Circulation: Cardiovascular Interventions最新文献

{"title":"Prospective Observational Study on the Accuracy of Predictors of Permanent Pacemaker Secondary to High-Grade Atrioventricular Conduction Block After TAVI (CONDUCT-TAVI).","authors":"Karan Rao, Bernard Chan, Kunwardeep Bhatia, Natasha Saad, Alexandra Baer, David Whalley, Christopher Choong, Peter Hansen, Ravinay Bhindi","doi":"10.1161/CIRCINTERVENTIONS.125.015446","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015446","url":null,"abstract":"<p><strong>Background: </strong>The incidence of permanent pacemaker implantation (PPMI) due to high-grade atrioventricular block after transcatheter aortic valve implantation (TAVI) is 10% to 15% at 1-year, and current prediction algorithms remain unreliable.</p><p><strong>Methods: </strong>CONDUCT-TAVI is a prospective observational study of 200 patients undergoing TAVI across 2 centers. Baseline demographic, anatomic and procedural characteristics were recorded, followed by targeted electrophysiology studies and continuous rhythm monitoring using implantable loop recorders for 1 year. The primary outcome was PPMI secondary to high-grade atrioventricular block, and secondary outcomes included early (≤48 hours) and late (>48 hours) PPMI, new-onset persistent left bundle branch block, and new-onset atrial fibrillation. Predictors were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>PPMI due to high-grade atrioventricular block occurred in 21.0% of patients (early PPMI: 13.5%, late PPMI: 7.5%). Key predictors included preexisting right bundle branch block (adjusted odds ratio, 5.45 [95% CI, 1.67-17.84]; <i>P</i>=0.005), ΔHV interval >10 ms (adjusted odds ratio, 3.62 [95% CI, 1.23-10.67]; <i>P</i>=0.020), and pre-TAVI rapid atrial pacing-induced atrioventricular Wenckebach (adjusted odds ratio, 3.70 [95% CI, 1.37-9.98]; <i>P</i>=0.010). The CONDUCT-TAVI score combined these variables with high predictive accuracy (area under the curve=0.794) and negative predictive value (98%). New-onset persistent left bundle branch block (>24 hours) was observed in 19.1%, and new-onset atrial fibrillation in 21.7% at 1 year.</p><p><strong>Conclusions: </strong>The incidence of conduction abnormalities remains high after TAVI, and after factoring in anatomic, procedural, and electrophysiological factors, a baseline right bundle branch block and electrophysiology study-derived measures of AV conduction were the most significant predictors of PPMI. The CONDUCT-TAVI score incorporates these findings to help implanters stratify low-risk patients and tailor follow-up care.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015446"},"PeriodicalIF":7.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063404","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":"Current Concepts in Revascularization for Ischemic Heart Disease With Reduced Ejection Fraction.","authors":"Ramya C Mosarla, Judith S Hochman, Leon Axel, Ravichandran Ramasamy, Stuart D Katz, Sripal Bangalore","doi":"10.1161/CIRCINTERVENTIONS.125.014625","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.014625","url":null,"abstract":"<p><p>Ischemic heart disease is the leading cause of heart failure with reduced ejection fraction in the developed world. An evolution of background medical therapy over the past decade has spurred improvement in symptoms and a reduction in morbidity and mortality with ischemic cardiomyopathy. However, there is still ongoing debate about the role and impact of revascularization. Much of the societal guidance regarding revascularization with coronary artery bypass grafting in ischemic cardiomyopathy comes from the STICH trial (Surgical Treatment for Ischemic Heart Failure) which predates improvements in medical therapy. More recently, the REVIVED-BCIS2 trial (Revascularization for Ischemic Ventricular Dysfunction-British Cardiovascular Intervention Society) failed to show a benefit of percutaneous coronary intervention on heart failure hospitalization and mortality in ischemic cardiomyopathy over contemporary medical therapy alone. Yet, there are outstanding questions regarding the role and modality of revascularization required to improve outcomes. We review current data and future directions in the management of ischemic cardiomyopathy and the potential role of revascularization.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014625"},"PeriodicalIF":7.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063374","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":"Comparative Effectiveness of TAVI Platforms and Surgical Aortic Valve Replacement: A Network Meta-Analysis of Randomized Controlled Trials.","authors":"Francesco Moroni, Pablo Lamelas, Ariel Izcovich, Farid Foroutan, Stephen E Fremes, Ana Carolina Alba, Thomas Agoritsas, Richard Whitlock, Martin Denicolai, Oscar Mendiz, Mamas A Mamas, Rodrigo Bagur","doi":"10.1161/CIRCINTERVENTIONS.125.015387","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015387","url":null,"abstract":"<p><strong>Background: </strong>Evidence informing clinical guidelines assumes that all transcatheter aortic valve implantation (TAVI) devices have similar effectiveness, in other words, displaying a class effect across TAVI valves. We aimed to assess the comparative effectiveness of different TAVI platforms relative to other TAVI counterparts or surgical aortic valve replacement (SAVR).