Circulation: Genomic and Precision Medicine最新文献

{"title":"Natural History, Phenotype Spectrum, and Clinical Outcomes of Desmin (<i>DES</i>)-Associated Cardiomyopathy.","authors":"Babken Asatryan, Marina Rieder, Brittney Murray, Steven A Muller, Crystal Tichnell, Alessio Gasperetti, Richard T Carrick, Emily Joseph, Doris G Leung, Anneline S J M Te Riele, Stefan L Zimmerman, Hugh Calkins, Cynthia A James, Andreas S Barth","doi":"10.1161/CIRCGEN.124.004878","DOIUrl":"10.1161/CIRCGEN.124.004878","url":null,"abstract":"<p><strong>Background: </strong>Pathogenic/likely pathogenic (LP) desmin (<i>DES</i>) variants cause heterogeneous cardiomyopathy and skeletal myopathy phenotypes. Limited data suggest a high incidence of major adverse cardiac events (MACEs), including cardiac conduction disease, sustained ventricular arrhythmias (VA), and heart failure (HF) events (HF hospitalization, left ventricular assist device/cardiac transplant, HF-related death) in patients with pathogenic/LP <i>DES</i> variants. However, pleiotropic presentation and small cohort sizes have limited clinical phenotype and outcome characterization. We aimed to describe the natural history, phenotype spectrum, familial penetrance and outcomes in patients with pathogenic/LP <i>DES</i> variants through a systematic review and individual patient data meta-analysis using published reports.</p><p><strong>Methods: </strong>We searched Medline (PubMed) and Embase for studies that evaluated cardiac phenotypes in patients with pathogenic/LP <i>DES</i> variants. Cardiomyopathy diagnosis or occurrence of MACE was considered evidence of cardiac involvement/penetrance. Lifetime event-free survival from cardiac conduction disease, sustained VA, HF events, and composite MACE was assessed.</p><p><strong>Results: </strong>Of the 4212 screened publications, 71 met the inclusion criteria. A total of 230 patients were included (52.6% men, 52.2% probands, median age: 31 years [22.0-42.8] at first evaluation, median follow-up: 3 years [0-11.0]). Overall, 124 (53.9%) patients were diagnosed with cardiomyopathy, predominantly dilated cardiomyopathy (14.8%), followed by restrictive cardiomyopathy (13.5%), whereas other forms were less common: arrhythmogenic cardiomyopathy (7.0%), hypertrophic cardiomyopathy (6.1%), arrhythmogenic right ventricular cardiomyopathy (5.2%), and other forms (7.4%). Overall, 132 (57.4%) patients developed MACE, with 96 (41.7%) having cardiac conduction disease, 36 (15.7%) sustained VA, and 43 (18.7%) HF events. Familial penetrance of cardiac disease was 63.6% among relatives with pathogenic/LP <i>DES</i> variants. Male sex was associated with an increased risk of sustained VA (hazard ratio, 2.28; <i>P</i>=0.02) and HF events (hazard ratio, 2.45; <i>P</i>=0.008).</p><p><strong>Conclusions: </strong><i>DES</i> cardiomyopathy exhibits heterogeneous phenotypes and a distinct natural history, characterized by high familial penetrance and a substantial MACE burden. Male patients face a higher risk of sustained VA events.</p>","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e004878"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Implications Between hsCRP and <i>CYP2C19</i> Genotype in Patients From East Asia: Insights From the PTRG-DES Consortium.","authors":"Se Hun Kang, Jae Youn Moon, Seung-Yul Lee, Sang-Hoon Kim, Jeehoon Kang, Hyo-Soo Kim, Hyung Joon Joo, Do-Sun Lim, Sang Yeub Lee, Young-Hoon Jeong, Jung-Won Suh, Byeong-Keuk Kim, Kiyuk Chang, Yongwhi Park, Young Bin Song, Sung Gyun Ahn, Jung Rae Cho, Ae-Young Her, Eun-Seok Shin, Moo Hyun Kim","doi":"10.1161/CIRCGEN.124.004998","DOIUrl":"10.1161/CIRCGEN.124.004998","url":null,"abstract":"","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e004998"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Scientist Perspective on Developing Genetic Therapies for Marfan Syndrome.","authors":"Lauren C Testa","doi":"10.1161/CIRCGEN.125.005114","DOIUrl":"10.1161/CIRCGEN.125.005114","url":null,"abstract":"","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e005114"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence to Enhance Precision Medicine in Cardio-Oncology: A Scientific Statement From the American Heart Association.","authors":"Rohan Khera, Aarti H Asnani, Jacob Krive, Daniel Addison, Han Zhu, Alexi Vasbinder, Matthew R Fleming, Rima Arnaout, Pedram Razavi, Tochukwu M Okwuosa","doi":"10.1161/HCG.0000000000000097","DOIUrl":"10.1161/HCG.0000000000000097","url":null,"abstract":"<p><p>Artificial intelligence is poised to transform cardio-oncology by enabling personalized care for patients