiliary instrument compared with traditional methods for closure of a full-thickness defect of the stomach in an ex vivo model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twelve perforation sites (10–20 mm in diameter) were created in the ex vivo porcine stomach models. Two physicians (A and B had performed endoscopic surgery for 6 and 3 years) performed suturing using both the experimental and traditional (control) instruments. Operation time, success rate, and number of attempts for successful suture required were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For physician A, the median suturing time was 56.50 s (interquartile range [IQR] 40.50 s, 134.50 s) and 215.50 s (IQR 63.75 s, 254.75 s) in the experimental and control groups. For physician B, they were 53.00 s (IQR 38.50 s, 87.75 s) and 174.00 s (IQR 104.50 s, 279.25 s), respectively. The differences between experimental and control groups were statistically significant for both physicians A (<i>p</i> = 0.010) and B (<i>p</i> = 0.004). The median number of attempts required for successful suturing in the experimental and control groups was 1 (IQR 1, 2) and 2 (IQR 1, 3) for physician A, and 1 (IQR 1, 1) and 3 (IQR 2, 3) for physician B, which were statistically significant for both physicians (<i>p</i> = 0.026 and 0.006). The overall success rate was significantly higher in the experimental group (100% vs. 75.0%, <i>p</i> = 0.022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This novel purse-string suture auxiliary instrument may assist in single-channel endoscopic suturing operations, improve the suture success rate, reduce the number of operations required, and shorten the operation time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 1-2","pages":"74-79"},"PeriodicalIF":2.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884081","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}
Xin Yi Lu, Yu Xiang Wen, Ni Jiang, Si Qi Zhou, Tian Yang, Liang Liang Shi, Hui Min Guo, Wei Zhang, Qi Peng Zhang, Ni Na Zhang
Objectives
Designer receptors exclusively activated by designer drugs (DREADDs)-based chemogenetic tools are commonly used to activate or silence targeted neurons by the agonistic ligand deschloroclozapine (DCZ). This study aimed to establish a Gi-DREADD-based murine model of slow transit constipation (STC) and elucidate its pathophysiological mechanisms.
Methods
Adeno-associated virus (AAV) 9-hM4Di was injected into the intestinal wall of mice, and colonic motility was evaluated. The efficiency and immunogenicity of AAV9-hM4Di transduction in the enteric nervous system (ENS) were evaluated. Nitric oxide (NO), acetylcholine (ACh), and substance P (SP) in the colonic tissues and serum samples were analyzed. Calcium (Ca2+) imaging was performed to evaluate the responses of AAV9-hM4Di on enteric nerves.
Results
AAV9-hM4Di-treated mice showed gastrointestinal motility dysfunction, including reduced fecal pellets and decreased fecal mass and water content. Electrophysiological recording of muscle contraction in the isolated colonic tissues from the chemogenetic mice showed decreased frequency and amplitude after DCZ treatment. The mice treated with AAV9-hM4Di showed the highest levels of transduction in the myenteric plexuses of the ENS. There were no differences in transduction in neuronal nitric oxide synthase (nNOS) and choline acetyltransferase (ChAT) neurons. Gi-DREADDs significantly downregulated ACh but not NO or SP expression in the distal colon in the chemogenetic mice. Ca2+ transient in neurons of ENS in chemogenetic mice was strongly inhibited by DCZ.
Conclusions
It is feasible to apply the DREADDs-based chemogenetic tools to the ENS. Gi-DREADDs can selectively modulate the ENS, inducing STC without excitatory-neural bias, offering targeted neuromodulation for gastrointestinal motility disorders.