</p><p><strong>Methods: </strong>MEDLINE/Embase/CENTRAL were searched from inception until April 2025, for randomized controlled trials comparing outcomes with different commercially available TAVI devices relative to other TAVI counterparts or SAVR. The certainty of the evidence was assessed following the Grading of Recommendations, Assessment, Development, and Evaluations approach. We performed a frequentist network meta-analysis to generate treatment effect estimates. All-cause, cardiovascular mortality, and stroke were considered critically important patient-centered outcomes.</p><p><strong>Results: </strong>We identified 11 randomized controlled trials with 9946 participants and reporting outcomes between 1 to 10 years. TAVI with CoreValve-Evolut was associated with a similar risk of all-cause (absolute risk difference [ARD], 31/1000 from -12 to 79), and cardiovascular mortality (ARD, -8/1000 from -39 to 28) compared with SAVR (moderate certainty). Compared with SAVR, TAVI with SAPIEN and ACURATE neo were associated with an increased risk of all-cause (ARD, 109/1000 from 56 to 169, high certainty and ARD, 123/1000 from 9 to 277, moderate certainty, respectively) and cardiovascular mortality (ARD, 58/1000 from 18 to 105, high certainty and ARD, 105 from 7 to 247, moderate certainty, respectively). Moderate and high-certainty evidence showed that all TAVI platforms were associated with an increased risk of reinterventions and pacemaker implant versus SAVR. Compared with TAVI with CoreValve-Evolut, SAPIEN was associated with higher all-cause (ARD, 75/1000 from 13 to 147, high certainty) and cardiovascular mortality (ARD, 66/1000 from 15 to 130, high certainty), same scenario for ACURATE neo (ARD 113/1000 from 13 to 259, high certainty). TAVI with SAPIEN was associated with a higher risk of stroke compared with CoreValve-Evolut (ARD, 31/1000 from 5 to 65, high certainty), whereas CoreValve-Evolut showed higher rates of pacemaker implant compared with SAPIEN, ACURATE neo.</p><p><strong>Conclusions: </strong>TAVI with CoreValve-Evolut is probably associated with similar mortality to SAVR. TAVI with SAPIEN and ACURATE neo were associated with increased risk of mortality compared with SAVR and CoreValve-Evolut. The current body of evidence from randomized controlled trials goes against the hypothesis of a class effect across TAVI valves.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk; Unique identifier: CRD42024512026.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015387"},"PeriodicalIF":7.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032876","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":"Between a Rock and a Hard Place: Comparing Interventional Approaches to Calcified Nodules.","authors":"Amir Darki, John J Lopez","doi":"10.1161/CIRCINTERVENTIONS.125.015890","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015890","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015890"},"PeriodicalIF":7.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029056","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":"TMVR for the Treatment of Mitral Regurgitation: A State-of-the-Art Review.","authors":"Francesco Tartaglia, Giulia Antonelli, Mauro Gitto, Kamil Stankowski, Dario Donia, Giulio Stefanini, Azeem Latib, Antonio Colombo, Antonio Mangieri, Mauro Chiarito","doi":"10.1161/CIRCINTERVENTIONS.125.015298","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015298","url":null,"abstract":"<p><p>Mitral regurgitation is the most common valve disease worldwide. Despite its wide success in inoperable or high-risk surgical patients, transcatheter edge-to-edge repair remains limited by some anatomic features and the not negligible rate of significant residual regurgitation. Transcatheter mitral valve replacement has emerged as a viable alternative that promises to overcome these issues, but its development has been progressing slowly. This review aims to provide a comprehensive overview of the current state of transcatheter mitral valve replacement, including patient selection, procedural techniques, and currently available outcomes.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015298"},"PeriodicalIF":7.