Clinical Kidney Journal最新文献

{"title":"ERA Registry Figure of the month Patient survival on dialysis and kidney transplantation.","authors":"Vianda S Stel, Alberto Ortiz, Anneke Kramer","doi":"10.1093/ckj/sfaf051","DOIUrl":"https://doi.org/10.1093/ckj/sfaf051","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfaf051"},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555959","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":"Integrated primary and secondary care optimizes the management of people with CKD-the LUCID project.","authors":"Rupert W Major, Niraj Lakhani, Yaseen Ahmed, Jade Atkin, Richard Baines, Rose Balment, Chee Kay Cheung, Matthew P Graham-Brown, Claire Ellwood, Laura Harding, Osasuyi Iyasere, Tracy Jesa, Jorge Jesus-Silva, Yusuf Jinadu, Arshad Khalid, Jibran Khatri, Yahya Makkeyah, Maria Martinez, Helen Mather, James F Medcalf, Kirk Moore, James Ogle, Eleanor Oseya, Dipesh Patel, Reena Patel, Tracy Pollard, William Priestman, Amit Rastogi, Nil Sanganee, Mark Shaffu, Michael Steiner, Tun Than, Gang Xu, Fahad Rizvi, James O Burton","doi":"10.1093/ckj/sfaf049","DOIUrl":"https://doi.org/10.1093/ckj/sfaf049","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis, risk stratification and medication optimization are essential to improve the management of chronic kidney disease (CKD) and other long-term conditions. The introduction of Integrated Care Systems (ICS) in England provides the opportunity to revolutionize the management of these conditions. Annual National Health Service kidney disease costs are ∼£6.4 billion.</p><p><strong>Methods: </strong>We designed, piloted and implemented at scale an ICS-level virtual care programme for CKD, the 'Leicester, Leicestershire, and Rutland Chronic Kidney Disease Integrated Care Delivery Project' (LUCID), based on the principles of patient and professional education, early disease identification, medicines optimization and disease surveillance.</p><p><strong>Results: </strong>In April 2022, virtual multidisciplinary team (MDT) meetings were piloted in Leicester, Leicestershire and Rutland, UK. Since April 2023 virtual MDT meetings have been available to all general practices in Leicester, Leicestershire and Rutland, representing a population of approximately 1.2 million people. As of 31 March 2024, general practices representing an estimated population of 700 000 (58.3%) were participating in the LUCID programme. Some 1085 consultations took place for 821 patients, 590 (54.4%) of which were medicines optimization consultations.</p><p><strong>Conclusions: </strong>LUCID may represent an efficient and cost-effective model to deliver patient and professional education, medicine optimization and risk stratification for people living with CKD at an ICS-wide population level. This model may be adaptable for other long-term physical and mental health conditions.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 4","pages":"sfaf049"},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969247","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":"Does low-dose spironolactone increase cardiovascular protection in patients with chronic kidney disease?","authors":"Clara García-Carro, Pantelis Sarafidis","doi":"10.1093/ckj/sfaf038","DOIUrl":"10.1093/ckj/sfaf038","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf038"},"PeriodicalIF":3.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596426","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":"Mechanisms and treatment of obesity-related hypertension-Part 2: Treatments.","authors":"Aneliya Parvanova, Manuela Abbate, Elia Reseghetti, Piero Ruggenenti","doi":"10.1093/ckj/sfaf035","DOIUrl":"10.1093/ckj/sfaf035","url":null,"abstract":"<p><p>Hypertension is a frequent comorbidity of obesity that significantly and independently increases the risk of cardiovascular and renal events. Obesity-related hypertension is a major challenge to the healthcare system because of the rapid increase in obesity prevalence worldwide. However, its treatment is still not specifically addressed by current guidelines. Weight loss (WL) <i>per se</i> reduces blood pressure (BP) and increases patient responsiveness to BP-lowering medications. Thus, a weight-centric approach is essential for the treatment of obesity-related hypertension. Diet and physical activity are key components of lifestyle interventions for obesity-related hypertension, but, in real life, their efficacy is limited by poor long-term patient adherence and frequently require pharmacotherapy implementation to achieve target BP. In this context, first-generation anti-obesity drugs such as orlistat, phentermine/topiramate, and naltrexone/bupropion are poorly effective, whereas second-generation incretin receptor