{"title":"DREADDs-Based Chemogenetics Induced Slow Transit Constipation via Inhibition of Enteric Neurons","authors":"Xin Yi Lu, Yu Xiang Wen, Ni Jiang, Si Qi Zhou, Tian Yang, Liang Liang Shi, Hui Min Guo, Wei Zhang, Qi Peng Zhang, Ni Na Zhang","doi":"10.1111/1751-2980.13344","DOIUrl":"https://doi.org/10.1111/1751-2980.13344","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Designer receptors exclusively activated by designer drugs (DREADDs)-based chemogenetic tools are commonly used to activate or silence targeted neurons by the agonistic ligand deschloroclozapine (DCZ). This study aimed to establish a Gi-DREADD-based murine model of slow transit constipation (STC) and elucidate its pathophysiological mechanisms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adeno-associated virus (AAV) 9-hM4Di was injected into the intestinal wall of mice, and colonic motility was evaluated. The efficiency and immunogenicity of AAV9-hM4Di transduction in the enteric nervous system (ENS) were evaluated. Nitric oxide (NO), acetylcholine (ACh), and substance P (SP) in the colonic tissues and serum samples were analyzed. Calcium (Ca<sup>2+</sup>) imaging was performed to evaluate the responses of AAV9-hM4Di on enteric nerves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AAV9-hM4Di-treated mice showed gastrointestinal motility dysfunction, including reduced fecal pellets and decreased fecal mass and water content. Electrophysiological recording of muscle contraction in the isolated colonic tissues from the chemogenetic mice showed decreased frequency and amplitude after DCZ treatment. The mice treated with AAV9-hM4Di showed the highest levels of transduction in the myenteric plexuses of the ENS. There were no differences in transduction in neuronal nitric oxide synthase (nNOS) and choline acetyltransferase (ChAT) neurons. Gi-DREADDs significantly downregulated ACh but not NO or SP expression in the distal colon in the chemogenetic mice. Ca<sup>2+</sup> transient in neurons of ENS in chemogenetic mice was strongly inhibited by DCZ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>It is feasible to apply the DREADDs-based chemogenetic tools to the ENS. Gi-DREADDs can selectively modulate the ENS, inducing STC without excitatory-neural bias, offering targeted neuromodulation for gastrointestinal motility disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 1-2","pages":"62-73"},"PeriodicalIF":2.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13344","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883781","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}
Shuai Xia, Zhi Ying He, Xiao Ning Wu, Xiao Fei Tong, Min Li, Shan Shan Wu, Wen Zhang, Ji Dong Jia, Bing Qiong Wang, Hong You
Objectives
Etiological therapy has been documented to improve portal hypertension. We aimed to analyze the effectiveness of etiological therapy on hepatic venous pressure gradient (HVPG) reduction by conducting a systematic review and meta-analysis.
Methods
Literature search of the PubMed, EMBASE, and Cochrane Library was performed to identify studies involving patients with PHT published up to January 2024. The absolute HVPG reduction and the HVPG response rate were assessed. Pooled analyses were performed using random-effects models, and the heterogeneity was evaluated using sensitivity and subgroup analyses.
Results
Altogether 21 studies were included for analysis. After etiological therapy, the absolute reduction in HVPG was 2.25 mmHg (95% confidence interval [CI] 1.80–2.71). Longer (> 1 year) duration of etiological therapy showed more significant HVPG reduction compared with those treated with 1 year or less (3.02 mmHg vs. 2.24 mmHg, p = 0.001). A more pronounced HVPG reduction was also observed in patients with viral hepatitis-induced cirrhosis than in those with non-viral hepatitis-induced cirrhosis (2.39 mmHg vs. 1.27 mmHg, p = 0.001). Furthermore, 64% and 41% of patients showed ≥ 10% HVPG reduction and a reduction of ≥ 20% or to ≤ 12 mmHg, respectively, after etiology control.
Conclusion
Effective etiology control can significantly decrease HVPG and increase the HVPG response rate, which may contribute to the improvement of the prognosis of cirrhotic patients.
目的病因治疗已被证实可改善门静脉高压症。我们的目的是通过系统回顾和荟萃分析来分析病因治疗对肝静脉压梯度（HVPG）降低的有效性。方法对PubMed、EMBASE和Cochrane图书馆进行文献检索，以确定截至2024年1月发表的涉及PHT患者的研究。评估HVPG绝对减少率和HVPG缓解率。采用随机效应模型进行合并分析，采用敏感性和亚组分析评估异质性。结果共纳入21项研究进行分析。病因治疗后，HVPG绝对降低2.25 mmHg（95%可信区间[CI] 1.80-2.71）。病因治疗持续时间较长（1年）的患者与治疗时间不超过1年的患者相比，HVPG降低更为显著（3.02 mmHg vs. 2.24 mmHg, p = 0.001）。与非病毒性肝炎肝硬化患者相比，病毒性肝炎肝硬化患者的HVPG降低更为明显（2.39 mmHg vs. 1.27 mmHg, p = 0.001）。此外，在病因控制后，64%和41%的患者HVPG降低≥10%，降低≥20%或≤12 mmHg。结论有效的病因控制可显著降低肝硬化患者的HVPG水平，提高HVPG应答率，有助于改善肝硬化患者的预后。
