Pub Date : 2025-10-11DOI: 10.1016/j.aohep.2025.102139
Tianhao Wu , Mingyi Du , Tiejun Zhang , Xingdong Chen , Zhenqiu Liu
Introduction and Objectives
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), the most prevalent primary liver cancer subtypes, present significant global health challenges. We aimed to comprehensively compare their incidence rates, risk factors, and potential preventability.
Materials and Methods
We analyzed liver cancer histological subtypes from Cancer Incidence in Five Continents Volume XII and assessed 85 modifiable risk factors for HCC and iCCA using the UK Biobank data. We calculated population attributable fraction to assess the population preventability of the cancers.
Results
Incidence data from 49 countries revealed a moderate positive correlation between the incidences of HCC and iCCA (ρ=0.41, P=0.003), with the highest rates observed in the Republic of Korea (15.6 vs 3.3 per 100,000, respectively). The global variation of HCC incidence was more pronounced than iCCA. After applying a Bonferroni correction for p-value, we identified 42 modifiable risk factors for HCC (n=470) and eight for iCCA (n=508). The effects of nearly all risk factors were more pronounced for HCC than for iCCA. Up to 83.3 % of HCC cases could be attributed to modifiable risk factors, although the preventable fraction varied across subpopulations. By contrast, only 37.7 % of iCCA cases were attributable to such factors, and the preventable fraction remained consistent across subgroups.
Conclusions
Our findings reveal the distinct yet partly overlapping epidemiological characteristics of HCC and iCCA, emphasizing the urgent need to clarify risk factors for iCCA. However, these findings may not be globally applicable, as modifiable risk factors can differ across regions due to varying exposures.
简介和目的:肝细胞癌(HCC)和肝内胆管癌(iCCA)是最常见的原发性肝癌亚型,对全球健康构成重大挑战。我们的目的是全面比较它们的发病率、危险因素和潜在的可预防性。材料和方法:我们分析了五大洲癌症发病率第十二卷中的肝癌组织学亚型,并使用英国生物银行的数据评估了肝癌和iCCA的85个可改变的危险因素。我们计算了人群归因分数来评估癌症的人群可预防性。结果:来自49个国家的发病率数据显示,HCC发病率与iCCA之间存在中度正相关(ρ=0.41, P=0.003),其中韩国的发病率最高(分别为15.6 vs 3.3 / 100000)。HCC发病率的全球变化比iCCA更明显。应用Bonferroni校正p值后,我们确定了42个可改变的HCC危险因素(n=470)和8个可改变的iCCA危险因素(n=508)。几乎所有危险因素对HCC的影响都比对iCCA的影响更明显。高达83.3%的HCC病例可归因于可改变的危险因素,尽管可预防的部分在亚人群中有所不同。相比之下,只有37.7%的iCCA病例可归因于这些因素,可预防部分在亚组中保持一致。结论:我们的研究结果揭示了HCC和iCCA的不同但部分重叠的流行病学特征,强调了澄清iCCA危险因素的迫切需要。然而,这些发现可能并不适用于全球,因为可改变的风险因素可能因暴露程度不同而在不同地区有所不同。
{"title":"Comparisons of global incidence and risk factor profiles of hepatocellular carcinoma and intrahepatic cholangiocarcinoma","authors":"Tianhao Wu , Mingyi Du , Tiejun Zhang , Xingdong Chen , Zhenqiu Liu","doi":"10.1016/j.aohep.2025.102139","DOIUrl":"10.1016/j.aohep.2025.102139","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), the most prevalent primary liver cancer subtypes, present significant global health challenges. We aimed to comprehensively compare their incidence rates, risk factors, and potential preventability.</div></div><div><h3>Materials and Methods</h3><div>We analyzed liver cancer histological subtypes from Cancer Incidence in Five Continents Volume XII and assessed 85 modifiable risk factors for HCC and iCCA using the UK Biobank data. We calculated population attributable fraction to assess the population preventability of the cancers.</div></div><div><h3>Results</h3><div>Incidence data from 49 countries revealed a moderate positive correlation between the incidences of HCC and iCCA (ρ=0.41, P=0.003), with the highest rates observed in the Republic of Korea (15.6 <em>vs</em> 3.3 per 100,000, respectively). The global variation of HCC incidence was more pronounced than iCCA. After applying a Bonferroni correction for p-value, we identified 42 modifiable risk factors for HCC (n=470) and eight for iCCA (n=508). The effects of nearly all risk factors were more pronounced for HCC than for iCCA. Up to 83.3 % of HCC cases could be attributed to modifiable risk factors, although the preventable fraction varied across subpopulations. By contrast, only 37.7 % of iCCA cases were attributable to such factors, and the preventable fraction remained consistent across subgroups.</div></div><div><h3>Conclusions</h3><div>Our findings reveal the distinct yet partly overlapping epidemiological characteristics of HCC and iCCA, emphasizing the urgent need to clarify risk factors for iCCA. However, these findings may not be globally applicable, as modifiable risk factors can differ across regions due to varying exposures.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102139"},"PeriodicalIF":4.4,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285370","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}
Pub Date : 2025-10-10DOI: 10.1016/j.aohep.2025.102136
Ziming Zheng , Yumei Huang , Jijuan Zhang , Jinchi Xie , An Pan , Yunfei Liao , Yu Zhang
Introduction and Objectives
The association between antibiotic consumption and the risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD) remains ambiguous. This study aimed to investigate this relationship within a large prospective cohort from the UK Biobank.