agonists, including the GLP-1 receptor agonists liraglutide and semaglutide, and in particular the dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) co-agonist tirzepatide, substantially contribute to effective WL and BP control in obesity. SGLT2 inhibitors are weak body weight and BP-lowering medications, but clearly synergize the benefits of these medications. Bariatric surgery remains the gold standard treatment for severe \"pathological\" obesity and related life-threatening complications. Renal denervation is a valuable rescue treatment for drug-resistant hypertension, commonly related to obesity. Integrating a multifaceted weight-based approach with other strategies, such as antihypertensive drugs and renal denervation, could specifically target the main neuro-hormonal and renal pathophysiological mechanisms of obesity-related hypertension, including sympathetic-nervous and renin-angiotensin-aldosterone systems overactivity, salt retention, and volume expansion. This comprehensive strategy can provide a personalized algorithm for managing hypertension in obesity within the context of \"precision medicine\" principles.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf035"},"PeriodicalIF":3.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699902","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":"The role of obinutuzumab in rituximab-refractory membranous nephropathy and minimal change disease.","authors":"Zewei Chen, Dechao Xu, Shuangcheng Wu, Wenyu Liu, Jianxiang Wu, Shengqiang Yu, Bing Dai, Zhiguo Mao, Xiang Gao","doi":"10.1093/ckj/sfaf039","DOIUrl":"10.1093/ckj/sfaf039","url":null,"abstract":"<p><strong>Background: </strong>Obinutuzumab, a new-generation anti-CD20 monoclonal antibody, was originally developed to overcome resistance to rituximab in B-cell malignancies. There is limited research regarding the use of obinutuzumab in patients with rituximab-refractory membranous nephropathy (MN) and minimal change disease (MCD).</p><p><strong>Methods: </strong>A retrospective analysis was performed at Changzheng Hospital from September 2022 to September 2024, and screened patients with rituximab-refractory MN or MCD. Participants were treated because they were refractory to rituximab and consented to receive infusions of obinutuzumab. Primary outcomes were defined as complete remission (CR, proteinuria <0.3 g/d) or partial remission (PR, proteinuria <3.5 g/d with a ≥50% reduction). Secondary outcome was immunological remission in patients with phospholipase A2 receptor (PLA2R)-related MN.</p><p><strong>Results: </strong>Seven patients with MN and five with MCD were included in the cohort. Among patients with MN, six of seven (86%) achieved at least PR, of whom two patients reached CR with a median time to first remission (either PR or CR) of 8.0 months. Among patients with positive serum anti-PLA2R antibodies at baseline, all achieved an immunological response. No patients experienced a relapse during the follow-up period. Among patients with MCD, all patients achieved a CR with the median time of 1.0 months. Patients who were steroid-dependent or immunosuppressant-dependent were able to taper their medications in the short term without experiencing relapse. No treatment-related severe adverse events were reported.</p><p><strong>Conclusions: </strong>Our study demonstrated that obinutuzumab represents a promising alternative therapeutic option for the management of rituximab-refractory MN and MCD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf039"},"PeriodicalIF":3.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656283","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":"Preoperative localization of parathyroid glands in secondary hyperparathyroidism: correlations between 99mTc-MIBI-SPECT/CT, ultrasound, and pathological characteristics.","authors":"Binghan Li, Xiaoli Zhao, Sha Luo, Qi Zhong, Hanxue Zhao, Chengxiang Du, Guojuan Zhang","doi":"10.1093/ckj/sfaf040","DOIUrl":"10.1093/ckj/sfaf040","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between imaging findings and histopathological characteristics of parathyroid glands in patients with secondary hyperparathyroidism (SHPT).</p><p><strong>Methods: </strong>Seventy-four glands from 21 patients with SHPT who underwent parathyroidectomy were evaluated for their pathological characteristics. The detection rates of parathyroid glands using ultrasound (US) and 99Tc-MIBI-SPECT/CT (MIBI) were compared. Glands were classified as either US-positive or US-negative, and MIBI-positive or MIBI-negative. Morphological and pathological differences between the positive and negative groups were systematically analysed.