Clinical Toxicology最新文献

{"title":"A pregnant woman with diquat poisoning leading to miscarriage and pontine haematoma.","authors":"Rui-Kai Shang, Qiao-Xin Tian, Xiang-Dong Jian, Hong-Yu Liu, Yu-Ru Liu, Qi-Lu Li","doi":"10.1080/15563650.2025.2454972","DOIUrl":"https://doi.org/10.1080/15563650.2025.2454972","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sotalol poisoning and its unique treatment considerations compared with traditional therapies for beta-adrenoceptor blocking drug poisoning.","authors":"Jon B Cole, Nathan M Kunzler, Arthur R Jurao, Ryan T Fuchs, Travis D Olives, Jenna L Wilkinson","doi":"10.1080/15563650.2025.2454291","DOIUrl":"https://doi.org/10.1080/15563650.2025.2454291","url":null,"abstract":"<p><strong>Introduction: </strong>Sotalol is a beta-adrenoceptor blocking drug with unique physical and pharmacologic properties. Unlike most beta-adrenoceptor blocking drugs, sotalol is amenable to extracorporeal removal and causes QT interval prolongation and ventricular dysrhythmias. These properties have implications for treating sotalol poisoning.</p><p><strong>Patients: </strong><b><i>Patient 1</i></b>: A man in his seventh decade of life overdosed on sotalol 9 g and presented with bradycardia, hypotension, QT interval >600 ms and transient ventricular tachycardia. Dopamine, isoprenaline (isoproterenol), and a transvenous pacemaker were used instead of high-dose insulin due to the risk of iatrogenic hypokalemia. Hemodynamics improved, and the pacemaker was removed six days later. <b><i>Patient 2:</i></b> A woman in her seventh decade of life on sotalol presented with hypotension in the setting of anuric acute kidney failure. Hypotension worsened after administration of additional sotalol. Hemodialysis was performed for refractory hypotension, followed by improvement in hemodynamics and kidney function.</p><p><strong>Discussion: </strong>High-dose insulin, a standard therapy in beta-adrenoceptor blocking drug poisoning, causes hypokalemia, which may exacerbate QT interval prolongation and ventricular dysrhythmias in patients with sotalol poisoning. Sotalol is cleared renally and is amenable to extracorporeal removal; hemodialysis may be a useful therapy in patients with cardiotoxicity and concomitant kidney injury.</p><p><strong>Conclusions: </strong>Chronotropes and overdrive pacing may be preferred therapies for patients with severe sotalol poisoning. If concomitant kidney injury occurs, hemodialysis may be a useful adjunctive therapy.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case series of ibogaine toxicity reported to the United Kingdom National Poisons Information Service (NPIS) over a 10-year period.","authors":"Ella P Edwards, Laurence A Gray, Muhammad E M O Elamin, Aravindan Veiraiah, Ruben H K Thanacoody, James M Coulson","doi":"10.1080/15563650.2024.2447500","DOIUrl":"https://doi.org/10.1080/15563650.2024.2447500","url":null,"abstract":"<p><strong>Introduction: </strong>Ibogaine is a psychoactive alkaloid derived from the root bark of the West African shrub <i>Tabernanthe iboga</i>. It is not licensed in the United Kingdom but is used by individuals to alleviate drug or alcohol use.</p><p><strong>Methods: </strong>A retrospective analysis of telephone enquiries involving ibogaine between 1 January 2012 and 31 December 2022 to the United Kingdom National Poisons Information Service was performed.</p><p><strong>Case series: </strong>Eleven enquiries relating to seven patients were made to the United Kingdom National Poisons Information Service in this period. Five of these patients were male (71%) with the majority in the age category 31-40 years (57%). All patients presented symptomatically. The circumstances for all seven cases were recorded as \"recreational abuse.\" The exact indication was not specified in three cases but in two cases it was being used to alleviate diacetylmorphine (heroin) use and in another two cases it was being used for relief from insomnia. Three sources of ibogaine were reported - in one case it was bought online, in one case by a dealer and in two cases it was bought from a shaman. When reported, the dose ingested ranged from 5g to 34g. Two patients took it in tablet form and four patients ingested the root bark. The time since exposure, when reported, ranged from 16 h to 1 month. Seven patients experienced neurological symptoms and six displayed features of cardiotoxicity. The most frequently reported features included cardiac arrest, hypoxia, torsade de pointes, QT interval prolongation, coma, convulsions, stupor, bradycardia, vomiting and anxiety.</p><p><strong>Conclusions: </strong>Individuals using ibogaine in variable doses to self-treat for drug use are at risk of developing severe cardiotoxicity and neurological symptoms. Further studies to quantify dose-response relationship and to further improve knowledge of its pharmacokinetics are required.