Joint Bone Spine最新文献

{"title":"Screening for transthyretin amyloid cardiomyopathy in patients with musculoskeletal symptoms: Red flags in the rheumatology/orthopedics practice setting","authors":"Thomas Bardin ,&nbsp;Nicolas Bigorre ,&nbsp;Eric Hachulla ,&nbsp;Roland Chapurlat ,&nbsp;Marc-Antoine Delbarre ,&nbsp;Laurent Obert ,&nbsp;Jean Sibilia ,&nbsp;Uma Basseville ,&nbsp;Margaux Dubois ,&nbsp;Michel Slama ,&nbsp;Olivier Lairez ,&nbsp;Thibaud Damy","doi":"10.1016/j.jbspin.2025.106028","DOIUrl":"10.1016/j.jbspin.2025.106028","url":null,"abstract":"<div><div>Musculoskeletal manifestations of transthyretin amyloidosis (ATTR) are common, early in the disease course (usually years before cardiac involvement), and are potentially predictive. They include carpal tunnel syndrome (CTS), trigger finger, atraumatic tears of the brachial biceps tendon or rotator cuff, spinal stenosis, and large joint osteoarthritis. These extra-cardiac ‘red flags’ for ATTR amyloidosis may present individually or in clusters, particularly in older males, several years in advance of signs of ATTR cardiomyopathy (ATTR-CM), such as arrhythmia or heart failure. Deposition of ATTR in the heart leads to severe, often fatal, ATTR-CM that can now be effectively treated. Available treatments slow amyloid fiber deposition but do not allow fiber removal, making early diagnosis and early treatment crucial to improve prognosis. Orthopedists’ and rheumatologists’ knowledge, recognition, and participation in the diagnostic pathway of amyloidosis-related musculoskeletal conditions may help increase suspicion, facilitate early diagnosis, allowing prompt disease-modifying treatment, improving patient outcomes. If surgical intervention is required in patients with these red flags, tissue biopsy at the time of surgery may allow early diagnosis of ATTR deposition, followed by cardiologic screening and/or patient referral to amyloidosis specialty centers if amyloid deposition is evident in biopsy findings. To improve awareness among orthopedic and rheumatology specialists, this narrative review summarizes the published literature on musculoskeletal disorders associated with ATTR amyloidosis, presents relevant diagnostic pathways and indications for histologic examination to facilitate identification of at-risk patients among large numbers of patients, and suggests appropriate follow-up approaches for patients in whom amyloidosis is detected during musculoskeletal surgical procedures.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106028"},"PeriodicalIF":4.3,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with kinesiophobia in patients with rheumatic and musculoskeletal diseases: A systematic review","authors":"Xue Ding ,&nbsp;Dan Li ,&nbsp;Jing Zhang ,&nbsp;Shujie Wang ,&nbsp;Ziyi Luo ,&nbsp;Zijing Wu","doi":"10.1016/j.jbspin.2025.106029","DOIUrl":"10.1016/j.jbspin.2025.106029","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite the importance of activity for rehabilitating patients with rheumatic and musculoskeletal diseases (RMDs), the activity levels remain suboptimal in many patients. This is partly due to kinesiophobia and avoidance behaviors triggered by concerns about pain or joint damage. This systematic review aimed to synthesize the available evidence to identify factors associated with kinesiophobia in patients with RMDs.</div></div><div><h3>Methods</h3><div>We searched 11 databases (PubMed, Web of Science, CINAHL, Cochrane Library, EMBASE, PsycINFO, Scopus, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP, SinoMed) from the time of database inception to October 11, 2025. Eligible studies were English/Chinese articles reporting factors associated with kinesiophobia in patients with RMDs. Letters, editorials, conference abstracts/presentations, and duplicate records were excluded. Study selection, quality assessment, and data extraction were independently conducted by two reviewers. The biopsychosocial model guided factor classification.</div></div><div><h3>Results</h3><div>A total of 17 studies (7,356 participants) were included, comprising one longitudinal study and 16 cross-sectional studies. Sixteen studies were rated as high quality. Guided by the biopsychosocial model, poor physical function, negative psychological states, low self-efficacy, and inadequate social support were identified as main correlates of kinesiophobia in patients with RMDs.</div></div><div><h3>Conclusion</h3><div>Kinesiophobia is prevalent in patients with RMDs, with its correlates aligning with the biopsychosocial model. Targeted multidimensional interventions (optimizing physical function, psychological regulation, and social support) may mitigate kinesiophobia and improve rehabilitation outcomes.