Clinical nephrology最新文献

{"title":"Construction and validation of a survival prognostic model for clear cell renal cell carcinoma.","authors":"Chen-Li Li, Yu-Qian Jiang, Wei Pan, Yan-Li Yang","doi":"10.5414/CN111509","DOIUrl":"10.5414/CN111509","url":null,"abstract":"<p><strong>Objective: </strong>Utilizing expression data of clear cell renal cell carcinoma (ccRCC) genes from the Cancer Genome Atlas (TCGA) database, this study employs weighted gene co-expression network analysis (WGCNA) and Cox regression analysis to identify genes associated with the occurrence and development of ccRCC, thereby providing a scientific basis for its treatment.</p><p><strong>Materials and methods: </strong>Differentially expressed genes between tumor and control groups were identified by preprocessing and batch correction of ccRCC transcriptome data in the TCGA database using the Wilcoxon test. Prognostic prediction models were established through a combination of WGCNA analysis, univariate Cox regression analysis, and multivariate Cox regression analysis. The reliability of these prognostic models was evaluated by plotting Kaplan-Meier survival analysis and receiver operating characteristic (ROC) curves and by further analyzing the relationship between model gene expression levels, tumor staging, and tumor grading.</p><p><strong>Results: </strong>Post-batch correction, M2-type macrophage infiltration was pronounced in tumor tissue, and 13 out of 290 screened relevant differential genes were included in the prognostic model. The Kaplan-Meier survival curves indicated that the 3- and 5-year overall survival rates were significantly higher in the low-risk group compared with the high-risk group (83.7 vs. 69.1%; 75.7 vs. 52.6%, p = 1.169e-08). The area under the ROC curve was 0.732, signifying strong predictive power for the survival curve. In this model, the expression levels of 11 genes were positively correlated with tumor stage and pathological grade, whereas the remaining 2 genes were negatively correlated.</p><p><strong>Conclusion: </strong>This model can predict the overall survival of patients with ccRCC and has the potential to become an important therapeutic target.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the status and associated factors of stigma in patients undergoing maintenance hemodialysis.","authors":"Qiyun Zhuo, Na Xu, Huixian Wang, Bihong Huang, Wenwen Lu","doi":"10.5414/CN111405","DOIUrl":"10.5414/CN111405","url":null,"abstract":"<p><p>This cross-sectional survey assessed the status and the associated factors of stigma among patients undergoing maintenance hemodialysis (MHD). 154 MHD patients were enrolled. General information was collected. The Social Impact Scale, the Generalized Anxiety Disorder-7 Scale, the Patient Health Questionnaire-9, the Perceived Social Support Scale, and the Barthel Index Scale were used for data collection. These patients had an average age of 60.89 years, with 76 (49.4%) male patients, and an average hemodialysis duration of 8.35 years. The total score of stigma was 58.11 ± 9.22, with the highest score in the social rejection dimension (19.03 ± 3.93) and the lowest score in the financial insecurity dimension (7.95 ± 1.87). Univariate analysis showed that there were significant differences in stigma in terms of self-perceived financial burden (p = 0.001), history of falls in the past year (p = 0.004), and different hemodialysis durations (p = 0.042). Pearson correlation analysis revealed that the total score of stigma was positively correlated with the total scores of anxiety and depression, negatively correlated with the total score of social support, and not correlated with the total score of activities of daily living. Multivariate linear regression analysis indicated that self-perceived financial burden, a history of falls in the past year, and anxiety were significant factors associated with stigma. Collectively, the stigma in MHD patients is closely related to self-perceived financial burden, history of falls in the past year, and total anxiety score, suggesting that intervention strategies should be enhanced based on these risk factors. Our findings may guide the intervention of stigma in this population.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human albumin infusion and risk of acute kidney injury in adults with nephrotic syndrome due to minimal change disease: A single-center retrospective study.","authors":"Siwei Tang, Siyan Tang, Tong Liu, Xiaolan Chen, Xiayin Li, Yi Liu, Shiren Sun, Peng Zhang, Ming Bai","doi":"10.5414/CN111480","DOIUrl":"10.5414/CN111480","url":null,"abstract":"<p><strong>Background: </strong>The use of human albumin in patients with minimal change disease (MCD) remains controversial. The aim of the current study was to assess whether infusion of human albumin increased the risk of acute kidney injury (AKI) in adult patients with MCD.