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-5"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of acetylcysteine on the prothrombin time and international normalized ratio: a narrative review.","authors":"Messia Nazar, Jenny E Kootstra-Ros, Paola Mian, Daniel J Touw, Marieke G G Sturkenboom","doi":"10.1080/15563650.2025.2451642","DOIUrl":"https://doi.org/10.1080/15563650.2025.2451642","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Patients poisoned with paracetamol are treated with acetylcysteine. In patients without hepatocellular injury, an increased prothrombin time or international normalized ratio has been observed during acetylcysteine administration. The international normalized ratio is preferred as it is a standardized calculation of prothrombin time independent of reagents and machinery. Since the prothrombin time and international normalized ratio are used as markers of liver injury in patients with paracetamol poisoning, it is important to assess the magnitude of the effect of acetylcysteine treatment on the prothrombin time and international normalized ratio. The aim of this narrative review is to describe the effect of acetylcysteine on the prothrombin time and international normalized ratio.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Embase, PubMed and Web of Science were searched to identify the effect of acetylcysteine on coagulation factors II, VII, IX or X, the prothrombin time and the international normalized ratio in &lt;i&gt;in vitro&lt;/i&gt; and &lt;i&gt;in vivo&lt;/i&gt; studies in healthy subjects and clinical studies involving both those poisoned with paracetamol and surgical patients. The search terms employed were acetylcysteine combined with prothrombin time, international normalized ratio, coagulation or haemostasis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search identified a total of 2,471 articles, of which 19 studies were included. Six &lt;i&gt;in vitro&lt;/i&gt; and/or &lt;i&gt;in vivo&lt;/i&gt; studies, five clinical studies in paracetamol-poisoned patients and eight clinical studies in surgical patients were included. Acetylcysteine caused a 15-30% increase in prothrombin time and international normalized ratio. This increase was dose-dependent and was caused by a decrease in the activity of coagulation factors II, VII, IX and X. The effect of acetylcysteine on the increased prothrombin time and international normalized ratio was more prominent after the high loading dose but remained present during the lower maintenance dose of acetylcysteine. The effect was observed in both &lt;i&gt;in vitro&lt;/i&gt; and &lt;i&gt;in vivo&lt;/i&gt; studies and confirmed in clinical studies in paracetamol-poisoned patients without hepatic injury. Studies in surgical patients treated with acetylcysteine showed conflicting results. Twelve of the 13 clinical studies suffered from risk of bias, limiting the value of these studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The moderate 15-30% increase in the international normalized ratio induced by acetylcysteine is especially important in hospitals using the international normalized ratio as a marker for hepatotoxicity due to paracetamol poisoning and underlines the need for the international normalized ratio to be assessed at admission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Acetylcysteine treatment leads to an estimated 15-30% increase in prothrombin time and international normalized ratio in both experimental studies and paracetamol-poisoned patients. Isolated incr","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-10"},"PeriodicalIF":3.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presence of sibutramine and sildenafil in weight loss dietary supplements: a case series with analytical and clinical investigation.","authors":"Marie Carles, Tessa Pietri, Joelle Micallef, Clara Corteggiani-Giraud, Magali Richez, Caroline Solas-Chesneau, Bruno Lacarelle, Nicolas Fabresse","doi":"10.1080/15563650.2025.2452297","DOIUrl":"https://doi.org/10.1080/15563650.2025.2452297","url":null,"abstract":"<p><strong>Introduction: </strong>The use of weight loss supplements is increasing, often driven by online marketing. However, many of these supplements are adulterated with undeclared pharmaceutical substances, potentially posing significant health risks. We investigated the presence of sibutramine and sildenafil in weight loss supplements and assessed the associated clinical outcomes.</p><p><strong>Materials and methods: </strong>A total of 12 weight loss supplement samples (capsules, tea, and coffee bags) were analyzed using liquid chromatography-high resolution mass spectrometry. Demographic and clinical data were collected by the Marseille Regional Pharmacovigilance Centre from 29 patients who reported using these products.</p><p><strong>Results: </strong>All samples were found to contain sibutramine, with concentrations ranging from 7.5 mg to 15.4 mg per unit. Sildenafil was detected in all samples, with concentrations ranging from 1.7 mg to 4.8 mg per unit. Clinical data from 29 users showed significant weight loss, with an average of 7.5 kg after 37 days of use. Adverse effects included anorexia (<i>n</i> = 15), tachycardia (<i>n</i> = 13), insomnia (<i>n</i> = 2) and chest pain (<i>n</i> = 4). In some cases, more serious effects such as seizures and dependence were observed.