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029076","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":"Microvascular Function and Ambulatory Capacity in Peripheral Artery Disease.","authors":"Alexander E Sullivan, Adam Behroozian, Crystal Coolbaugh, Emily Shardelow, Emily K Smith, Quinn S Wells, Daniel G Clair, Aaron W Aday, C Louis Garrard, John A Curci, Tara A Holder, Joey V Barnett, Matthew S Freiberg, Rachelle L Crescenzi, Denis J Wakeham, Christopher M Hearon, Manus J Donahue, Joshua A Beckman","doi":"10.1161/CIRCINTERVENTIONS.125.015582","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015582","url":null,"abstract":"<p><strong>Background: </strong>Patients with peripheral artery disease experience walking impairment that is incompletely explained by large-artery atherosclerotic occlusive disease and abnormal ankle-brachial index (ABI). Microvascular dysfunction is associated with adverse outcomes, including amputation, but its effect on ambulation is unknown. We tested the hypothesis that skeletal muscle microvascular function directly associates with walking distance, is a more sensitive indicator of walking distance than conduit artery blood inflow, and correlates with ambulatory improvement following peripheral artery disease interventions.</p><p><strong>Methods: </strong>Sixty-eight participants, including 50 with peripheral artery disease (ABI ≤0.85) and 18 healthy controls, underwent vascular function assessment after sphygmomanometer cuff-induced calf ischemia using magnetic resonance imaging measures of blood oxygenation level-dependent reactivity and arterial spin labeling perfusion reactivity. Functional status was assessed using the 6-minute walk test. A subgroup of patients with peripheral artery disease underwent repeat testing after supervised exercise therapy (n=14) or revascularization (n=14). Multivariable linear regression models were used to assess the association of macrovascular reactive hyperemic blood inflow within the conduit arteries, skeletal muscle microvascular blood oxygenation level-dependent reactivity, and walking distance.</p><p><strong>Results: </strong>Resting large-artery pressure by ABI (R=0.74; <i>P</i><0.001), macrovascular blood inflow (R=0.40; <i>P</i><0.001), and skeletal muscle microvascular blood oxygenation level-dependent reactivity (R=0.66; <i>P</i><0.001) significantly correlated with the 6-minute walk test distance in univariable vascular testing. In multivariable analysis of each vascular parameter, however, calf skeletal muscle microvascular reactivity was most strongly associated with the 6-minute walk test (β=825.3; <i>P</i>=0.023). In those with repeat testing after intervention, the change in microvascular reactivity, but not ABI or macrovascular blood inflow, significantly correlated with the change in the 6-minute walk test distance (R=0.46; <i>P</i>=0.014).</p><p><strong>Conclusions: </strong>Microvascular reactivity after ischemia directly associates with walking distance and was a stronger predictor of walking distance than macrovascular blood inflow and ABI. After supervised exercise therapy or revascularization, improvements in microvascular function, but not macrovascular inflow or ABI, correlate with improvement in walking distance. Further study of microvascular dysfunction as a mechanistic driver of ambulatory function is warranted.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03490968.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015582"},"PeriodicalIF":7.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991528","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":"Percutaneous Thoracic Duct Externalization and Autotransfusion in Patients With Lymphatic Failure Due to Elevated Central Venous Pressure.","authors":"Yoav Dori, Erin Pinto, Lauren Biroc, Matthew J Gillespie, Ryan Callahan, Jessica Tang, Michael L O'Byrne, Brooke Ford, Danish Vaiyani, Aaron G DeWitt, Denise Merrill, Digvijay Shinde, Emmanuelle Favilla, Rachel Shustak, Fernando A Escobar, Ganesh Krishnamurthy, Abhay Srinivasan, Jonathan J Rome, Christopher L Smith","doi":"10.1161/CIRCINTERVENTIONS.125.015336","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015336","url":null,"abstract":"<p><strong>Background: </strong>External drainage of the thoracic duct can temporarily reduce tissue congestion and improve symptoms in patients with heart failure. However, loss of fluid limits the duration of this approach. Here, we report on our initial experience with thoracic duct drainage and autotransfusion in patients with elevated central venous pressure.</p><p><strong>Methods: </strong>This is a retrospective review of medical records of 8 patients who underwent percutaneous thoracic duct drainage with autotransfusion as part of their medical care. We reviewed clinical and procedural outcomes, laboratory data, and imaging.