Circulation: Heart Failure最新文献

{"title":"Developments in Digital Wearable in Heart Failure and the Rationale for the Design of TRUE-HF (Ted Rogers Understanding of Exacerbations in Heart Failure) Apple CPET Study.","authors":"Yasbanoo Moayedi, Farid Foroutan, Yuan Gao, Ben Kim, Enza De Luca, Margaret Brum, Darshan H Brahmbhatt, Joe Duhamel, Anne Simard, Christopher McIntosh, Heather J Ross","doi":"10.1161/CIRCHEARTFAILURE.124.012204","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012204","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a highly prevalent condition characterized by exercise intolerance, an important metric for ambulatory prognostication. However, current methods to assess exercise capacity are often limited to tertiary HF centers, lacking scalability or accessibility. Wearable devices can enable near-continuous dynamic biometrics including exercise tolerance.</p><p><strong>Methods: </strong>Leveraging the capabilities of Apple Watch and a custom application, the TRUE-HF (Ted Rogers Understanding of Exacerbations in Heart Failure) Apple cardiopulmonary exercise testing study aims to investigate whether HealthKit data from Apple Watch can estimate cardiorespiratory fitness, as compared with the gold standard peak oxygen uptake from cardiopulmonary exercise testing. The TRUE-HF study will evaluate the potential impact of wearable technology in the functional assessment of ambulatory patients with HF. The primary end point is to use HealthKit variables to estimate a TRUE-HF peak oxygen uptake. We outline key features of this trial designed to reduce the burden of wearable technology. In addition, we highlight the benefits of various machine learning analyses, with a particular focus on transformer models for the wearable space.</p><p><strong>Conclusions: </strong>Using cutting-edge wearable technology and machine learning analytics, TRUE-HF may provide state-of-the-art assessment of functional capacity by measuring participant-generated free-world data.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05008692.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012204"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Acute Antioxidant and Tetrahydrobiopterin (BH₄) Administration on Locomotor Muscle Microvascular Function in Patients With Heart Failure.","authors":"Stephen M Ratchford, Heather L Clifton, Jayson R Gifford, D Taylor LaSalle, Taylor S Thurston, Kanokwan Bunsawat, Jeremy K Alpenglow, Josephine B Wright, Markus Amann, John J Ryan, D Walter Wray","doi":"10.1161/CIRCHEARTFAILURE.124.012446","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012446","url":null,"abstract":"<p><strong>Background: </strong>Peripheral microvascular dysfunction is a hallmark feature of both heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) pathophysiology, due partly to impairments in nitric oxide signaling secondary to tetrahydrobiopterin (BH₄) deficiency and oxidative stress.</p><p><strong>Methods: </strong>Using a randomized, double-blind, placebo-controlled crossover design, this study examined the impact of enteral BH₄ (10 mg/kg), an antioxidant cocktail (AOx), and coadministration of these 2 agents (BH₄+AOx) on microvascular function in patients with HFrEF (n=14, 64±10 years) and HFpEF (n=19, 74±9 years). Passive limb movement was utilized to assess locomotor muscle microvascular function, and biomarkers of inflammation and oxidative damage were measured.</p><p><strong>Results: </strong>Compared with placebo, the peak change in leg blood flow was not statistically different after AOx administration (HFrEF, <i>P</i>=0.60; HFpEF, <i>P</i>=0.61), but improved following BH₄ (<i>P</i>=0.033) and BH₄+AOx (<i>P</i>=0.019) in both HFrEF (placebo: 234±31; BH₄: 357±45; BH₄+AOx: 355±49 mL/min) and HFpEF (placebo: 269±33; BH₄: 367±47; BH₄+AOx: 394±65 mL/min). The total hyperemic response to passive limb movement (leg blood flow area under the curve) was not statistically different across treatments in patients with HFrEF (<i>P</i>=0.29), but increased following BH₄ (<i>P</i>=0.016) and BH₄+AOx (<i>P</i>=0.040) in the HFpEF group. CRP (C-reactive protein) was lower following BH₄ (<i>P</i>=0.007) and BH₄+AOx (<i>P</i>=0.007) in HFpEF (placebo: 4268±547; BH₄: 2721±391; BH₄+AOx: 2779±376 ng/mL), but was not statistically different in HFrEF (<i>P</i>=0.39).</p><p><strong>Conclusions: </strong>Together, these results provide new evidence for the efficacy of acute BH₄ administration to improve some aspects of locomotor muscle microvascular function in patients with HFrEF and HFpEF, with no apparent benefit of AOx administration, alone or in combination with BH₄, in either group. These findings lend further conceptual support for the nitric oxide pathway as a modifiable target in the treatment of heart failure.