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106029"},"PeriodicalIF":4.3,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods and strategies of bioengineered cell exosomes for the treatment of osteoarthritis","authors":"Chengjun Zhang ,&nbsp;Jinming Liu ,&nbsp;Shijie Chen ,&nbsp;Dacheng Zhao ,&nbsp;Changshun Chen ,&nbsp;Bin Geng ,&nbsp;Yayi Xia","doi":"10.1016/j.jbspin.2025.106030","DOIUrl":"10.1016/j.jbspin.2025.106030","url":null,"abstract":"<div><div>Exosomes, as nanoscale extracellular vesicles, have emerged as vital mediators of intercellular communication through the delivery of functional cargos such as proteins, lipids, DNA, and regulatory RNAs, including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and small interfering RNAs (siRNAs). Their natural biocompatibility, targeting ability, and ability to cross biological barriers make them promising therapeutic tools for osteoarthritis (OA), a degenerative joint disease characterized by cartilage degradation and chronic inflammation. In recent years, the bioengineering of exosomes has opened new avenues for enhancing their therapeutic potential in cartilage regeneration and OA treatment. This review comprehensively summarizes recent progress in exosome engineering, including the selection of parental cells, the design and targeting of exosomes, and advanced bioengineering techniques such as RNA, protein, and drug loading, as well as surface modification. We further discuss scalable approaches for exosome purification and mass production, and the incorporation of exosomes into biomaterial scaffolds or hydrogels to enable controlled release and localized delivery. In addition, we explore therapeutic strategies involving gene therapy, chemotherapy, immunotherapy, and protein therapy, highlighting the versatility of engineered exosomes in modulating inflammation, promoting chondrocyte survival, and restoring cartilage homeostasis. Emerging technologies such as synthetic exosome mimics and vexosomes are also discussed, offering insight into future directions for enhanced delivery efficiency and clinical translation. By integrating molecular biology, materials science, and therapeutic design, engineered exosomes represent a powerful platform for precision treatment of OA. This review aims to provide a theoretical foundation and practical reference for future research and clinical application in exosome-based osteoarthritis therapy.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106030"},"PeriodicalIF":4.3,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polychondritis revealing the acutisation of myelodysplasia into acute myeloid leukaemia in a 36-year-old woman: A case report","authors":"Emilie Gefard ,&nbsp;Thomas Fauthoux ,&nbsp;Raphaëlle Meunier","doi":"10.1016/j.jbspin.2025.106027","DOIUrl":"10.1016/j.jbspin.2025.106027","url":null,"abstract":"<div><div>This was a young female patient admitted to the rheumatology department with nasal and chest pain, which led to a diagnosis of polychondritis. Her medical history included myelodysplastic syndrome (MDS), which had been considered stable during a hematological reassessment a few days earlier. During the evaluation, we observed immature blood cells and biological markers of macrophage activation. This acute rheumatological manifestation allowed us to diagnose rapidly progressive acute leukemia and offer her early treatment. She is currently in remission.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 2","pages":"Article 106027"},"PeriodicalIF":4.3,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment sequences of biological and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis: A nationwide population-based study in France","authors":"Anna Molto ,&nbsp;Laurent Arnaud ,&nbsp;Mélanie Chartier ,&nbsp;Arnaud Panes ,&nbsp;Pauline Lemeille ,&nbsp;Bruno Fautrel","doi":"10.1016/j.jbspin.2025.106023","DOIUrl":"10.1016/j.jbspin.2025.106023","url":null,"abstract":"<div><h3>Objectives</h3><div>The study aimed to describe nationwide treatment sequences in French patients with rheumatoid arthritis (RA) initiating a first biological or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD).</div></div><div><h3>Methods</h3><div>This analysis is based on the French National Health Claims Database (SNDS), covering over 67 million people. Patients with RA (ICD-10 codes M05, M060, M068 or M069) and ≥<!--> <!