</p><p><strong>Materials and methods: </strong>Adult patients who underwent renal biopsy for the diagnosis of MCD at the center between 2017 and 2022 were screened. Logistic regression and Nelson-Aalen cumulative risk curve analysis were used to compare data from patients with and without human albumin infusion.</p><p><strong>Results: </strong>A total of 190 adult patients with MCD diagnosed by renal biopsy were included, of whom 45 received human albumin infusion before MCD diagnosis and 34 developed AKI within 4 weeks of MCD diagnosis. Nelson-Aalen cumulative risk curve analysis showed that patients who received human albumin infusion had a longer time to partial or complete response (p < 0.001), were more likely to develop AKI (p < 0.001), and were more likely to relapse (p = 0.002) than those who did not receive human albumin infusion. Multivariate logistic regression analysis showed that human albumin infusion was an independent risk factor for AKI in adult patients with MCD after adjusting for confounding factors (OR = 3.259, 95% CI, 1.209 - 8.780, p = 0.020).</p><p><strong>Conclusion: </strong>Receiving human albumin infusions may be associated with the development of AKI in adult patients with MCD. Adult MCD patients who received human albumin infusion had a longer time to achieve partial or complete remission and were more likely to relapse.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy and safety of low-dose roxadustat in combination with recombinant human erythropoietin for treating hemodialysis patients with moderate anemia: A retrospective cohort study.","authors":"Yanfei Huang, Xinxin Jiang, Guiqin Shu, Hui Li, Jingjing Lin, Qingqing Duan, Xue Cao, Min Cheng, Zhigui Zheng","doi":"10.5414/CN111433","DOIUrl":"10.5414/CN111433","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the safety and efficacy of low-dose roxadustat combined with low-dose recombinant human erythropoietin (rhEPO) for the treatment of renal anemia in hemodialysis patients.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed the medical records of hemodialysis patients with moderate renal anemia between December 2019 and July 2023 from two medical centers. Patients were classified into 3 groups: rhEPO (150 - 300 IU/kg/week), roxadustat (1.5 - 2.5 mg/kg thrice weekly), and combination therapy (low-dose (≤ 1.5 mg/kg thrice weekly) roxadustat in addition to low-dose (≤ 150 IU/kg per week) rhEPO. After 24 weeks of treatment, the efficacy therapeutic endpoints and the safety endpoints were evaluated.</p><p><strong>Results: </strong>Overall, a total of 158 patients were included: 53 in the rhEPO group, 52 in the roxadustat group, and 53 in the combination group. The median time to achieve Hb response in the combination therapy group was 20 days, which was shorter than that in the roxadustat group (20 vs. 25.5 days, log-rank p = 0.027) and the rhEPO group (20 vs. 27 days, log-rank p = 0.004). The mean rate of increase in Hb (g/L/month) during the first month of the treatment period was significantly greater in the combination group than in the roxadustat group (15.4 ± 4.7 vs. 11.1 ± 5.7, p = 0.038) or in the rhEPO group (15.4 ± 4.7 vs. 10.5 ± 4.3, p = 0.026). The incidence and frequency of adverse events were similar among the 3 groups.</p><p><strong>Conclusion: </strong>The combination of low-dose roxadustat and rhEPO appears to have better effects in treating hemodialysis patients with moderate anemia by shortening the hemoglobin response time with minimal adverse effects.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hemodialysis patient unable to walk - brown tumor as the culprit: Case report and review of the literature.","authors":"Guangyan Nie, Ting Bao, Deguang Wang, Xuerong Wang","doi":"10.5414/CN111469","DOIUrl":"10.5414/CN111469","url":null,"abstract":"<p><strong>Introduction: </strong>Brown tumors are benign lesions caused by hyperparathyroidism and characterized by increased osteoclast activity and mass effect, which can lead to paraplegia when the spine is involved. Secondary hyperparathyroidism is common in patients on long-term hemodialysis therapy.</p><p><strong>Case report: </strong>We report the case of a 48-year-old man on regular dialysis who presented with leg weakness as well as back pain and was diagnosed with secondary hyperparathyroidism and thoracic spine tumor. Since the spinal cord was compressed, T12 mass excision combined with spinal canal decompression was performed under general anesthesia. Post-operative pathology demonstrated abundant fibrovascular tissue and osteoclast-like multinucleated giant cells with hemorrhage and hemosiderin pigment deposition. The patient was diagnosed with brown tumor. Following operation, the patient recovered well. He remains on regular hemodialysis with follow-ups and unaffected activities 10 years later.</p><p><strong>Discussion: </strong>In dialysis patients with combined spinal tumors, brown tumors should be considered. For patients presenting with symptoms of spinal cord compression, surgical resection can lead to a favorable prognosis.