</p><p><strong>Discussion: </strong>Both sibutramine and sildenafil were withdrawn from the market due to cardiovascular risks. As such, the unregulated use of these products pose a serious risk to public health, particularly in individuals with underlying cardiovascular disease.</p><p><strong>Conclusion: </strong>We detected sibutramine and sildenafil in all 12 weight loss supplements tested, which highlights the need for stricter regulation and monitoring.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veno-venous extracorporeal membrane oxygenation (VV-ECMO) for acute poisonings in United States: a retrospective analysis of the Extracorporeal Life Support Organization Registry.","authors":"Hong K Kim, Andrew O Piner, Lauren N Day, Kevin M Jones, Danilo Alunnifegatelli, Matteo Di Nardo","doi":"10.1080/15563650.2024.2447496","DOIUrl":"https://doi.org/10.1080/15563650.2024.2447496","url":null,"abstract":"<p><strong>Introduction: </strong>Veno-arterial extracorporeal membrane oxygenation is frequently considered and implemented to help manage patients with cardiogenic shock from acute poisoning. However, utilization of veno-venous extracorporeal membrane oxygenation in acutely poisoned patients is largely unknown.</p><p><strong>Method: </strong>We conducted a retrospective study analyzing the epidemiologic, clinical characteristics and survival of acutely poisoned patients placed on veno-venous extracorporeal membrane oxygenation using the Extracorporeal Life Support Organization registry. Adult cases in the United States were included after a systematic search of the registry between January 1, 2003, and November 30, 2019. Study outcomes included survival to discharge, time to cannulation, and changes in metabolic, hemodynamic, and ventilatory parameters stratified by survival.</p><p><strong>Results: </strong>One hundred and seventeen cases were included in the analysis after excluding 216 non-poisoning-related cases. Their median age was 34 years and 69.2% were male. Opioids (45.3%) were most commonly implicated, followed by neurologic drugs (e.g., antidepressants, antiepileptics) (14.5%) and smoke inhalation (13.7%); 23 patients (19.7%) had a pre-extracorporeal membrane oxygenation cardiac arrest. The median time from admission to extracorporeal membrane oxygenation was 47 h with a median duration of extracorporeal membrane oxygenation support of 146.5 h. Survivors were cannulated significantly earlier than non-survivors (25 h versus 123 h; <i>P</i> = 0.02). Eighty-four patients (71.2%) survived to hospital discharge. Clinical parameters (hemodynamic, metabolic, and ventilatory) improved with veno-venous extracorporeal membrane oxygenation support, but no statistically significant difference was noted between survivors and non-survivors.</p><p><strong>Discussion: </strong>Our study showed that veno-venous extracorporeal membrane oxygenation was infrequently utilized for poisoning-associated acute respiratory distress syndrome. Opioids were the most frequently reported exposure among the cases in which indirect lung injury may have occurred from aspiration. Although no specific clinical parameters were associated with survival, early initiation of extracorporeal membrane oxygenation may improve clinical outcomes.</p><p><strong>Conclusions: </strong>The use of veno-venous extracorporeal membrane oxygenation for refractory respiratory failure due to poisoning was associated with a clinically significant survival benefit compared to other respiratory diagnoses requiring veno-venous extracorporeal membrane oxygenation.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding an overdose: intention, motivation, and risk.","authors":"Matthew Robert Dernbach, Erin Seery, J J Rasimas, Hilary S Connery","doi":"10.1080/15563650.2024.2447490","DOIUrl":"https://doi.org/10.1080/15563650.2024.2447490","url":null,"abstract":"<p><strong>Background: </strong>Overdose is frequently categorized dichotomously: an inadvertent therapeutic or recreational misadventure versus a deliberate overdose for self-injurious or suicidal purposes. Categorizing overdoses based on this dichotomy of intention is fraught with methodological problems and may result in potentially inappropriate and/or divergent care pathways.</p><p><strong>Overdose-related intent lies along a continuum: </strong>Suicidality can rapidly shift in magnitude and frequency at different points in time. A patient's overdose may reflect varying degrees of desire to die, ambivalence about living, disregard for risk, or pleasure-seeking. Careful assessment of overdose-related cognitions is warranted in all overdose patients.</p><p><strong>The clinical interview is key to understanding an overdose: </strong>There is an irreducibly subjective character to an overdose such that a collaborative understanding of an overdose episode can only be discovered by spending time in dialogue with the patient. At the same time, the objective risk factors for and circumstances of the overdose need to be integrated with the subjective experience for a comprehensive prevention approach.