Patients and Methods
We conducted a prospective cohort study of 143,279 adults aged 40 to 70 years, among whom 1477 were diagnosed with MASLD for the first time. Multivariate Cox proportional hazards regression models were employed to assess the data. The genetic risk score (GRS) for MASLD was derived from five single-nucleotide variants, and mediation analysis was performed to evaluate the role of metabolic syndrome (MetS).
Results
Our findings demonstrated that individuals with antibiotic exposure during childhood or adolescence exhibited a significantly higher risk of developing MASLD compared to those without antibiotic exposure (P < 0.001, HR 1.39; 95 % CI 1.21–1.59). No significant interaction was observed between antibiotic consumption and genetic predisposition for MASLD. Mediation analysis revealed that MetS and central obesity accounted for 21.98 % and 13.55 % of the association between early-life antibiotic exposure and MASLD, respectively (P < 0.001), particularly in women (P for interaction = 0.031).
Conclusions
Long-term antibiotic exposure in early life was significantly associated with a higher risk of developing MASLD, and this association persisted after adjustment for genetic predisposition factors.
{"title":"Antibiotic consumption, genetic risk and incidence of metabolic dysfunction-associated steatotic liver disease: a prospective cohort study","authors":"Ziming Zheng , Yumei Huang , Jijuan Zhang , Jinchi Xie , An Pan , Yunfei Liao , Yu Zhang","doi":"10.1016/j.aohep.2025.102136","DOIUrl":"10.1016/j.aohep.2025.102136","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The association between antibiotic consumption and the risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD) remains ambiguous. This study aimed to investigate this relationship within a large prospective cohort from the UK Biobank.</div></div><div><h3>Patients and Methods</h3><div>We conducted a prospective cohort study of 143,279 adults aged 40 to 70 years, among whom 1477 were diagnosed with MASLD for the first time. Multivariate Cox proportional hazards regression models were employed to assess the data. The genetic risk score (GRS) for MASLD was derived from five single-nucleotide variants, and mediation analysis was performed to evaluate the role of metabolic syndrome (MetS).</div></div><div><h3>Results</h3><div>Our findings demonstrated that individuals with antibiotic exposure during childhood or adolescence exhibited a significantly higher risk of developing MASLD compared to those without antibiotic exposure (<em>P</em> < 0.001, HR 1.39; 95 % CI 1.21–1.59). No significant interaction was observed between antibiotic consumption and genetic predisposition for MASLD. Mediation analysis revealed that MetS and central obesity accounted for 21.98 % and 13.55 % of the association between early-life antibiotic exposure and MASLD, respectively (<em>P</em> < 0.001), particularly in women (<em>P</em> for interaction = 0.031).</div></div><div><h3>Conclusions</h3><div>Long-term antibiotic exposure in early life was significantly associated with a higher risk of developing MASLD, and this association persisted after adjustment for genetic predisposition factors.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102136"},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273528","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}
Pub Date : 2025-10-10DOI: 10.1016/j.aohep.2025.102137
Nikolaj Torp, Nick Freemantle, Mads Israelsen, Aleksander Krag, Alastair O’Brien
{"title":"Limitations of MELD and MELD 3.0 for prognostication in patients with cirrhosis hospitalized with acute decompensation: an analysis of the ATTIRE trial","authors":"Nikolaj Torp, Nick Freemantle, Mads Israelsen, Aleksander Krag, Alastair O’Brien","doi":"10.1016/j.aohep.2025.102137","DOIUrl":"10.1016/j.aohep.2025.102137","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102137"},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273521","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}
Pub Date : 2025-10-08DOI: 10.1016/j.aohep.2025.102135
Carolina Vazquez , Gonzalo Gómez Perdiguero , Esteban González Ballerga , Ilse Pardo Ivirico , Camila M. Briz , Agustín Di Santo , Maria D. Murga , Ana Palazzo , Lorena Notari , Josefina Pages , Julia Brutti , Brenda Osso Sánchez , Manuel Mendizabal , Margarita Anders , Diego H. Giunta , Gisela Gualano , Agostina Romero , Alina Zerega , Pablo Calzetta , Martín Elizondo , Sebastián Marciano
Introduction and Objectives
As antimicrobial resistance rises, selecting appropriate empirical antibiotics for treating urinary tract infections (UTIs) has become complex. This study aimed to estimate the antimicrobial susceptibility patterns of microorganisms that cause UTIs in patients with cirrhosis.
Materials and Methods
This study analyzed UTI episodes in patients with cirrhosis from Argentina and Uruguay (Dec 2020–July 2024). The coordinating center reviewed all antibiograms.
Results
A total of 277 UTI episodes in 233 patients were included (community-acquired: 119, healthcare-associated: 68, and nosocomial: 90). Escherichia coli and Klebsiella pneumoniae were the predominant pathogens (70.6 %, n = 202). Multidrug resistance and extensive drug resistance were observed in 51.6 % and 11.6 % of the episodes, respectively. Carbapenemase-producing organisms were particularly prevalent in nosocomial infections (30.3 %, 95 % CI: 21.5–40.8). In community-acquired UTIs, coverage rates for ceftriaxone, cefepime, and piperacillin-tazobactam ranged from 60–70 %. Aminoglycosides (82.2 %, 95 %CI: 74.1–88.2) and carbapenems (90.0 %, 95 %CI: 83.0–94.2) provided coverage exceeding 80 %. For nosocomial UTIs, carbapenems demonstrated suboptimal coverage; in contrast, adequate coverage was observed with ceftazidime-avibactam plus aztreonam (83.0 %, 95 %CI: 73.4–89.6) or plus vancomycin (76.1 %, 95 %CI: 65.9–84.0).