with cancer, who are at a heightened risk of cardiovascular disease due to both the disease and its treatments. The rising prevalence of cancer and the availability of multiple new therapeutic options has resulted in improved survival among patients with cancer and has expanded the scope of cardio-oncology to not only short-term but also long-term cardiovascular risks resulting from both cancer and its treatments. However, there is considerable heterogeneity in cardiovascular risk, driven by the nature of the malignancy as well as each individual's unique characteristics. The use of novel therapies, such as targeted therapies and immune checkpoint inhibitors, across multiple cancer groups has also broadened the populations among which cardiotoxicity has become an important consideration of therapy. Therefore, the ability to understand and personalize cardiovascular risk management in patients with cancer is a key target for artificial intelligence, which can deduce and respond to complex patterns within the data. These advances necessitate an overview of established biomarkers of risk, spanning advanced imaging, diagnostic testing, and multi-omics, the evidence supporting their use, and the proven and proposed role of artificial intelligence in refining this risk to attain greater precision in risk prediction and management in cardio-oncologic care.</p>","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e000097"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Disclosing a Polygenic Risk Score for Coronary Heart Disease on Adverse Cardiovascular Events.","authors":"Mohammadreza Naderian, Marwan E Hamed, Ali A Vaseem, Kristjan Norland, Ozan Dikilitas, Azin Teymourzadeh, Kent R Bailey, Iftikhar J Kullo","doi":"10.1161/CIRCGEN.124.004968","DOIUrl":"10.1161/CIRCGEN.124.004968","url":null,"abstract":"<p><strong>Background: </strong>In the Myocardial Infarction Genes clinical trial (URL: https://www.clinicaltrials.gov; Unique identifier: NCT01936675), participants at intermediate risk of coronary heart disease (CHD) were randomized to receive a Framingham risk score (Framingham risk score group, n=103) or an integrated risk score (integrated risk score group [IRS_g], n=104) that additionally included a polygenic risk score. After 6 months, IRS_g participants had higher statin initiation and lower low-density lipoprotein cholesterol. We conducted a post hoc 10-year follow-up analysis to investigate whether disclosure of a polygenic risk score for CHD was associated with a reduction in major adverse cardiovascular events (MACE).</p><p><strong>Methods: </strong>Participants were followed from randomization in October 2013 to September 2023 to ascertain MACE, testing for CHD, and changes in risk factors. The primary outcome was time to first MACE, defined as cardiovascular death, nonfatal myocardial infarction, coronary revascularization, and nonfatal stroke. Statistical analyses included Cox proportional hazards regression and linear mixed-effects models.</p><p><strong>Results: </strong>We followed all participants who completed the trial, 100 in Framingham risk score group and 103 in IRS_g (mean age at the end of follow-up, 68.2±5.2; 48% male). During a median follow-up of 9.5 years, 9 MACEs occurred in Framingham risk score group and 2 in IRS_g (hazard ratio, 0.20 [95% CI, 0.04-0.94]; <i>P</i>=0.042). In Framingham risk score group, 47 (47%) underwent at least 1 diagnostic test for CHD, compared with 30 (29%) in IRS_g (hazard ratio, 0.51 [95% CI, 0.32-0.81]; <i>P</i>=0.004). A higher proportion of IRS_g participants were on statin therapy during the first 4 years postrandomization and had a greater reduction in low-density lipoprotein cholesterol for up to 3 years postrandomization. No significant differences were observed between 2 groups in other traditional cardiovascular risk factors during follow-up.</p><p><strong>Conclusions: </strong>Disclosure of an integrated risk score that included a polygenic risk score to individuals at intermediate risk for CHD was associated with lower MACE incidence after 10 years, likely due to higher statin initiation, leading to lower low-density lipoprotein cholesterol levels.