</p><p><strong>Results: </strong>In 5 (62.5%) patients, central venous pressure was elevated secondary to congenital heart disease, 1 (12.5%) had a lymphatic conduction disorder and trisomy 21, 1 (12.5%) had a lymphatic conduction disorder with Noonan syndrome and congenital heart disease, and 1 (12.5%) patient had severe chronic lung disease due to prematurity. Median central venous pressure was 15.5 mm Hg (range, 12-28), and all patients presented with severe multicompartment lymphatic failure including plastic bronchitis (12.5%), pleural effusions (37.5%), protein-losing enteropathy (62.5%), ascites (75%), and anasarca (100%). Over 7 (87.5%) patients survived to decannulation, and the median duration of autotransfusion was 11.5 days (range, 6-126). There was a significant reduction in creatinine from a median of 0.63 (0.3-2.4) to 0.36 (0.16-0.8) mg/dL (<i>P</i>=0.017). There was also a significant reduction in weight (<i>P</i>=0.017) and drainage output (<i>P</i>=0.017). There were no intraprocedural or autotransfusion-related deaths.</p><p><strong>Conclusions: </strong>Thoracic duct drainage with autotransfusion can improve fluid status and end-organ function without significant complications and presents a new therapeutic option. Further studies are needed to better define indications for this procedure and long-term outcomes.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015336"},"PeriodicalIF":7.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991533","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":"Hemodynamic Super-Response to Mechanical Thrombectomy in Patients With Intermediate-Risk Pulmonary Embolism.","authors":"Eugene Yuriditsky, Robert S Zhang, Peter Zhang, Hannah P Truong, Lindsay Elbaum, Allison A Greco, Radu Postelnicu, James M Horowitz, Samuel Bernard, Vikramjit Mukherjee, Kerry Hena, Carlos L Alviar, Norma M Keller, Sripal Bangalore","doi":"10.1161/CIRCINTERVENTIONS.125.015235","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015235","url":null,"abstract":"<p><strong>Background: </strong>Among patients with intermediate-risk pulmonary embolism undergoing mechanical thrombectomy, the mean change in cardiac index (CI) is modest. We sought to identify variables associated with a hemodynamic super-response or a CI increase of ≥25% postthrombectomy.</p><p><strong>Methods: </strong>This was a single-center retrospective study including patients with intermediate-risk pulmonary embolism undergoing mechanical thrombectomy with pulmonary artery catheter-derived hemodynamic indices obtained preprocedure and postprocedure.</p><p><strong>Results: </strong>Overall, 105 intermediate-risk patients had complete hemodynamic profiles, with 41 patients (39%) classified as super-responders. Super-responders had a lower baseline CI (1.9±0.7 versus 2.3±0.6 L/min per m²). The mean change in CI postthrombectomy was 0.8±0.4 L/min per m² among super-responders versus 0.1±0.4 L/min per m² among non-super-responders. Several established indices of poor right ventricular function were associated with a significant increase in the CI in a univariable model. An left ventricular outflow tract velocity-time integral ≤15 cm, tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ≤0.34 mm/mm Hg, and substantial inferior vena cava contrast reflux were associated with a hemodynamic super-response with an odds ratio of 16.19 (95% CI, 1.97-133.24,), 6.5 (95% CI, 2.13-19.83), and 2.53 (95% CI, 1.09-5.88), respectively. In a multivariable model, a preprocedure CI ≤2.2 L/min per m² was associated with a hemodynamic super-response (odds ratio, 3.76 [95% CI, 1.09-13.0]).</p><p><strong>Conclusions: </strong>Patients with intermediate-risk pulmonary embolism with the more severe hemodynamic derangements had the greatest improvement in CI post thrombectomy. This group can be identified with commonly available noninvasive indices of right ventricular dysfunction.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015235"},"PeriodicalIF":7.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945214","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":"Response by Demir et al to Letter Regarding Article, \"Pressure Derived Indices in the Left Main Coronary Artery: Insights From Comprehensive In Vivo Hemodynamic Studies of Diseased and Unobstructed Vessels\".","authors":"Ozan M Demir, Haseeb Rahman, Divaka Perera","doi":"10.1161/CIRCINTERVENTIONS.125.015752","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015752","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015752"},"PeriodicalIF":7.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871746","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":"Fetal Atrial Septal Intervention for HLHS With Restrictive Septum: Promising Progress, Persistent Questions.","authors":"Gerald Tulzer, Iris Scharnreitner, Andreas Tulzer","doi":"10.1161/CIRCINTERVENTIONS.125.015909","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015909","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015909"},"PeriodicalIF":7.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945209","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}