Conclusions
The study highlights alarming antimicrobial resistance, particularly in nosocomial UTIs. Traditional antibiotics, such as ceftriaxone for community-acquired UTIs and carbapenems or piperacillin/tazobactam for nosocomial infections, fail to provide sufficient empirical coverage. More comprehensive approaches to empirical treatment, such as combination therapies or newer antibiotics targeting resistant pathogens, are needed.
{"title":"Prospective surveillance reveals high rates of antimicrobial resistance in urinary tract infections among patients with cirrhosis.","authors":"Carolina Vazquez , Gonzalo Gómez Perdiguero , Esteban González Ballerga , Ilse Pardo Ivirico , Camila M. Briz , Agustín Di Santo , Maria D. Murga , Ana Palazzo , Lorena Notari , Josefina Pages , Julia Brutti , Brenda Osso Sánchez , Manuel Mendizabal , Margarita Anders , Diego H. Giunta , Gisela Gualano , Agostina Romero , Alina Zerega , Pablo Calzetta , Martín Elizondo , Sebastián Marciano","doi":"10.1016/j.aohep.2025.102135","DOIUrl":"10.1016/j.aohep.2025.102135","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>As antimicrobial resistance rises, selecting appropriate empirical antibiotics for treating urinary tract infections (UTIs) has become complex. This study aimed to estimate the antimicrobial susceptibility patterns of microorganisms that cause UTIs in patients with cirrhosis.</div></div><div><h3>Materials and Methods</h3><div>This study analyzed UTI episodes in patients with cirrhosis from Argentina and Uruguay (Dec 2020–July 2024). The coordinating center reviewed all antibiograms.</div></div><div><h3>Results</h3><div>A total of 277 UTI episodes in 233 patients were included (community-acquired: 119, healthcare-associated: 68, and nosocomial: 90). <em>Escherichia coli</em> and <em>Klebsiella pneumoniae</em> were the predominant pathogens (70.6 %, <em>n</em> = 202). Multidrug resistance and extensive drug resistance were observed in 51.6 % and 11.6 % of the episodes, respectively. Carbapenemase-producing organisms were particularly prevalent in nosocomial infections (30.3 %, 95 % CI: 21.5–40.8). In community-acquired UTIs, coverage rates for ceftriaxone, cefepime, and piperacillin-tazobactam ranged from 60–70 %. Aminoglycosides (82.2 %, 95 %CI: 74.1–88.2) and carbapenems (90.0 %, 95 %CI: 83.0–94.2) provided coverage exceeding 80 %. For nosocomial UTIs, carbapenems demonstrated suboptimal coverage; in contrast, adequate coverage was observed with ceftazidime-avibactam plus aztreonam (83.0 %, 95 %CI: 73.4–89.6) or plus vancomycin (76.1 %, 95 %CI: 65.9–84.0).</div></div><div><h3>Conclusions</h3><div>The study highlights alarming antimicrobial resistance, particularly in nosocomial UTIs. Traditional antibiotics, such as ceftriaxone for community-acquired UTIs and carbapenems or piperacillin/tazobactam for nosocomial infections, fail to provide sufficient empirical coverage. More comprehensive approaches to empirical treatment, such as combination therapies or newer antibiotics targeting resistant pathogens, are needed.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102135"},"PeriodicalIF":4.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273586","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}
Pub Date : 2025-10-02DOI: 10.1016/j.aohep.2025.102134
Mohamed El-Kassas , Yusuf Yilmaz , Chun-Jen Liu , Marlen I.Castellanos Fernández , Yuichiro Eguchi , Khalid Al-Naamani , Doaa Abdeltawab , Mohammed A. Medhat , Wah-Kheong Chan , Stuart Gordon , Vasily Isakov , Ming Lung Yu , Maria Buti , George V. Papatheodoridis , Fatema Nader , Andrei Racila , Linda Henry , Maria Stepanova , Zobair M. Younossi , the Global Liver Council
Introduction and Objectives
Up-to-date knowledge of hepatitis C virus (HCV) management among healthcare providers is crucial for improving patient outcomes. This study evaluates physicians' awareness, attitudes, self-efficacy, perceptions, and barriers related to current HCV management guidelines and post-treatment follow-up.
Materials and Methods
We invited healthcare providers treating HCV patients to complete a 48-question survey regarding their practices, guideline familiarity, and related attitudes.
Results
The survey was completed by 183 physicians from 8 countries, including hepatologists (32 %), gastroenterologists (39 %), internal medicine specialists (12 %), and infectious disease specialists (16 %). The majority (95 %) were aware of at least one treatment guideline, with the EASL guideline cited by 84 % and the AASLD guideline by 72 %. Most (94 %) believed post-HCV treatment follow-up was effective for detecting complications, and 93 % recommended continued follow-up. Although 90 % felt well-informed about guidelines, 39 % reported encountering inconsistencies. Sixty-one percent recognized that HCV elimination reduces the rate of decompensation but does not abolish the risk of hepatocellular carcinoma (HCC). Overall, 86 % acknowledged the need for follow-up in patients who achieved sustained virological response (SVR), with the most commonly recommended intervals being six months for non-cirrhotic patients and three months for cirrhotic patients. Minimal barriers to follow-up were reported, with only 1.6 % to 4.4 % not discussing its benefits due to time or resource constraints.