</p>","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e004968"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of AlphaMissense and Other In Silico Predictors to Determine Pathogenicity of Missense Variants in Sarcomeric Genes.","authors":"Mario Ruiz, Juan Pablo Ochoa, Candela Migoyo-Bettoni, Jorge de la Barrera, Alba Delrio-Lorenzo, Manuel A Fernández-Rojo, Ines Martinez-Martin, Jorge Alegre-Cebollada, Enrique Lara-Pezzi, Fatima Sanchez-Cabo, Pablo Garcia-Pavia","doi":"10.1161/CIRCGEN.124.004922","DOIUrl":"10.1161/CIRCGEN.124.004922","url":null,"abstract":"","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e004922"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Advanced Echocardiographic Modalities to Discriminate Preclinical Hypertrophic Cardiomyopathy Mutation Carriers From Non-Carriers.","authors":"Ada K C Lo, Thomas Mew, Christina Mew, Kristyan Guppy-Coles, Arun Dahiya, Arnold Ng, Julie McGaughran, Louise McCormack, Sandhir Prasad, John J Atherton","doi":"10.1161/CIRCGEN.124.004806","DOIUrl":"10.1161/CIRCGEN.124.004806","url":null,"abstract":"<p><strong>Background: </strong>It remains challenging to determine which hypertrophic cardiomyopathy (HCM) family members will subsequently develop HCM. Standard 2-dimensional and conventional Doppler echocardiography have been unable to reliably distinguish HCM genotype-positive and phenotype-negative (G+P-) from genotype-negative and phenotype-negative (G-P-) family members. We aimed to determine if advanced echocardiographic modalities can discriminate HCM G+P- from G-P- individuals.</p><p><strong>Methods: </strong>Comprehensive echocardiography including speckle tracking evaluation of myocardial deformation and color M-mode were performed in 199 participants aged ≥16 years who had undergone genetic testing from families with a known HCM pathogenic variant: 58 G+P-, 39 G-P-, and 102 overt patients with HCM (genotype-positive and phenotype-positive). The primary analysis compared these measures in all G+P- and G-P- individuals. A secondary analysis was undertaken in younger subjects (age ≤40 years).</p><p><strong>Results: </strong>Comparing G+P- and G-P- individuals, there were no significant differences in left ventricular ejection fraction, cavity size, wall thickness and outflow tract gradient, and tissue Doppler-derived myocardial velocities; however, septal/posterior wall thickness ratio was higher (1.06±0.09 versus 1.02±0.04, <i>P</i>=0.007). G+P- individuals had significantly lower color M-mode flow propagation velocity (color M-mode velocity propagation, 42.6 cm/s [interquartile range, 34.5-48.5 cm/s] versus 51.0 cm/s [interquartile range, 45.2-61.0 cm/s]; <i>P</i><0.001) and higher global longitudinal strain (<i>P</i>=0.021), circumferential strain (<i>P</i>=0.003), and peak apical rotation (<i>P</i>=0.005). Multivariable logistic regression identified 2 independent predictors (color M-mode velocity propagation and peak apical rotation). A derived regression equation allowed reasonable discrimination of G+P- individuals with a sensitivity of 82.6% and specificity of 72.2% (<i>P</i><0.0001) at the optimal cutoff. Similar findings were demonstrated when the analysis was restricted to younger subjects, although in addition to color M-mode velocity propagation and apical rotation, left ventricular ejection fraction was also independently predictive.</p><p><strong>Conclusions: </strong>In HCM family members, color M-mode velocity propagation and apical rotation provide good sensitivity and specificity for identifying mutation carriers and may represent early disease markers before the onset of hypertrophy. Longitudinal studies involving larger cohorts are required to validate these findings.</p>","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e004806"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Effects of Mavacamten on Patients Based on Hypertrophic Cardiomyopathy Pathogenic Genetic Variant Status: Insights From VALOR-HCM Trial.","authors":"Milind Y Desai, Anjali Owens, Sara Saberi, Andrew Wang, Kathy Wolski, Paul C Cremer, Neal K Lakdawala, Albree Tower-Rader, Mark Zenker, Mark Sherrid, Jeffrey B Geske, David Fermin, Srihari S Naidu, Kathy Lampl, Steven E Nissen","doi":"10.1161/CIRCGEN.125.005100","DOIUrl":"10.1161/CIRCGEN.125.005100","url":null,"abstract":"","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e005100"},"PeriodicalIF":6.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Importance of Genomic and Clinical Risk for Coronary Artery Disease Over the Life Course.","authors":"Sarah M Urbut, So Mi Jemma Cho, Kaavya Paruchuri, Buu Truong, Sara Haidermota, Gina M Peloso, Whitney E Hornsby, Anthony Philippakis, Akl C Fahed, Pradeep Natarajan","doi":"10.1161/CIRCGEN.124.004681","DOIUrl":"10.1161/CIRCGEN.124.004681","url":null,"abstract":"<p><strong>Background: </strong>Earlier identification of high coronary artery disease (CAD) risk individuals may enable more effective prevention strategies. However, existing 10-year risk frameworks are ineffective at earlier identification. We sought to understand how the variable importance of genomic and clinical factors across life stages may significantly improve lifelong CAD event prediction.