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012446"},"PeriodicalIF":8.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forgotten After Discharge? ECMO Patients Deserve Better.","authors":"Shan P Modi, Manreet K Kanwar","doi":"10.1161/CIRCHEARTFAILURE.125.013176","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013176","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013176"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Organ Procurement and Transplant Network Heart Allocation Policy: 6 Years Later.","authors":"Lauren K Truby, Liviu Klein, Jane E Wilcox, Maryjane Farr","doi":"10.1161/CIRCHEARTFAILURE.124.011631","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011631","url":null,"abstract":"<p><p>In 2014, the Organ Procurement and Transplant Network began reappraisal of the United States heart transplant allocation policy. Driven by ongoing discordance between organ supply and demand, high waitlist mortality, and increasing exception requests, the Thoracic Committee radically redesigned the priority scheme and drafted a 6-tiered algorithm, included durable device complications into policy, expanded broader sharing, and increased the number of mandatory listing variables to develop a future heart allocation score. This became the 2018 New Heart Allocation Policy. Changes in allocation priority have resulted in a significant increase in the use of temporary mechanical circulatory support in waitlisted candidates with a concomitant decrease in the number of patients bridged to transplanted with durable left ventricular assist device support. The number of exception requests continues to increase, particularly for patients listed status 2 and for multiorgan transplants. Importantly, fewer patients are being delisted for clinical improvement, suggesting missed opportunities for recovery. The current review will critically evaluate the 2018 heart allocation policy 6 years later, briefly focusing on the history of heart allocation in the United States, the current and evolving algorithms for candidate prioritization including continuous distribution, the impact of technology and innovation on transplant rates and future policy development, and the ongoing regulatory oversight and governance changes in the Organ Procurement and Transplant Network.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011631"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musclin Counteracts Skeletal Muscle Dysfunction and Exercise Intolerance in Heart Failure With Preserved Ejection Fraction.","authors":"Eng Leng Saw, Louis Dominic Werner, Hannah L Cooper, David R Pimental, Payman Zamani, Julio A Chirinos, María Valero-Muñoz, Flora Sam","doi":"10.1161/CIRCHEARTFAILURE.124.012350","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012350","url":null,"abstract":"<p><strong>Background: </strong>Exercise intolerance is a hallmark of heart failure with preserved ejection fraction (HFpEF) and is characterized by skeletal muscle (SkM) dysfunction with impaired oxidative capacity. To maintain oxidative capacity, the SkM secretes myokines such as musclin, which has been shown to potentiate NP (natriuretic peptide) signaling and induce PGC-1α (peroxisome proliferator-activated receptor-γ coactivator-1 alpha) signaling. We sought to investigate the role of musclin in SkM dysfunction in HFpEF. For this study, we selected the oxidative-predominant SkM soleus in HFpEF mice and vastus lateralis from patients with HFpEF.</p><p><strong>Methods: </strong>Using the SAUNA model, mice underwent HFpEF induction by uninephrectomy, d-aldosterone infusion, and 1% sodium chloride drinking water for 4 weeks. Exogenous musclin was given to HFpEF mice every 2 days during the last 2 weeks of HFpEF induction. Molecular analyses were conducted on blood samples and SkM from HFpEF mice and patients with HFpEF.</p><p><strong>Results: </strong>In HFpEF mice and patients with HFpEF, increased musclin expression was accompanied by decreased cyclic guanosine monophosphate levels and PGC-1α expression in SkM, suggesting impaired NP signaling. Exogenous administration of musclin in mice with HFpEF demonstrated augmented circulating musclin levels and potentiated NP signaling in SkM as shown by increased PKG1 (protein kinase G1) activity and PGC-1α expression. This was associated with a transition from type-2A to type-1 fiber (type-1 has more endurance) and increased succinate dehydrogenase activity, hindlimb blood flow, and capillary density in the soleus muscle. Exogenous musclin also mitigated cardiac hypertrophy without affecting blood pressure or diastolic function. Most importantly, HFpEF mice treated with musclin demonstrated improved functional and exercise capacity.