Conclusions
The surveyed physicians demonstrated a strong awareness of the current HCV guidelines but indicated potential gaps in knowledge and inconsistencies. Continuous education and support are essential to enhance adherence to HCV management protocols.
{"title":"A multinational survey of physician knowledge about management of chronic hepatitis C","authors":"Mohamed El-Kassas , Yusuf Yilmaz , Chun-Jen Liu , Marlen I.Castellanos Fernández , Yuichiro Eguchi , Khalid Al-Naamani , Doaa Abdeltawab , Mohammed A. Medhat , Wah-Kheong Chan , Stuart Gordon , Vasily Isakov , Ming Lung Yu , Maria Buti , George V. Papatheodoridis , Fatema Nader , Andrei Racila , Linda Henry , Maria Stepanova , Zobair M. Younossi , the Global Liver Council","doi":"10.1016/j.aohep.2025.102134","DOIUrl":"10.1016/j.aohep.2025.102134","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Up-to-date knowledge of hepatitis C virus (HCV) management among healthcare providers is crucial for improving patient outcomes. This study evaluates physicians' awareness, attitudes, self-efficacy, perceptions, and barriers related to current HCV management guidelines and post-treatment follow-up.</div></div><div><h3>Materials and Methods</h3><div>We invited healthcare providers treating HCV patients to complete a 48-question survey regarding their practices, guideline familiarity, and related attitudes.</div></div><div><h3>Results</h3><div>The survey was completed by 183 physicians from 8 countries, including hepatologists (32 %), gastroenterologists (39 %), internal medicine specialists (12 %), and infectious disease specialists (16 %). The majority (95 %) were aware of at least one treatment guideline, with the EASL guideline cited by 84 % and the AASLD guideline by 72 %. Most (94 %) believed post-HCV treatment follow-up was effective for detecting complications, and 93 % recommended continued follow-up. Although 90 % felt well-informed about guidelines, 39 % reported encountering inconsistencies. Sixty-one percent recognized that HCV elimination reduces the rate of decompensation but does not abolish the risk of hepatocellular carcinoma (HCC). Overall, 86 % acknowledged the need for follow-up in patients who achieved sustained virological response (SVR), with the most commonly recommended intervals being six months for non-cirrhotic patients and three months for cirrhotic patients. Minimal barriers to follow-up were reported, with only 1.6 % to 4.4 % not discussing its benefits due to time or resource constraints.</div></div><div><h3>Conclusions</h3><div>The surveyed physicians demonstrated a strong awareness of the current HCV guidelines but indicated potential gaps in knowledge and inconsistencies. Continuous education and support are essential to enhance adherence to HCV management protocols.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102134"},"PeriodicalIF":4.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228317","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}
Pub Date : 2025-10-01DOI: 10.1016/j.aohep.2025.102133
Janus P. Ong , Geohari Hamoy , Eric David B. Ornos , Vanessa Co-Tanco , Joy Gillera , Jhunnel Macalanda , Jae-Ann Sumalo
Introduction and Objectives
Chronic viral hepatitis remains a major global public health challenge. The WHO launched the Global Health Sector Strategy on Viral Hepatitis in 2016, emphasizing health equity. Digital learning offers a promising solution to barriers in achieving hepatitis elimination. This study describes a digital learning initiative to strengthen primary care capacity for viral hepatitis management in the Philippines.
Materials and Methods
The initiative utilized asynchronous computer-based training (CBT) on the HepLearn platform and synchronous telementoring via HepTalks. The CBT was developed collaboratively with the Department of Health, WHO, Hepatology Society of the Philippines, and University of the Philippines Manila. The course addressed essential hepatitis B and C topics. Telementoring paired primary care physicians with specialists from the Hepatology Society of the Philippines using Zoom for interactive case discussions. Eight one-hour sessions were conducted, each starting with expert-led didactic lectures followed by case discussions.
Results
Evaluation included quantitative and qualitative methods: surveys, pre- and post-test assessments, and feedback forms. Among 189 enrollees, 111 (58.7 %) completed HepLearn. Mean pre-test score was 2.63 ± 0.29, rising to 7.09 ± 1.90 post-test (p<0.001), demonstrating significant knowledge gain. Participant feedback indicated high satisfaction (72 % to 98 %) with course content. Thirteen physicians participated in HepTalks. Confidence in viral hepatitis care increased significantly, with 67 % expressing strong agreement that the sessions helped them provide better care.
Conclusions
This integrated eLearning approach demonstrates potential for scalable digital education to enhance hepatitis care in primary and remote communities. eLearning should be a strategy for eliminating viral hepatitis by 2030.