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"B cell-driven reduced-dose rituximab as induction therapy for 2 patients with ANCA-associated renal vasculitis: A case series.","authors":"Qinglian Wang, Simeng Wang, Xiang Liu, Fajuan Cheng, Ying Xu","doi":"10.5414/CN111372","DOIUrl":"10.5414/CN111372","url":null,"abstract":"<p><strong>Objective: </strong>Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV), a multisystem autoimmune disorder, deteriorates small vessels. Kidney involvement occurs in most affected patients and is the most common cause of rapidly progressive glomerulonephritis (RPGN). Rituximab (RTX), an anti-CD20 antibody, has been used in the induction and maintenance therapy of AAV as a non-inferior alternative to cyclophosphamide. Administration of 4 once-weekly doses of 375 mg/m² is the common dose in remission induction therapy, referred to as a conventional regimen. Recently, it was shown that the cumulative complete remission (CR) rates did not differ between low-dose RTX (2 once-weekly doses of 375 mg/m²) and the conventional RTX regimen. We aimed to explore the effect of the B cell-driven RTX dosing regimen.</p><p><strong>Case reports: </strong>Herein, we reported B cell-driven reduced-dose RTX therapies in a 71-year-old male de novo patient (case 1) and a 60-year-old female patient (case 2). Case 1, de novo diagnosed based on kidney biopsy, received 3 once-semimonthly doses of 300 mg RTX as induction therapy. Case 2, who was clinically diagnosed with ANCA-associated renal vasculitis 4 years before receiving treatment at our hospital, accepted 4 once-monthly doses of 300 mg RTX as induction therapy. Further dosages were dependent on peripheral CD19+ B-cell levels.</p><p><strong>Results: </strong>During the course of treatment, peripheral B-cell counts of both patients turned 0, and symptoms of both patients improved, complete remission occurred in case 1, with a Birmingham vasculitis activity score (BVAS) of 0.</p><p><strong>Conclusion: </strong>B cell-driven reduced-dose RTX might be also effective in induction therapy for AAV. Further study is warranted to confirm the efficacy, safety, and risk of relapse of a reduced-dose RTX regimen.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of depression on clinical outcomes of peritoneal dialysis: A systematic review and meta-analysis.","authors":"Meiling Xu, Wei Zhang","doi":"10.5414/CN111454","DOIUrl":"10.5414/CN111454","url":null,"abstract":"<p><strong>Objective: </strong>Depression has become a highly prevalent mental disorder around the globe. With a large number of end-stage renal disease patients taking up peritoneal dialysis (PD), a substantial number of PD patients with concomitant depression are expected to be treated in the future. However, the effects of depression on outcomes of PD are unclear. This review systematically examines the effect of depression on mortality, technique survival, or peritonitis in PD patients.</p><p><strong>Materials and methods: </strong>Studies comparing outcomes of PD patients with and without depression and published on Google Scholar, Embase, Web of Science, and PubMed till February 5, 2024 were included.</p><p><strong>Results: </strong>Eleven studies were eligible; 5 studies reported data on mortality. Pooled analysis showed that depression was not a significant predictor of mortality in PD patients (HR: 1.22 95% CI: 0.86, 1.72). Only 2 studies reported analyzable data on technique survival and 3 studies on peritonitis. Meta-analysis found no statistically significant effect of depression on technique survival (OR: 1.28 95% CI: 0.38, 4.35) and peritonitis (OR: 1.89 95% CI: 0.82, 4.33). Qualitative analysis of remaining studies also suggested no effect of depression on patient and technique survival.</p><p><strong>Conclusion: </strong>Depression may not be an independent predictor of patient and technique survival in PD patients. Data on the risk of peritonitis is conflicting and needs to be investigated further.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"333-342"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of POCUS in sepsis-associated AKI in children.","authors":"Rupesh Raina, Jieji Hu, Shreeyans Bhavaraju, Sidharth Kumar Sethi","doi":"10.5414/CN111554","DOIUrl":"10.5414/CN111554","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The protective powers of L-theanine against drug-induced kidney damage.","authors":"Yahya Altinkaynak, Elizaveta Burenkova, Akcan Buket","doi":"10.5414/CN111549","DOIUrl":"10.5414/CN111549","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Drug-induced kidney damage (DIKD) is a significant medical concern linked to many drugs, including nonsteroidal anti-inflammatory drugs, antibiotics, and chemotherapy agents, due to its complex pathophysiology. L-theanine, a