</p><p><strong>Conclusions: </strong>Musclin mediates beneficial effects in SkM and heart with improved exercise capacity likely by improving oxidative capacity in SkM. Future studies are warranted to address the therapeutic efficacy of exogenous musclin in humans with HFpEF.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012350"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where Adults With Heart Failure Die: Insights From the CDC-WONDER Database.","authors":"Farman Ali, Shaaf Ahmad, Aman Ullah, Ali Salman, Adarsh Raja, Faizan Ahmed, Prinka Perswani, Ahsan Alam, Jishanth Mattumpuram, Muhammad Talha Maniya, Hamza Janjua, Tyler J Bonkowski, Aravinda Nanjundappa","doi":"10.1161/CIRCHEARTFAILURE.124.012447","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012447","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is associated with high mortality rates and substantial health care costs. While there is growing emphasis on integrating palliative care for patients with HF, limited data exist on the locations where adults with HF spend their final days. The study aimed to analyze the location and circumstances of death among adults with HF in the United States using Centers for Disease Control and Prevention's Wide-ranging Online Data for epidemiological Research data.</p><p><strong>Methods: </strong>Mortality data from individuals aged ≥20 years, with HF listed as the cause of death between 1999 and 2023, were analyzed. The places of death were categorized as the emergency room, hospice/nursing home, inpatient medical facility, or home. Multinomial logistic regression was performed to examine the associations between demographic factors and death location.</p><p><strong>Results: </strong>HF-related mortality rates declined from 1999 (3.60% and 143.6 age-adjusted mortality rate) to 2010 (3.47% and 123.1 age-adjusted mortality rate). However, rates gradually increased thereafter, reaching 5.18% and 168.1 age-adjusted mortality rate in 2023. Deaths at home nearly doubled, rising from 18.41% (50 648 of 275 132) in 1999 to 33.47% (132 470 of 395 826) in 2023. Hospice/nursing home deaths increased from 30.95% (85 144 of 275 132) in 1999 to 34.71% (116 634 of 336 014) in 2017, but declined to 29.54% (116 931 of 395 826) by 2023. Young adults (20-34 years) had the highest proportion of inpatient deaths. Sex, ethnicity, and urbanization were significant predictors of death location, with men, White individuals, and those in large metropolitan areas more likely to die in medical facilities.</p><p><strong>Conclusions: </strong>This study underscores the shifting trends in the locations of death among patients with HF, with a ≈2-fold increase in HF-related deaths occurring at home over the past 2 decades. The recent decline in hospice/nursing home deaths, following a period of steady growth, calls for an in-depth examination of contributing barriers. Further research is essential to understand the sociodemographic factors driving disparities in HF-related death locations.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012447"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatopulmonary Syndrome or Portopulmonary Hypertension? Two Contrasting Cases of Exertional Hypoxemia From Liver Disease.","authors":"Fadi Adel, Adel Kabbara Allababidi, Yogesh N V Reddy","doi":"10.1161/CIRCHEARTFAILURE.124.012506","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012506","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012506"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study.","authors":"Ary Serpa Neto, Alisa M Higgins, Michael J Bailey, Shannah Anderson, Stephen Bernard, Bentley J Fulcher, Annalie Jones, Natalie J Linke, Jasmin V Board, Daniel Brodie, Heidi Buhr, Aidan J C Burrell, D James Cooper, Eddy Fan, John F Fraser, David J Gattas, Ingrid K Hopper, Sue Huckson, Edward Litton, Shay P McGuinness, Priya Nair, Neil Orford, Rachael L Parke, Vincent A Pellegrino, David V Pilcher, Craig Dicker, Benjamin A J Reddi, Dion Stub, Tony V Trapani, Andrew A Udy, Carol L Hodgson","doi":"10.1161/CIRCHEARTFAILURE.124.012476","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012476","url":null,"abstract":"<p><strong>Background: </strong>Long-term outcomes and quality of life have been identified as core patient-centered outcomes for venoarterial extracorporeal membrane oxygenation (VA-ECMO) research. The aim of this study is to investigate the incidence of death or new disability at 12 months after the initiation of VA-ECMO.