{"title":"Piloting eLearning initiatives: Computer-based training and telementoring for viral hepatitis care in public primary care setting","authors":"Janus P. Ong , Geohari Hamoy , Eric David B. Ornos , Vanessa Co-Tanco , Joy Gillera , Jhunnel Macalanda , Jae-Ann Sumalo","doi":"10.1016/j.aohep.2025.102133","DOIUrl":"10.1016/j.aohep.2025.102133","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Chronic viral hepatitis remains a major global public health challenge. The WHO launched the Global Health Sector Strategy on Viral Hepatitis in 2016, emphasizing health equity. Digital learning offers a promising solution to barriers in achieving hepatitis elimination. This study describes a digital learning initiative to strengthen primary care capacity for viral hepatitis management in the Philippines.</div></div><div><h3>Materials and Methods</h3><div>The initiative utilized asynchronous computer-based training (CBT) on the <em>HepLearn</em> platform and synchronous telementoring via <em>HepTalks.</em> The CBT was developed collaboratively with the Department of Health, WHO, Hepatology Society of the Philippines, and University of the Philippines Manila. The course addressed essential hepatitis B and C topics. Telementoring paired primary care physicians with specialists from the Hepatology Society of the Philippines using Zoom for interactive case discussions. Eight one-hour sessions were conducted, each starting with expert-led didactic lectures followed by case discussions.</div></div><div><h3>Results</h3><div>Evaluation included quantitative and qualitative methods: surveys, pre- and post-test assessments, and feedback forms. Among 189 enrollees, 111 (58.7 %) completed <em>HepLearn</em>. Mean pre-test score was 2.63 ± 0.29, rising to 7.09 ± 1.90 post-test (p<0.001), demonstrating significant knowledge gain. Participant feedback indicated high satisfaction (72 % to 98 %) with course content. Thirteen physicians participated in <em>HepTalks</em>. Confidence in viral hepatitis care increased significantly, with 67 % expressing strong agreement that the sessions helped them provide better care.</div></div><div><h3>Conclusions</h3><div>This integrated eLearning approach demonstrates potential for scalable digital education to enhance hepatitis care in primary and remote communities. eLearning should be a strategy for eliminating viral hepatitis by 2030.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102133"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224829","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}
Pub Date : 2025-09-25DOI: 10.1016/j.aohep.2025.102131
Nahum Méndez-Sánchez , Mariana M. Ramírez-Mejía , Carlos Cortez-Hernández , Elianee M. Tovar-Bojorquez , Raúl Contreras-Omaña , Juan D. Monsiváis-Morales , Jacqueline Cordova-Gallardo , Mauricio Castillo-Barradas , Nubia Guzmán-Rodríguez , María S. González-Huezo , Adrian Sandez-Araiza , Eira Cerda-Reyes , Stefanny Cornejo-Hernández , Beatriz Barranco-Fragoso , Ana D. Cano-Contreras , José M. Remes-Troche , Fatima Higuera-de-la-Tijera , José L. Pérez-Hernández , Norberto Chávez-Tapia , Francisco J. Valentin-Cortez , Heriberto Rodríguez-Hernández
Introduction and Objectives
Hepatocellular carcinoma (HCC) represents a major complication of chronic liver disease and an emerging public health challenge in Mexico. As the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) continues to increase, a comprehensive understanding of the current epidemiological landscape of HCC has become increasingly important. This study aims to describe the epidemiologic features and etiologic distribution of HCC in patients with cirrhosis in Mexico using multicenter data collected from 2018 to 2024.
Materials and Methods
We conducted a multicenter retrospective study of 2182 patients with cirrhosis diagnosed between 2018 and 2024 across 13 tertiary care hospitals in northern, central, and southern Mexico. HCC was identified using standardized imaging and/or histological criteria. Data on demographics, cirrhosis etiology and clinical characteristics were collected.
Results
Among 2182 patients with cirrhosis (mean age 61 ± 12 years; 53.8 % female), 8.8 % (n = 194) developed HCC. Prevalence was higher in women (55.1 %) and in older adults, with 78.3 % of HCC cases occurring in individuals aged ≥60 years. In women, HCC peaked between ages 70–79, while in men it peaked between 60 and 69 years. Regional differences were observed, with the highest prevalence in central Mexico (10.4 %) and the lowest in the south (3.8 %) (p < 0.001). MASLD was the leading etiology (39.1 %), followed by HCV (33.0 %) and ALD (18.6 %).
Conclusions
These findings highlight the growing impact of MASLD as the leading cause of HCC in patients with cirrhosis in Mexico, with notable age, sex and regional disparities. Understanding these patterns is essential to inform targeted prevention and early detection strategies.