-->2 b/tsDMARD dispensings from January 1, 2014 to December 31, 2019 were included, and followed until December 31, 2020 or death. Differences in patients characteristics at each b/tsDMARD initiation were tested with Mann Whitney U tests and χ² tests.</div></div><div><h3>Results</h3><div>Overall, 26 478 patients were identified (mean (SD) age 57.0 years (±<!--> <!-->14.4)) including 70.9% females. The most frequent first-line of b/tsDMARD were TNF inhibitors (TNFi) (62.6%), followed by abatacept (CTLA4-Ig) (12.0%), rituximab (11.0%), IL-6R inhibitors (IL-6Ri) (10.0%), and JAK inhibitors (JAKi) (3.9%). The mean (SD) follow-up duration was 3.8 years (±<!--> <!-->1.7 years,), for a total of 100 332 person-years. Throughout the study period, 12,662 patients (47.8%) maintained their first b/tsDMARD, while 7531 (28.4%) switched to a second b/tsDMARD, and 3046 (11.1%) to a third b/tsDMARD, after a mean duration of 54.1 (±<!--> <!-->34.0), 31.9 (±<!--> <!-->27.8) and 25.9 (±<!--> <!-->22.2) months, respectively. In terms of mode of action associated profiles, the main discrepancies were age, higher in CD20i and LT modulator patients, and comorbidities, more prevalent in CD20i treated patients.</div></div><div><h3>Conclusion</h3><div>In this nation-wide analysis of 26 478 patients, TNFi was the most frequently dispensed first-line b/tsDMARD, with LT modulators and IL-6i preferred in second-line therapy.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 3","pages":"Article 106023"},"PeriodicalIF":4.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of regulatory events on JAK inhibitor prescribing in rheumatoid arthritis: Insights from the French MAJIK Registry","authors":"Marie-Elise Truchetet ,&nbsp;Clément Prati ,&nbsp;Pascale Thevenot ,&nbsp;Christophe Bologna ,&nbsp;Guillermo Carvajal Alegria ,&nbsp;Claire Immediato Daien ,&nbsp;Divi Cornec ,&nbsp;Emmanuelle Dernis ,&nbsp;Bruno Fautrel ,&nbsp;Antoine Pariente ,&nbsp;Christian Roux ,&nbsp;Jean-Hugues Salmon ,&nbsp;Jérémie Sellam ,&nbsp;Emilie Hucteau ,&nbsp;Julien Bezin ,&nbsp;Jérôme Avouac","doi":"10.1016/j.jbspin.2025.106021","DOIUrl":"10.1016/j.jbspin.2025.106021","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 2","pages":"Article 106021"},"PeriodicalIF":4.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling sarcopenia prevalence in post-cancer patients: Integrating functional and morphological assessments for accurate diagnosis","authors":"Marie Meunier ,&nbsp;Emmanuel Massy ,&nbsp;Melanie Auréal ,&nbsp;Marine Gaude ,&nbsp;Justine Bérardet ,&nbsp;Alexandre Foncelle ,&nbsp;Milène Seauve ,&nbsp;Benjamin Laurent ,&nbsp;Laure Christophe ,&nbsp;Sophie Courtois ,&nbsp;Cyrille B. Confavreux","doi":"10.1016/j.jbspin.2025.106022","DOIUrl":"10.1016/j.jbspin.2025.106022","url":null,"abstract":"<div><h3>Objectives</h3><div>Sarcopenia is a muscle disease characterized by the progressive loss of muscle mass, strength, and function. Despite evolving definitions, validated diagnostic tools for younger individuals, especially those with cancer or chronic diseases, remain lacking. Oncological treatments can lead to severe muscle deconditioning. Many patients face limited follow-up and remain physically diminished in post-cancer period. We aimed to determine the prevalence of sarcopenia in post-cancer patients and to highlight its occurrence even in younger individuals and long after completion of oncological treatments.</div></div><div><h3>Methods</h3><div>We performed prospective and standardized muscle assessment through: physical activity questionnaires (International Physical Activity Questionnaire [IPAQ] and Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls [SARC-F]); functional tests (grip strength, 6-minute walk, and 30-second chair stand tests); and appendicular lean mass (ALM) index measurement by dual-energy X-ray absorptiometry (DXA; ALM/height² in kg/m²).</div></div><div><h3>Results</h3><div>Ninety-eight patients (68 females) were included (age (mean<!--> <!-->±<!--> <!-->SD) 53.8<!--> <!-->±<!--> <!-->11.0 years and body mass index (BMI) 27.8<!--> <!-->±<!--> <!-->6.4<!--> <!-->kg/m²). Fifty-five had solid tumors (41 metastatic) with a post-treatment duration of 20.3<!--> <!-->±<!--> <!-->21.75 months. SARC-F score was 1.5<!--> <!-->±<!--> <!-->1.6. Grip strength and ALM index were 27.3<!--> <!-->±<!--> <!-->11.7<!--> <!-->kg and 6.4<!--> <!-->±<!--> <!-->1.4<!--> <!-->kg/m² respectively. Considering cancer as a sarcopenia at risk status, we used European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria and identified 27 (27.6%) patients with sarcopenia. Patients with sarcopenia were younger (50.2<!