</p><p><strong>Methods: </strong>Prospective, multicenter, registry-embedded cohort study in 26 hospitals in Australia and New Zealand from February 2019 through April 2023. Adult patients admitted to a participating ICU and who underwent VA-ECMO were included. The primary outcome was death or new disability at 6 and 12 months. All results were adjusted for patient characteristics at the time of ECMO initiation.</p><p><strong>Results: </strong>Among 389 patients who received VA-ECMO (median age, 57 [44-65] years; 35% women), the incidence of death or new disability at 12 months was 70.6% compared with 70.8% at 6 months (adjusted odds ratio for 12 versus 6 months, 0.61 [95% CI, 0.25-1.49]; <i>P</i>=0.27). Compared with 6 months, at 12 months after VA-ECMO more patients were independent in activities of daily living (62.1% versus 48.2%; adjusted odds ratio, 2.84 [95% CI, 1.50-5.36]; <i>P</i>=0.001), and fewer patients were unemployed due to health reasons (32.7% versus 47.4%; adjusted odds ratio, 0.29 [95% CI, 0.13-0.65]; <i>P</i><0.001). Differences in outcomes were found according to the reason for VA-ECMO initiation.</p><p><strong>Conclusions: </strong>At 12 months after VA-ECMO, 30% of patients are alive and without disability, with differences in outcome associated with the reason for VA-ECMO initiation. The major burden of disability appears to develop in the first 6 months after VA-ECMO initiation and is sustained between 6 and 12 months.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03793257.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012476"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary Transthyretin Cardiac Amyloidosis With the p.V142I Variant: Mechanistic Insights and Diagnostic Challenges.","authors":"Simon Vanhentenrijk, Justin L Grodin, Silvio Nunes Augusto, W H Wilson Tang","doi":"10.1161/CIRCHEARTFAILURE.124.012469","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012469","url":null,"abstract":"<p><p>The most common form of hereditary transthyretin cardiac amyloidosis (hATTR-CA) in the United States and the United Kingdom is the p.V142I variant. About 3% to 4% of patients with African ancestry carry this genetic predisposition to develop signs and symptoms of hATTR-CA. Nevertheless, clinical manifestations of hATTR-CA appear only late in the fifth and sixth decades of life, despite its clear genetic background. Imbalances in native protein-stabilizing and elementary breakdown cellular mechanisms are postulated as potential causes for affecting transthyretin structural integrity and myocardial fibril deposition. Noncoding variants, epigenetic and environmental factors, as well as gut microbiome derangements may serve as disease-modifying factors that feature detrimental amyloidogenic organ involvement and impact disease severity. Organ amyloid deposition varies widely among different carriers of a genetic transthyretin variant. The genotype-phenotype interdependence causes unpredictable phenotypic penetrance that results in a variety of signs and symptoms and patient outcomes. Cardiovascular biomarkers and multimodality imaging may identify initial amyloidogenic organ involvement. These early clinical clues through the course of hATTR-CA offer a window of opportunity for early treatment onset to cease disease progression and alter prognosis. Identifying at-risk patients requires information on the genetic background of probands and their relatives. Initiatives to reveal asymptomatic gene carriers early in the disease should be encouraged, as it necessitates stringent patient follow-up and immediate treatment onset to reduce the burden of heart failure hospitalization and mortality in hATTR-CA.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012469"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Presentation of an Increasingly Recognized Disease: Transthyretin Amyloidosis Presenting With 18F-Fluorodeoxyglucose Uptake on Cardiac Positron Emission Tomography and Focal Late Gadolinium Enhancement on Cardiac Magnetic Resonance.","authors":"Kyla Brezitski, Karen Flores Rosario, Han W Kim, Johana R Fajardo, Michel G Khouri, Salvador Borges-Neto, Ravi Karra","doi":"10.1161/CIRCHEARTFAILURE.124.012002","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012002","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012002"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}