{"title":"Epidemiology and etiologic trends of hepatocellular carcinoma in cirrhotic patients in Mexico: a multicenter retrospective study (2018–2024)","authors":"Nahum Méndez-Sánchez , Mariana M. Ramírez-Mejía , Carlos Cortez-Hernández , Elianee M. Tovar-Bojorquez , Raúl Contreras-Omaña , Juan D. Monsiváis-Morales , Jacqueline Cordova-Gallardo , Mauricio Castillo-Barradas , Nubia Guzmán-Rodríguez , María S. González-Huezo , Adrian Sandez-Araiza , Eira Cerda-Reyes , Stefanny Cornejo-Hernández , Beatriz Barranco-Fragoso , Ana D. Cano-Contreras , José M. Remes-Troche , Fatima Higuera-de-la-Tijera , José L. Pérez-Hernández , Norberto Chávez-Tapia , Francisco J. Valentin-Cortez , Heriberto Rodríguez-Hernández","doi":"10.1016/j.aohep.2025.102131","DOIUrl":"10.1016/j.aohep.2025.102131","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatocellular carcinoma (HCC) represents a major complication of chronic liver disease and an emerging public health challenge in Mexico. As the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) continues to increase, a comprehensive understanding of the current epidemiological landscape of HCC has become increasingly important. This study aims to describe the epidemiologic features and etiologic distribution of HCC in patients with cirrhosis in Mexico using multicenter data collected from 2018 to 2024.</div></div><div><h3>Materials and Methods</h3><div>We conducted a multicenter retrospective study of 2182 patients with cirrhosis diagnosed between 2018 and 2024 across 13 tertiary care hospitals in northern, central, and southern Mexico. HCC was identified using standardized imaging and/or histological criteria. Data on demographics, cirrhosis etiology and clinical characteristics were collected.</div></div><div><h3>Results</h3><div>Among 2182 patients with cirrhosis (mean age 61 ± 12 years; 53.8 % female), 8.8 % (<em>n</em> = 194) developed HCC. Prevalence was higher in women (55.1 %) and in older adults, with 78.3 % of HCC cases occurring in individuals aged ≥60 years. In women, HCC peaked between ages 70–79, while in men it peaked between 60 and 69 years. Regional differences were observed, with the highest prevalence in central Mexico (10.4 %) and the lowest in the south (3.8 %) (p < 0.001). MASLD was the leading etiology (39.1 %), followed by HCV (33.0 %) and ALD (18.6 %).</div></div><div><h3>Conclusions</h3><div>These findings highlight the growing impact of MASLD as the leading cause of HCC in patients with cirrhosis in Mexico, with notable age, sex and regional disparities. Understanding these patterns is essential to inform targeted prevention and early detection strategies.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102131"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181875","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}
Pub Date : 2025-09-22DOI: 10.1016/j.aohep.2025.102117
Tomáš Uher, Pavlína Kleinová, Jana Woronyczová, Lubomír Štěpánek, Manuela Vaněčková, Jan Krásenský, Renata Cífková, Dana Horáková, Eva Havrdová, David Hoskovec, Martin Leníček, Libor Vítek
Introduction and objectives: Bilirubin is negatively associated with neurodegenerative diseases, including multiple sclerosis (MS). Since previous studies were small or did not evaluate all diagnostic aspects, the objective of the present study was to assess a large cohort of MS patients with multiple determinations of serum bilirubin.
Patients and methods: The study was carried out in 2,696 consecutive MS patients (median age=37.1 years, disease duration=6.8 years, follow-up duration=7.2 years, and Expanded Disability Status Scale (EDSS)=2.5) with 28,501 visits. Individuals from the Czech post-MONICA study representing the general Czech population (n=2,621) were used as controls. Serum bilirubin concentrations in study subjects were compared with multiple diagnostic and clinical parameters.
Results: Serum bilirubin concentrations in MS patients were significantly lower compared to the general population (8.3 vs. 9.6 μmol/L, P<0.001). Hyperbilirubinemia >17 µmol/L in MS patients was much less frequent compared to the general population (8.2 vs. 12.5 %, P<0.001). An increase in disease duration by 10 years was associated with an 8 % decrease in bilirubin concentration (p<0.0001). Ten percent higher serum bilirubin concentration was associated with a 9 % decrease in EDSS (p=0.001) and a 1.5 % decrease in normalized brain volume (p<0.0001). The frequencies of individual UGT1A1 (TA)n/n genotypes did not differ between MS patients and the control population.
Conclusions: MS patients have markedly lower serum bilirubin concentrations, most likely due to consumption during the increased oxidative stress since the frequencies of UGT1A1 were comparable in the MS and control populations. Higher serum bilirubin is associated with lower disability and lower brain atrophy.
简介和目的:胆红素与神经退行性疾病,包括多发性硬化症(MS)负相关。由于先前的研究规模较小或没有评估所有诊断方面,本研究的目的是评估具有多种血清胆红素测定的MS患者的大队列。患者和方法:研究纳入2,696例连续MS患者(中位年龄=37.1岁,病程=6.8年,随访时间=7.2年,扩展残疾状态量表(EDSS)=2.5),共28,501次就诊。来自捷克monica后研究的个体代表捷克一般人群(n=2,621)作为对照。研究对象的血清胆红素浓度与多种诊断和临床参数进行比较。结果:MS患者血清胆红素浓度明显低于普通人群(8.3 μmol/L vs. 9.6 μmol/L), MS患者血清胆红素浓度明显低于普通人群(8.2 μmol/L vs. 12.5%)。结论:MS患者血清胆红素浓度明显较低,很可能是由于氧化应激增加期间的消耗,因为UGT1A1的频率在MS和对照组人群中是相当的。较高的血清胆红素与较低的残疾和较低的脑萎缩有关。