</p><p><strong>Results: </strong>The detection rates for parathyroid glands were 71% with US, 65% with MIBI, and 82% when combining both methods. US and MIBI showed similar localization accuracy in SHPT (<i>P</i> = .38). MIBI-positive glands had significantly larger oxyphil nodules compared with MIBI-negative glands (area: 10.92 mm² vs 3.09 mm², <i>P</i> < .01; area proportion: 61% vs 30%, <i>P</i> = .002), while no significant differences were found in chief nodules. The US-positive group had fewer and smaller chief nodules (number: 2 vs 9, <i>P</i> = .005; area: 1.53 mm² vs 11.08 mm², <i>P</i> = .033) and a higher percentage of oxyphil nodules (74% vs 33%, <i>P</i> = .003) compared with the US-negative group. Thirteen glands undetected by both US and MIBI had smaller oxyphil nodule areas (3.59 vs 13.24 mm²) and lower oxyphil nodule area percentages (25% vs 68%). These pathological features, including adipose infiltration, intra-gland haemorrhage, cyst formation, and calcification, showed no correlation with the gland's imaging results.</p><p><strong>Conclusion: </strong>US and MIBI had similar value in preoperative localization of SHPT. Parathyroid glands with more and larger oxyphil nodules were more likely to be detected by both MIBI and US.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf040"},"PeriodicalIF":3.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613771","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":"T1 mapping magnetic resonance imaging predicts decline of kidney function.","authors":"Aurélie Huber, Ibtisam Aslam, Lindsey Crowe, Menno Pruijm, Thomas de Perrot, Sophie de Seigneux, Jean-Paul Vallée, Lena Berchtold","doi":"10.1093/ckj/sfaf032","DOIUrl":"10.1093/ckj/sfaf032","url":null,"abstract":"<p><strong>Background: </strong>Renal cortical interstitial fibrosis, typically assessed by biopsy, is crucial for kidney function prognosis. Magnetic resonance imaging (MRI) is a promising method to assess fibrosis non-invasively. Diffusion-weighted (DW) MRI correlates with renal fibrosis and predicts kidney function decline in chronic kidney disease (CKD) and kidney allograft patients. This study evaluates whether T1 and T2 mapping predict kidney function decline and if their simultaneous use enhances the predictive power of a DW-MRI-based model.</p><p><strong>Methods: </strong>We prospectively included 197 patients (42 CKD, 155 allograft kidneys). Each underwent a biopsy followed by multiparametric MRI without contrast within 1 week. Over a median follow-up of 2.2 years, laboratory parameters were recorded. The primary endpoint was a rapid decline in kidney function [glomerular filtration rate (GFR) reduction >30%] or replacement therapy initiation. The ability of T1 and T2 mapping sequences to predict poor renal outcome was examined using multivariable Cox regression models, incorporating MRI-derived parameters, estimated GFR (eGFR) and proteinuria.</p><p><strong>Results: </strong>Renal outcome occurred in 54 patients after a median of 1.1 years (interquartile range 0.9-2.1). Univariable survival analysis showed cortical T1 was associated with poor renal outcome {hazard ratio [HR] 3.02 [95% confidence interval (CI) 1.44-6.33]}, while T2 sequences had no significant predictive value. Adding cortical T1 to the established model (ΔADC, eGFR, proteinuria) did not improve the HR [from 4.62 (95% CI 1.56-13.67) to 4.36 (95% CI 1.46-13.02)] and marginally increased Harrell's C-index (0.77 to 0.79). Adjusting the regression model for ΔT2 yielded no enhancement in predictive power.</p><p><strong>Conclusions: </strong>Cortical T1 is strongly associated with poor renal outcome but did not enhance prognostic power of the DW-MRI-based model.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf032"},"PeriodicalIF":3.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691312","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":"Genetic vs non-genetic kidney disease: prognosis insights from a multi-cohort study.","authors":"Ahmet Burak Dirim, Roser Torra","doi":"10.1093/ckj/sfaf033","DOIUrl":"10.1093/ckj/sfaf033","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf033"},"PeriodicalIF":3.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566047","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":"Quality matters: chronic kidney disease progression is associated with reduced muscle strength independently of changes in skeletal muscle mass: an observational study.","authors":"Antoine Chatrenet, Pierre-Yves de Müllenheim, Massimo Torreggiani, Julia Nava Hernández, Rocío Urbina Arronte, Abril Gutiérrez Espinoza, Giorgina Barbara Piccoli","doi":"10.1093/ckj/sfaf036","DOIUrl":"10.1093/ckj/sfaf036","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is commonly associated with multifactorial neuromuscular impairments. Few studies have investigated CKD-induced changes in maximal voluntary force (MVF), and even fewer have longitudinal follow-up. The aim of this study is to investigate whether CKD progression modifies the relationship between skeletal muscle mass and force, and the prevalence of sarcopaenia and sarcopenic obesity.