</p><p><strong>There can be several motivations underlying an overdose: </strong>Some overdoses might be wholly inadvertent or simply impulsive. However, if there is some degree of intent present, then the patient who overdosed has attempted to communicate something by means of that overdose, and this message might include something other than the desire to die.</p><p><strong>Attending to both the subjective and objective perspectives of an overdose can assist in identifying modifiable risk factors: </strong>Overdose-related intent and motivation may be targeted with treatment plans to reduce elevated risk states. Some patient-specific overdose risk factors are modifiable, such as managing mental health and other psychosocial issues, reducing access to lethal means, and promoting safe prescribing and medication administration practices. Other risk factors are either unmodifiable (e.g., personal history of overdose) or involve public health systems.</p><p><strong>Conclusions: </strong>Overdose-whether involving medications, illicit substances, hazardous chemicals, or otherwise-can be conceptualized as a single behavioral episode with variable intentionality, personal motivations, and risk factors. Clinical/medical toxicologists are uniquely positioned to contribute to personalized risk reduction post-overdose.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extrapyramidal effects in a young child with acute organophosphorus insecticide poisoning.","authors":"Sharon Guy, Kate Webb, Gill Riordan, Cindy Stephen","doi":"10.1080/15563650.2025.2453057","DOIUrl":"https://doi.org/10.1080/15563650.2025.2453057","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed cerebrospinal fluid removal is ineffective in treating intrathecal baclofen overdose.","authors":"Nicolas Mutel, Jérémy Lecot, Fabien Lamoureux, Doria Ikhlef, Chloé Bruneau, Ariella Ganem, Dominique Vodovar, Fabienne Tamion, Marion Giry","doi":"10.1080/15563650.2025.2451641","DOIUrl":"https://doi.org/10.1080/15563650.2025.2451641","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting delayed neurological sequelae in patients with carbon monoxide poisoning using machine learning models.","authors":"Yunfeng Zhu, Tianshu Mei, Dawei Xu, Wei Lu, Dan Weng, Fei He","doi":"10.1080/15563650.2024.2437113","DOIUrl":"https://doi.org/10.1080/15563650.2024.2437113","url":null,"abstract":"<p><strong>Introduction: </strong>Delayed neurological sequelae is a common complication following carbon monoxide poisoning, which significantly affects the quality of life of patients with the condition. We aimed to develop a machine learning-based prediction model to predict the frequency of delayed neurological sequelae in patients with carbon monoxide poisoning.</p><p><strong>Methods: </strong>A single-center retrospective analysis was conducted in an emergency department from January 01, 2018, to December 31, 2023. We analyzed data from patients with carbon monoxide poisoning, which were divided into training and test sets. We developed and evaluated sixteen machine learning models, using accuracy, sensitivity, specificity, and other relevant metrics. Threshold adjustments were performed to determine the most accurate model for predicting patients with carbon monoxide poisoning at risk of delayed neurological sequelae.</p><p><strong>Results: </strong>A total of 360 patients with carbon monoxide poisoning were investigated in the present study, of whom 103 (28.6%) were diagnosed with delayed neurological sequelae, and two (0.6%) died. After threshold adjustment, the synthetic minority oversampling technique-random forest model demonstrated superior performance with an area under the receiver operating characteristic curve of 0.89 and an accuracy of 0.83. The sensitivity and specificity of the model were 0.9 and 0.8, respectively.</p><p><strong>Discussion: </strong>The study developed a machine learning-based synthetic minority oversampling technique-random forest model to predict delayed neurological sequelae in patients with carbon monoxide poisoning, achieving an area under the receiver operating characteristic curve of 0.89. This technique was used to handle class imbalance, and shapley additive explanations analysis helped explain the model predictions, highlighting important factors such as the Glasgow Coma Scale, hyperbaric oxygen therapy, kidney function, immune response, liver function, and blood clotting.</p><p><strong>Conclusions: </strong>The machine learning-based synthetic minority oversampling technique-random forest model developed in this study effectively identifies patients with carbon monoxide poisoning at high risk for delayed neurological sequelae.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-10"},"PeriodicalIF":3.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142976823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}