tea leaf amino acid, is explored for its protective effects against DIKD, considering its cognitive and calming benefits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;In the theoretical part of the article, the role of L-theanine in combating DIKD is reviewed, highlighting its ability to mitigate oxidative stress and inflammation by neutralizing reactive oxygen species, enhancing antioxidant defenses, and modulating anti-inflammatory pathways. L-theanine's influence on cell signaling and its synergy with other nephroprotective agents are discussed. The practical part describes an experimental study using a murine model, where 60 male C57BL/6 mice were divided into four groups: a control group, a nephrotoxic group treated with cisplatin, and two treatment groups that received L-theanine either before or after cisplatin administration. Serum biomarkers (creatinine and blood urea nitrogen (BUN)), histopathological kidney damage scores, and oxidative stress markers (malondialdehyde (MDA) and superoxide dismutase (SOD)) were measured.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Evidence from the murine study indicates that L-theanine protects against DIKD through antioxidative, anti-inflammatory, and anti-apoptotic mechanisms, potentially enhancing its synergy with other nephroprotective agents. In the nephrotoxic group (N), serum creatinine and BUN levels were significantly elevated, while pre-treatment with L-theanine (LTP) reduced these levels to 1.2 ± 0.3 mg/dL and 34 ± 4 mg/dL, respectively. Histopathological analysis revealed severe tubular necrosis in the N group (score: 3.8 ± 0.3), which was significantly reduced in the LTP group (1.6 ± 0.4). Oxidative stress markers, such as MDA, were markedly lowered in the LTP group compared to the N group, with corresponding increases in SOD activity, indicating enhanced antioxidant defense. These findings underscore L-theanine's potential in preserving renal health amidst pharmacotherapy-induced toxicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;L-theanine emerges as a promising nephroprotective agent, particularly in the context of increasing incidence of DIKD and the associated challenges in clinical management. The practical findings from this study in a murine model provide compelling evidence that L-theanine significantly reduces serum biomarkers of renal injury, attenuates tubular necrosis, and mitigates oxidative stress, with pronounced effects observed when administered as a pre-treatment. While these results are promising, the predominance of preclinical data underscores the need for rigorous human studies to validate L-theanine's efficacy and safety in the prevention of drug-related renal injuries. Such research is crucial for advancing renal protection strate","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting AKI in critical patients: An interpretable model based on albumin and fluid balance.","authors":"Yifan Xu, Zengyu Zhang, Bai Xu, Lan Sun, Lei Zhong, Yuqi Chen, Siyu Tang, Yan Qu, Xianghong Yang","doi":"10.5414/CN111510","DOIUrl":"10.5414/CN111510","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a clinically complex syndrome with a high incidence and mortality rate in the intensive care unit (ICU). Early identification of high-risk patients and timely intervention are crucial.</p><p><strong>Objective: </strong>A local database was used to construct a model that predicts the incidence of AKI in ICU patients within 48 hours.</p><p><strong>Materials and methods: </strong>We conducted a study involving 9,628 critically ill patients at Zhejiang Provincial People's Hospital and divided the cohort into derivation and validation groups. We collected and analyzed demographic data, vital signs, laboratory tests, medications, clinical interventions, and other information for all patients, resulting in a total of 232 variables. Six different machine learning algorithms were employed to construct models, and the optimal model was selected and validated.</p><p><strong>Results: </strong>A total of 2,441 patients were included, of whom 1,138 (46.62%) met the AKI criteria. A model was derived that included 16 variables such as albumin transfusion, fluid balance, diastolic blood pressure (DBP), partial pressure of oxygen (PO₂), blood glucose (GLU), platelet (PLT), baseline serum creatinine (bSCr), serum sodium, age, epinephrine, proton pump inhibitor (PPI), intra-abdominal infection, anemia, diabetes, glycerin fructose, and nutritional pathway. The area under the receiver operating characteristic curve (AUC) was 0.822. Subgroup analysis revealed the impact of blood pressure fluctuations on AKI. Additionally, the study demonstrated a bidirectional effect of albumin and fluid balance on AKI.</p><p><strong>Conclusion: </strong>This model is highly accurate and may facilitate the early diagnosis of and interventions for AKI.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}