</p><p><strong>Methods: </strong>The data used were prospectively collected during routine check-ups in a network of nutritional centres in Mexico and retrospectively analysed. From a dataset of 5430 patients, we selected 1098 patients with available anthropometric, kidney function, handgrip and bioimpedance data. The relationship between appendicular skeletal muscle mass (ASM) and MVF was investigated using mixed models and adjusted for age, sex, body mass index, physical activity level and CKD aetiology. Sarcopaenia prevalence were tested across period of follow-up using the Cochran-Mantel-Haenzen for repeated measures and across CKD stages using the Chi-2 test.</p><p><strong>Results: </strong>After normalization with ASM, MVF was higher in CKD G1-G3 compared with G4 and G5 (<i>P</i> ≤ .001, Cohen's d = 0.270-0.576). Slopes between MVF and ASM were lower in CKD G3, G4 and G5 than in CKD G1-G2 [-2.268 (-3.927, -0.609), <i>P</i> <i> </i>= .008; -2.694 (-4.593, -0.794), <i>P</i> <i> </i>= .006; -3.675 (-5.326, -1.725), <i>P</i> <i> </i>< .001, respectively]. The prevalence of sarcopaenia and sarcopaenic obesity did not differ across CKD stages, but recovery was most commonly observed in CKD G1-G2. Slope analysis showed an independent interaction between the slopes of kidney function and ASM on MVF evolution over time.</p><p><strong>Conclusions: </strong>CKD negatively, progressively and independently affects the neuromuscular system, and force production is reduced for any given muscle mass as CKD progresses. While no association was found between CKD stage and prevalence of sarcopaenia, recovery was more frequent in the early CKD stages. These results suggest the importance of early rehabilitation programs to improve musculoskeletal health, quality of life and survival in CKD patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf036"},"PeriodicalIF":3.9,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572313","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":"The hidden interplay between sex and adverse outcomes in incident dialysis patients: the role of aortic calcification.","authors":"Xue Zhao, Zitong Lei, Meng Wang, Hua Liu, Mengyao Yan, Linhui Huo, Zhumei Gao, Hongli Jiang, Limin Wei","doi":"10.1093/ckj/sfaf034","DOIUrl":"10.1093/ckj/sfaf034","url":null,"abstract":"<p><strong>Background: </strong>Research on the sex disparity in the prognosis of chronic kidney disease (CKD), particularly among those who are newly initiating dialysis, is limited and inconclusive. This study aimed to investigate the associations between sex, and all-cause mortality and major cardiovascular adverse events (MACE), with a particular focus on the presence of aortic calcification (AC).</p><p><strong>Methods: </strong>We conducted a <i>post hoc</i> analysis of 1459 incident dialysis patients included in this prospective cohort study. The primary outcome of interest was all-cause mortality, and the secondary endpoint was a composite of MACE.</p><p><strong>Results: </strong>During a median follow-up period of 3.55 years, 362 (269 male and 93 female) patients died and 477 (342 male and 135 female) patients developed MACE. The risks for all-cause mortality [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.47-0.79] and MACE (HR 0.74, 95% CI 0.60-0.93) were lower in females than in males. This finding was robust across multiple sensitivity analyses and most subgroups. Moreover, the associations between sex and adverse outcomes were significantly modified by AC status at dialysis initiation (<i>P</i> for interaction <.05). Specifically, among patients without AC, females exhibited lower risks for all-cause mortality (HR 0.45, 95% CI 0.29-0.69; <i>P</i> < .001) and MACE (HR 0.67, 95% CI 0.49-0.93; <i>P</i> = .015), whereas no differences were observed for all-cause mortality (HR 0.82, 95% CI 0.59-1.15; <i>P</i> = .256) or MACE (HR 0.80, 95% CI 0.59-1.10; <i>P</i> = .174) among patients with AC.</p><p><strong>Conclusions: </strong>In patients with renal failure receiving dialysis, AC abolished the survival and cardiovascular protection observed in female versus male patients. This finding supports the need for greater awareness of the AC burden in female dialysis patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf034"},"PeriodicalIF":3.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572316","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}