{"title":"Etiology Control for Reducing Hepatic Vein Pressure Gradient in Patients With Cirrhosis and Portal Hypertension: A Systematic Review and Meta-Analysis","authors":"Shuai Xia, Zhi Ying He, Xiao Ning Wu, Xiao Fei Tong, Min Li, Shan Shan Wu, Wen Zhang, Ji Dong Jia, Bing Qiong Wang, Hong You","doi":"10.1111/1751-2980.13343","DOIUrl":"https://doi.org/10.1111/1751-2980.13343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Etiological therapy has been documented to improve portal hypertension. We aimed to analyze the effectiveness of etiological therapy on hepatic venous pressure gradient (HVPG) reduction by conducting a systematic review and meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Literature search of the PubMed, EMBASE, and Cochrane Library was performed to identify studies involving patients with PHT published up to January 2024. The absolute HVPG reduction and the HVPG response rate were assessed. Pooled analyses were performed using random-effects models, and the heterogeneity was evaluated using sensitivity and subgroup analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 21 studies were included for analysis. After etiological therapy, the absolute reduction in HVPG was 2.25 mmHg (95% confidence interval [CI] 1.80–2.71). Longer (> 1 year) duration of etiological therapy showed more significant HVPG reduction compared with those treated with 1 year or less (3.02 mmHg vs. 2.24 mmHg, <i>p =</i> 0.001). A more pronounced HVPG reduction was also observed in patients with viral hepatitis-induced cirrhosis than in those with non-viral hepatitis-induced cirrhosis (2.39 mmHg vs. 1.27 mmHg, <i>p =</i> 0.001). Furthermore, 64% and 41% of patients showed ≥ 10% HVPG reduction and a reduction of ≥ 20% or to ≤ 12 mmHg, respectively, after etiology control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Effective etiology control can significantly decrease HVPG and increase the HVPG response rate, which may contribute to the improvement of the prognosis of cirrhotic patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 1-2","pages":"31-43"},"PeriodicalIF":2.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884101","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}
Kaitlyn Delaney Chappell, Otgonbayar Chinbaatar, Karen J. Goodman, Karen I. Kroeker
Objectives
People with inflammatory bowel disease (IBD) suffer from relapsing and remitting symptoms of gastrointestinal upset and are at substantial risk of experiencing comorbid mental distress symptoms. We aimed to conduct a systematic review of the evidence surrounding mental health telehealth interventions for IBD patients.
Methods
We searched EMBASE, MEDLINE, CINAHL, Scopus, and PsychINFO to systematically identify studies that evaluated the feasibility and acceptability of telehealth-based psychological and mind–body interventions to treat the physical and psychosocial symptoms of IBD patients. Predefined data extraction variables included descriptions of the interventions, participation and dropout rates, and preliminary effectiveness. The data was synthesized using tabular data displayed for quantitative variables and presented as narrative summaries to allow for comparison.
Results
Seven studies including 313 participants met our criteria and were included in the review. All studies evaluated distinct interventions. Participation rates ranged 32.4%–75%, and drop-out rates ranged 0%–33%. Most participants reported improvements in their quality of life and mental symptoms, and high satisfaction within their interventions. The authors of all included studies concluded that their interventions were feasible.
Conclusions
The evidence to support using telehealth-based psychological and mind–body interventions to support individuals with IBD is limited, but promising. Interventions were positively evaluated, strongly adhered to, and preliminary effectiveness data suggest that these interventions could improve the psychosocial well-being of people with IBD. Future research is warranted to assess the effectiveness of these interventions and to evaluate the barriers to integrating them into IBD care.
{"title":"The Future of Telehealth-Based Psychological and Mind–Body Interventions for People With Inflammatory Bowel Disease: A Systematic Review","authors":"Kaitlyn Delaney Chappell, Otgonbayar Chinbaatar, Karen J. Goodman, Karen I. Kroeker","doi":"10.1111/1751-2980.13342","DOIUrl":"10.1111/1751-2980.13342","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>People with inflammatory bowel disease (IBD) suffer from relapsing and remitting symptoms of gastrointestinal upset and are at substantial risk of experiencing comorbid mental distress symptoms. We aimed to conduct a systematic review of the evidence surrounding mental health telehealth interventions for IBD patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched EMBASE, MEDLINE, CINAHL, Scopus, and PsychINFO to systematically identify studies that evaluated the feasibility and acceptability of telehealth-based psychological and mind–body interventions to treat the physical and psychosocial symptoms of IBD patients. Predefined data extraction variables included descriptions of the interventions, participation and dropout rates, and preliminary effectiveness. The data was synthesized using tabular data displayed for quantitative variables and presented as narrative summaries to allow for comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven studies including 313 participants met our criteria and were included in the review. All studies evaluated distinct interventions. Participation rates ranged 32.4%–75%, and drop-out rates ranged 