</p><p><strong>Methods: </strong>A longitudinal study was performed using data from 2 cohort studies: the FOS (Framingham Offspring Study) with 3588 participants aged 19 to 57 years and the UKB (UK Biobank) with 327 837 participants aged 40 years to 70 years. A total of 134 765 and 3 831 734 person-time years were observed in FOS and UKB, respectively. Hazard ratios for CAD were calculated for polygenic risk score (PRS) and clinical risk factors at each age of enrollment. The relative importance of PRS and pooled cohort equations in predicting CAD events was also evaluated by age groups.</p><p><strong>Results: </strong>The importance of CAD PRS diminished over the life course, with a hazard ratio of 3.58 (95% CI, 1.39-9.19) at the age of 19 years in FOS and a hazard ratio of 1.51 (95% CI, 1.48-1.54) by the age of 70 years in UKB. Clinical risk factors exhibited similar age-dependent trends. PRS significantly outperformed pooled cohort equations in identifying subsequent CAD events in the 40- to 45-year age group, with 3.2-fold more appropriately identified events. Overall, adding PRS improved the area under the receiving operating curve of the pooled cohort equations by an average of +5.1% (95% CI, 4.9%-5.2%) across all age groups; among individuals <55 years, PRS augmented the area under the receiver operater curve (ROC) of the pooled cohort equations by 6.5% (95% CI, 5.5%-7.5%; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Genomic and clinical risk factors for CAD display time-varying importance across the lifespan. The study underscores the added value of CAD PRS, particularly among individuals younger than 55 years, for enhancing early risk prediction and prevention strategies. All results are available at https://surbut.github.io/dynamicHRpaper/index.html.</p>","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e004681"},"PeriodicalIF":6.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Machine Learning-Guided Strategy for Elevated Lipoprotein(a) Screening in Health Systems.","authors":"Arya Aminorroaya, Lovedeep S Dhingra, Evangelos K Oikonomou, Rohan Khera","doi":"10.1161/CIRCGEN.124.004632","DOIUrl":"10.1161/CIRCGEN.124.004632","url":null,"abstract":"<p><strong>Background: </strong>While universal screening for Lipoprotein(a) [Lp(a)] is increasingly recommended, <0.5% of patients undergo Lp(a) testing. Here, we assessed the feasibility of deploying Algorithmic Risk Inspection for Screening Elevated Lp(a) (ARISE), a validated machine learning tool, to health system electronic health records to increase the yield of Lp(a) testing.</p><p><strong>Methods: </strong>We randomly sampled 100 000 patients from the Yale-New Haven Health System to evaluate the feasibility of ARISE deployment. We also evaluated Lp(a)-tested populations in the Yale-New Haven Health System (n=7981) and the Vanderbilt University Medical Center (n=10 635) to assess the association of ARISE score with elevated Lp(a). To compare the representativeness of the Lp(a)-tested population, we included 456 815 participants from the UK Biobank and 23 280 from 3 US-based cohorts of Atherosclerosis Risk in Communities, Coronary Artery Risk Development in Young Adults, and Multi-Ethnic Study of Atherosclerosis.</p><p><strong>Results: </strong>Among 100 000 randomly selected Yale-New Haven Health System patients, 413 (0.4%) had undergone Lp(a) measurement. ARISE score could be computed for 31 586 patients based on existing data, identifying 2376 (7.5%) patients with a high probability of elevated Lp(a). A positive ARISE score was associated with significantly higher odds of elevated Lp(a) in the Yale-New Haven Health System (odds ratio, 1.87 [95% CI, 1.65-2.12]) and the Vanderbilt University Medical Center (odds ratio, 1.41 [95% CI, 1.24-1.60]). The Lp(a)-tested population significantly differed from other study cohorts in terms of ARISE features.</p><p><strong>Conclusions: </strong>We demonstrate the feasibility of deployment of ARISE in US health systems to define the risk of elevated Lp(a), enabling a high-yield testing strategy. We also confirm the markedly low adoption of Lp(a) testing, which is also being restricted to a highly selected population.</p>","PeriodicalId":10326,"journal":{"name":"Circulation: Genomic and Precision Medicine","volume":" ","pages":"e004632"},"PeriodicalIF":6.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}