{"title":"Serum bilirubin concentrations and their association with clinical and radiological outcomes in multiple sclerosis: A large cohort study.","authors":"Tomáš Uher, Pavlína Kleinová, Jana Woronyczová, Lubomír Štěpánek, Manuela Vaněčková, Jan Krásenský, Renata Cífková, Dana Horáková, Eva Havrdová, David Hoskovec, Martin Leníček, Libor Vítek","doi":"10.1016/j.aohep.2025.102117","DOIUrl":"10.1016/j.aohep.2025.102117","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Bilirubin is negatively associated with neurodegenerative diseases, including multiple sclerosis (MS). Since previous studies were small or did not evaluate all diagnostic aspects, the objective of the present study was to assess a large cohort of MS patients with multiple determinations of serum bilirubin.</p><p><strong>Patients and methods: </strong>The study was carried out in 2,696 consecutive MS patients (median age=37.1 years, disease duration=6.8 years, follow-up duration=7.2 years, and Expanded Disability Status Scale (EDSS)=2.5) with 28,501 visits. Individuals from the Czech post-MONICA study representing the general Czech population (n=2,621) were used as controls. Serum bilirubin concentrations in study subjects were compared with multiple diagnostic and clinical parameters.</p><p><strong>Results: </strong>Serum bilirubin concentrations in MS patients were significantly lower compared to the general population (8.3 vs. 9.6 μmol/L, P<0.001). Hyperbilirubinemia >17 µmol/L in MS patients was much less frequent compared to the general population (8.2 vs. 12.5 %, P<0.001). An increase in disease duration by 10 years was associated with an 8 % decrease in bilirubin concentration (p<0.0001). Ten percent higher serum bilirubin concentration was associated with a 9 % decrease in EDSS (p=0.001) and a 1.5 % decrease in normalized brain volume (p<0.0001). The frequencies of individual UGT1A1 (TA)n/n genotypes did not differ between MS patients and the control population.</p><p><strong>Conclusions: </strong>MS patients have markedly lower serum bilirubin concentrations, most likely due to consumption during the increased oxidative stress since the frequencies of UGT1A1 were comparable in the MS and control populations. Higher serum bilirubin is associated with lower disability and lower brain atrophy.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102117"},"PeriodicalIF":4.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136281","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}
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly common globally, but current diagnostic methods are inaccessible. This study aims to evaluate the efficacy of triglyceride glucose-body mass index (TyG-BMI) as a noninvasive diagnostic tool for MASLD.
Materials and Methods
Embase, PubMed, Cochrane Library, and Web of Science up to July 2025 were searched for related studies. Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was utilized for quality assessment. The effect size, odds ratio (OR), specificity, sensitivity, positive/negative likelihood ratios, diagnostic odds ratio, and heterogeneity were pooled using Stata18.0 and Meta-Disc1.4. The summary receiver operating characteristic (SROC) curves were plotted and the area under the curve (AUC) values were calculated. Random- or fixed-effects models were adopted based on the results of the heterogeneity test. Moreover, we investigated the source and influence of heterogeneity by subgroup and sensitivity analyses, and examined publication bias.
Results
Twenty-nine studies were included. The meta-analysis revealed a higher TyG-BMI in MASLD patients than in non-MASLD patients (SMD 3.09, 95% CI 2.49–3.68, P < 0.001). For each one-unit increase in TyG-BMI, the MASLD risk rose by 5% (OR 1.05, 95% CI 1.04–1.07, P < 0.001). The pooled sensitivity, specificity, and AUC of the diagnostic efficacy of TyG-BMI were 0.81 (95% CI 0.77–0.85), 0.72 (95% CI 0.67–0.77), and 0.83 (95% CI 0.80–0.86), respectively. The stratified analysis by sex revealed that the diagnostic efficacy was superior in females (sensitivity: 0.82, specificity: 0.80).
Conclusions
TyG-BMI, a cost-efficient and convenient indicator, is favorable for diagnosing MASLD, especially in females, which is worth popularizing.
简介和目的:代谢功能障碍相关的脂肪变性肝病(MASLD)在全球范围内越来越普遍,但目前的诊断方法尚无法获得。本研究旨在评估甘油三酯葡萄糖体重指数(TyG-BMI)作为MASLD无创诊断工具的有效性。材料与方法:检索Embase、PubMed、Cochrane Library和Web of Science截至2025年7月的相关研究。采用诊断准确性研究质量评估(QUADAS)-2进行质量评估。使用Stata18.0和Meta-Disc1.4汇总效应大小、优势比(OR)、特异性、敏感性、阳性/阴性似然比、诊断优势比和异质性。绘制总体受试者工作特征(SROC)曲线,计算曲线下面积(AUC)值。根据异质性检验结果,采用随机或固定效应模型。此外,我们通过亚组分析和敏感性分析调查了异质性的来源和影响,并检查了发表偏倚。结果:纳入29项研究。meta分析显示,MASLD患者的TyG-BMI高于非MASLD患者(SMD为3.09,95% CI为2.49 ~ 3.68)。结论:TyG-BMI是一种成本效益高且方便的指标,有利于MASLD的诊断,尤其是女性,值得推广。
{"title":"Diagnosis of metabolic dysfunction-associated steatotic liver disease by triglyceride glucose-body mass index: A systematic review and meta-analysis","authors":"Kexin Du , Yafang Huang , Yanhui Yu, Jianrong Guo, Jianmei Feng, Feng Jiang","doi":"10.1016/j.aohep.2025.102122","DOIUrl":"10.1016/j.aohep.2025.102122","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly common globally, but current diagnostic methods are inaccessible. This study aims to evaluate the efficacy of triglyceride glucose-body mass index (TyG-BMI) as a noninvasive diagnostic tool for MASLD.</div></div><div><h3>Materials and Methods</h3><div>Embase, PubMed, Cochrane Library, and Web of Science up to July 2025 were searched for related studies. Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was utilized for quality assessment. The effect size, odds ratio (OR), specificity, sensitivity, positive/negative likelihood ratios, diagnostic odds ratio, and heterogeneity were pooled using Stata18.0 and Meta-Disc1.4. The summary receiver operating characteristic (SROC) curves were plotted and the area under the curve (AUC) values were calculated. Random- or fixed-effects models were adopted based on the results of the heterogeneity test. Moreover, we investigated the source and influence of heterogeneity by subgroup and sensitivity analyses, and examined publication bias.</div></div><div><h3>Results</h3><div>Twenty-nine studies were included. The meta-analysis revealed a higher TyG-BMI in MASLD patients than in non-MASLD patients (SMD 3.09, 95% CI 2.49–3.68, P < 0.001). For each one-unit increase in TyG-BMI, the MASLD risk rose by 5% (OR 1.05, 95% CI 1.04–1.07, P < 0.001). The pooled sensitivity, specificity, and AUC of the diagnostic efficacy of TyG-BMI were 0.81 (95% CI 0.77–0.85), 0.72 (95% CI 0.67–0.77), and 0.83 (95% CI 0.80–0.86), respectively. The stratified analysis by sex revealed that the diagnostic efficacy was superior in females (sensitivity: 0.82, specificity: 0.80).</div></div><div><h3>Conclusions</h3><div>TyG-BMI, a cost-efficient and convenient indicator, is favorable for diagnosing MASLD, especially in females, which is worth popularizing.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102122"},"PeriodicalIF":4.4,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074295","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}
Pub Date : 2025-09-12DOI: 10.1016/j.aohep.2025.102120
Alolia Aboikoni , Manon Allaire , Dominique Louvel , Marthe Alogo A. Nwatsok , Paul Ngock Dime , Ala Ouni , Larissa Tangan , Magaly Zappa , Kinan Drak Alsibai , Maylis Douine , Mathieu Nacher , Lucie Catherine , Cecilia Busso , Nathalie Ganne , Moana Gelu-Simeon
Introduction and Objectives
Limited data are available on the prognosis of hepatocellular carcinoma (HCC) in the French overseas territories (FOT). This study aimed to describe the characteristics and outcomes of patients diagnosed with HCC in FOT, comparing them to those from a tertiary center located in Île-de-France (IDF).
Materials and Methods
We retrospectively included all patients with HCC diagnosis between 2013 and 2023 in the FOT and IDF. Socio-demographic and medical data were collected, with the first treatment performed and survival data. Overall survival was analyzed using Kaplan- Meier methods and Cox proportional hazards models.
Results
A total of 1114 patients were included (FOT 11 %, IDF 89 %). FOT patients had higher rates of hepatitis B (36 % vs. 16 %, p<0.001) and worse liver function (defined by higher MELD scores and fewer Child A cases) at HCC diagnosis. In contrast, IDF patients had a higher prevalence of MASLD (29 % vs. 16 %, p=0.004). HCC was diagnosed at more advanced stages in FOT compared to IDF, with 71 % vs. 49 % (p<0.001) of cases outside Milan criteria and 29 % vs. 5 % (p<0.001) in BCLC-D, leading to a significantly lower survival in FOT (median 9 vs. 23 months, p=0.02).
Conclusions
HCC patients in FOT have a poorer prognosis compared to IDF, with diagnoses at more advanced stages, limiting curative treatment options. These findings highlight the need for improved access to care and screening strategies for earlier diagnosis of HCC in FOT.
{"title":"Prognosis of hepatocellular carcinoma in the French overseas territories and comparison with a tertiary center in mainland France","authors":"Alolia Aboikoni , Manon Allaire , Dominique Louvel , Marthe Alogo A. Nwatsok , Paul Ngock Dime , Ala Ouni , Larissa Tangan , Magaly Zappa , Kinan Drak Alsibai , Maylis Douine , Mathieu Nacher , Lucie Catherine , Cecilia Busso , Nathalie Ganne , Moana Gelu-Simeon","doi":"10.1016/j.aohep.2025.102120","DOIUrl":"10.1016/j.aohep.2025.102120","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Limited data are available on the prognosis of hepatocellular carcinoma (HCC) in the French overseas territories (FOT). This study aimed to describe the characteristics and outcomes of patients diagnosed with HCC in FOT, comparing them to those from a tertiary center located in Île-de-France (IDF).</div></div><div><h3>Materials and Methods</h3><div>We retrospectively included all patients with HCC diagnosis between 2013 and 2023 in the FOT and IDF. Socio-demographic and medical data were collected, with the first treatment performed and survival data. Overall survival was analyzed using Kaplan- Meier methods and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>A total of 1114 patients were included (FOT 11 %, IDF 89 %). FOT patients had higher rates of hepatitis B (36 % vs. 16 %, p<0.001) and worse liver function (defined by higher MELD scores and fewer Child A cases) at HCC diagnosis. In contrast, IDF patients had a higher prevalence of MASLD (29 % vs. 16 %, p=0.004). HCC was diagnosed at more advanced stages in FOT compared to IDF, with 71 % vs. 49 % (p<0.001) of cases outside Milan criteria and 29 % vs. 5 % (p<0.001) in BCLC-D, leading to a significantly lower survival in FOT (median 9 vs. 23 months, p=0.02).</div></div><div><h3>Conclusions</h3><div>HCC patients in FOT have a poorer prognosis compared to IDF, with diagnoses at more advanced stages, limiting curative treatment options. These findings highlight the need for improved access to care and screening strategies for earlier diagnosis of HCC in FOT.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102120"},"PeriodicalIF":4.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063342","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}