0%–33%. Most participants reported improvements in their quality of life and mental symptoms, and high satisfaction within their interventions. The authors of all included studies concluded that their interventions were feasible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The evidence to support using telehealth-based psychological and mind–body interventions to support individuals with IBD is limited, but promising. Interventions were positively evaluated, strongly adhered to, and preliminary effectiveness data suggest that these interventions could improve the psychosocial well-being of people with IBD. Future research is warranted to assess the effectiveness of these interventions and to evaluate the barriers to integrating them into IBD care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 3-4","pages":"100-112"},"PeriodicalIF":2.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13342","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999544","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}
Yi Min Mao, Jie Ting Tang, Zhong Hua Lu, Ming Shao, Wei Feng Zhao, Jun Zhan, Zu Xiong Huang, Qing Hui Niu, Lin Chen, Zhan Feng Chen, Chun Hui Guo, Zi Hui Jia, Hai Li, Bo Liu, Jing Miao, Zhong Tian Peng, Yong Lan Pu, Li Hong Qu, Xiao Ming Shen, Wei Sun, Hong Wu Wang, Xiao Lan Lu, Jian Jun Xue, Ya Yun Yang, Zheng Yang, Zhong Hui Yang, Qing Ge Zhang, Tao Niu, Wei Dong Zhu, Xiao Lin Liu, Wei Zhong, Yi Nuo Dong, Yang Zhi, Xiao Yun Li, the Technology Committee on DILI Prevention, Management, Chinese Medical Biotechnology Association; Committee on Drug Liver Safety, China Primary Health Care Foundation; Study Group on Drug Induced Liver Disease, Chinese Society of Hepatology, Chinese Medical Association
Drug-induced liver injury (DILI) is a drug-induced disease that not only complicates the treatment of the primary disease but may also lead to acute liver failure or even death in severe cases. Drugs commonly used in primary care, such as anti-infective agents and nonsteroidal anti-inflammatory drugs, are major causes of DILI. In addition, a large elderly population, comorbidities, and combination therapy with multiple drugs increase the risk of DILI in primary care. Therefore, primary care providers should proactively screen and monitor high-risk patients to identify potential DILI timely. Currently, diagnosis of DILI relies on the exclusion of liver diseases of other etiologies. Collection of detailed medical history of the patients and careful exclusion of other potential liver injury of other etiologies are crucial for accurate diagnosis. This guideline, developed based on evidence-based medicine from the latest research, aimed to provide primary care providers with professional guidance on the timely identification of suspected DILI cases and standardized diagnosis and management in clinical practice.
{"title":"Chinese Guideline for the Diagnosis and Management of Drug-Induced Liver Injury in Primary Care (2024)","authors":"Yi Min Mao, Jie Ting Tang, Zhong Hua Lu, Ming Shao, Wei Feng Zhao, Jun Zhan, Zu Xiong Huang, Qing Hui Niu, Lin Chen, Zhan Feng Chen, Chun Hui Guo, Zi Hui Jia, Hai Li, Bo Liu, Jing Miao, Zhong Tian Peng, Yong Lan Pu, Li Hong Qu, Xiao Ming Shen, Wei Sun, Hong Wu Wang, Xiao Lan Lu, Jian Jun Xue, Ya Yun Yang, Zheng Yang, Zhong Hui Yang, Qing Ge Zhang, Tao Niu, Wei Dong Zhu, Xiao Lin Liu, Wei Zhong, Yi Nuo Dong, Yang Zhi, Xiao Yun Li, the Technology Committee on DILI Prevention, Management, Chinese Medical Biotechnology Association; Committee on Drug Liver Safety, China Primary Health Care Foundation; Study Group on Drug Induced Liver Disease, Chinese Society of Hepatology, Chinese Medical Association","doi":"10.1111/1751-2980.13337","DOIUrl":"10.1111/1751-2980.13337","url":null,"abstract":"<div>\u0000 \u0000 <p>Drug-induced liver injury (DILI) is a drug-induced disease that not only complicates the treatment of the primary disease but may also lead to acute liver failure or even death in severe cases. Drugs commonly used in primary care, such as anti-infective agents and nonsteroidal anti-inflammatory drugs, are major causes of DILI. In addition, a large elderly population, comorbidities, and combination therapy with multiple drugs increase the risk of DILI in primary care. Therefore, primary care providers should proactively screen and monitor high-risk patients to identify potential DILI timely. Currently, diagnosis of DILI relies on the exclusion of liver diseases of other etiologies. Collection of detailed medical history of the patients and careful exclusion of other potential liver injury of other etiologies are crucial for accurate diagnosis. This guideline, developed based on evidence-based medicine from the latest research, aimed to provide primary care providers with professional guidance on the timely identification of suspected DILI cases and standardized diagnosis and management in clinical practice.</p>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 1-2","pages":"2-21"},"PeriodicalIF":2.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803583","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}
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