--> <!-->±<!--> <!-->11.6 <em>vs</em> 55.2<!--> <!-->±<!--> <!-->12.0 years; <em>P</em> <!-->=<!--> <!-->0.07), more frequently in remission and long after treatment, and had lower BMI (23.3<!--> <!-->±<!--> <!-->3.2 vs 29.5<!--> <!-->±<!--> <!-->6.5<!--> <!-->kg/m²; <em>P</em> <!-->&lt;<!--> <!-->0.0001) compared to patients without sarcopenia. When using SARC-F for screening, only 5 patients were detected, underlining its poor sensitivity in this setting.</div></div><div><h3>Conclusion</h3><div>Sarcopenia is highly prevalent in post-cancer patients including younger individuals and those in long-term remission. The 2019 EWGSOP2 criteria, combining ALM and functional tests, effectively identified sarcopenia but screening with SARC-F may not be suitable in the post-cancer population.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106022"},"PeriodicalIF":4.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tapering or stopping tocilizumab in PMR: Toward optimized treatment withdrawal","authors":"Baptiste Chevet ,&nbsp;Valérie Devauchelle-Pensec","doi":"10.1016/j.jbspin.2025.106016","DOIUrl":"10.1016/j.jbspin.2025.106016","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106016"},"PeriodicalIF":4.3,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High disease activity is associated with incident osteoporotic fractures among veterans with rheumatoid arthritis","authors":"Katherine D. Wysham ,&nbsp;Hannah F. Brubeck ,&nbsp;Aaron Baraff ,&nbsp;Punyasha Roul ,&nbsp;Marianna Olave ,&nbsp;John S. Richards ,&nbsp;Paul Monach ,&nbsp;Dolores M. Shoback ,&nbsp;Patricia P. Katz ,&nbsp;Brian C. Sauer ,&nbsp;Beth Wallace ,&nbsp;Jose M. Garcia ,&nbsp;Grant W. Cannon ,&nbsp;Ted R. Mikuls ,&nbsp;Bryant R. England ,&nbsp;Joshua F. Baker","doi":"10.1016/j.jbspin.2025.106020","DOIUrl":"10.1016/j.jbspin.2025.106020","url":null,"abstract":"<div><h3>Objectives</h3><div>Rheumatoid arthritis (RA) increases osteoporosis and fracture risk. The relationship between disease activity and fracture is not well characterized. We aimed to study whether RA disease activity and its components were associated with incident osteoporotic fracture.</div></div><div><h3>Methods</h3><div>Data were from the multicenter Veterans Affairs RA (VARA) registry. Fractures were identified by ICD9/10 codes and validated by chart review. Multivariable Cox regression was used to quantify associations of time-varying and cumulative RA disease activity, using DAS28-ESR, with incident osteoporotic fracture. To directly compare hazard ratios (HRs), DAS28-ESR components were scaled, centered and evaluated in multivariable models. Sensitivity analyses, including evaluating DAS28-ESR categories, were also performed.</div></div><div><h3>Results</h3><div>Among 2912 veterans, 248 (9%) experienced incident osteoporotic fracture. Those who fractured were more likely to be female (19 versus 11%), White (83 vs. 75%) and had higher baseline disease activity (DAS28-ESR 4.0<!--> <!-->±<!--> <!-->1.5 vs. 3.8<!--> <!-->±<!--> <!-->1.6). The time-varying model demonstrated an 18% increased risk of incident osteoporotic fracture per unit increase of DAS28-ESR (aHR 1.18 [95% CI 1.09–1.28], <em>P</em> <!-->&lt;<!--> <!-->0.001). The cumulative model revealed a 3% increased risk per DAS28-ESR unit-year (aHR 1.03 [95% CI 1.01–1.05], <em>P</em> <!-->&lt;<!--> <!-->0.001). Patient global assessment of disease activity had the highest point estimates of the disease activity components in both time-varying and cumulative models. Compared to remission, moderate and high disease activity carried a 2-fold risk of incident osteoporotic fracture (aHR 2.24 and 2.01 respectively, both <em>P</em> <!-->&lt;<!--> <!-->0.01).</div></div><div><h3>Conclusion</h3><div>Time-varying and cumulative RA disease activity are associated with incident osteoporotic fracture. These data support achieving low disease activity or remission to reduce the risk of incident osteoporotic fracture.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 3","pages":"Article 106020"},"PeriodicalIF":4.3,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporomandibular joint tophus","authors":"Shio-Yi Liao ,&nbsp;Ching-Lan Wu ,&nbsp;Chien-Chih Lai","doi":"10.1016/j.jbspin.2025.106019","DOIUrl":"10.1016/j.jbspin.2025.106019","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 2","pages":"Article 106019"},"PeriodicalIF":4.3,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783575","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}