Herz最新文献

{"title":"Burden of disease in Germany attributed to ambient particulate matter pollution","authors":"Omar Hahad, Jos Lelieveld, Sadeer Al-Kindi, Volker H. Schmitt, Lukas Hobohm, Karsten Keller, Martin Röösli, Marin Kuntic, Andreas Daiber","doi":"10.1007/s00059-024-05269-8","DOIUrl":"https://doi.org/10.1007/s00059-024-05269-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Ambient fine particulate matter pollution with a diameter less than 2.5 micrometers (PM_2.5) is a significant risk factor for chronic noncommunicable diseases (NCDs), leading to a substantial disease burden, decreased quality of life, and deaths globally. This study aimed to investigate the disease and mortality burdens attributed to PM_2.5 in Germany in 2019.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Data from the Global Burden of Disease (GBD) Study 2019 were used to investigate disability-adjusted life–years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and deaths attributed to ambient PM_2.5 pollution in Germany.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>In 2019, ambient PM_2.5 pollution in Germany was associated with significant health impacts, contributing to 27,040 deaths (2.82% of total deaths), 568,784 DALYs (2.09% of total DALYs), 135,725 YLDs (1.09% of total YLDs), and 433,058 YLLs (2.92% of total YLLs). The analysis further revealed that cardiometabolic and respiratory conditions, such as ischemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and diabetes mellitus, were the leading causes of mortality and disease burden associated with ambient PM_2.5 pollution in Germany from 1990–2019. Comparative assessments between 1990 and 2019 underscored ambient PM_2.5 as a consistent prominent risk factor, ranking closely with traditional factors like smoking, arterial hypertension, and alcohol use contributing to deaths, DALYs, YLDs, and YLLs.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Ambient PM_2.5 pollution is one of the major health risk factors contributing significantly to the burden of disease and mortality in Germany, emphasizing the urgent need for targeted interventions to address its substantial contribution to chronic NCDs.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224665","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":"Assessing the efficacy of renal denervation in patients with resistant arterial hypertension","authors":"Ocílio Ribeiro Gonçalves, Francinny Alves Kelly, José Guilherme Maia, Artur de Oliveira Macena Lôbo, Vitor Kendi Tsuchiya Sano, Maria Eduarda Cavalcanti Souza, Francisco Cezar Aquino de Moraes, Nimra Farid, Arlindo Bispo da Silva Júnior, Avelar Alves da Silva","doi":"10.1007/s00059-024-05268-9","DOIUrl":"https://doi.org/10.1007/s00059-024-05268-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Renal denervation (RDN) is an innovative procedure designed to regulate the renal sympathetic nervous system for the control of arterial hypertension (HTN). RDN has emerged as an alternative for patients with resistant HTN. However, the clinical efficacy of RDN remains incompletely elucidated.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing the use of RDN with sham procedure or pharmacological treatment in patients with resistant HTN. Statistical analyses were performed using R Studio 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). Heterogeneity was examined with the Cochran Q test I² statistics. Mean difference (MD) with 95% confidence interval (CI) were pooled across trials. <i>P</i> values of &lt;0.05 were considered statistically significant. The primary outcomes of interest were changes from baseline in systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum creatinine.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Twenty-one RCTs comprising 3345 patients were included in this meta-analysis, whereby 2004 (59.91%) received renal denervation and 1341 (40.09%) received pharmacological treatment or sham procedure. Follow-up ranged from 2 to 48 months. Compared to control group, RDN significantly reduced SBP (MD −3.53 mm Hg; 95% CI −5.94 to −1.12; <i>p</i> = 0.004; I² = 74%) and DBP (MD −1.48 mm Hg; 95% CI −2.56 to −0.40; <i>p</i> = 0.007; I² = 51%). Regarding serum creatinine (MD −2.51; 95% CI −7.90 to 2.87; <i>p</i> = 0.36; I² = 40%), there was no significant difference between RDN and control groups.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In this meta-analysis of RCTs of patients with resistant HTN, RDN was associated with a reduction in SBP and DBP compared to sham procedure or pharmacological treatment.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":"20 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186980","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":"Rechtliche Aspekte in der digitalen Kardiologie","authors":"S. Manteufel, D. Duncker","doi":"10.1007/s00059-024-05262-1","DOIUrl":"https://doi.org/10.1007/s00059-024-05262-1","url":null,"abstract":"<p>Digitale Helfer sind inzwischen ein unverzichtbares Werkzeug in der modernen Kardiologie. Der damit einhergehende technologische Fortschritt bietet hierbei ein ausgesprochenes Potenzial, die Effizienz medizinischer Prozesse zu steigern, in kürzester Zeit präzisere Diagnosen zu ermöglichen und damit die Patientenversorgung zu verbessern. Doch mit der zunehmenden Integration digitaler Helfer im sonst arbeitsintensiven kardiologischen Berufsalltag ergeben sich auch neue Herausforderungen und Fragestellungen, insbesondere im Hinblick auf den Umgang mit dem Thema Recht. Der vorliegende Übersichtsartikel zielt darauf ab, ein Bewusstsein für einzelne juristische Themen zu schaffen, die aus der Verwendung digitaler Technologien in der Kardiologie resultieren. Dabei wird es im Kern um den wohlüberlegten Umgang mit den haftungsrechtlichen Themen der Therapiefreiheit, des kardiologischen Facharztstandards, der ärztlichen Schweigepflicht wie auch des Datenschutzes gehen. Die Integration digitaler Helfer in der Kardiologie führt insgesamt zu einer spürbaren Verbesserung der Effizienz und Qualität der Patientenversorgung, beinhaltet jedoch gleichzeitig eine Vielzahl rechtlicher Herausforderungen, die sorgfältig adressiert werden müssen.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":"40 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224666","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":"Evaluation of risk factors for long-term atrial fibrillation development in patients undergoing typical atrial flutter ablation: a multicenter pilot study.","authors":"Ahmet Çağdaş Yumurtaş, Levent Pay, Ozan Tezen, Tuğba Çetin, Furkan Fatih Yücedağ, Ertan Arter, Hikmet Kadıoğlu, Hüseyin Akgün, Eyüp Özkan, Abdulkadir Uslu, Ayhan Küp, Faysal Şaylık, Tufan Çınar, Mert İlker Hayıroğlu","doi":"10.1007/s00059-024-05261-2","DOIUrl":"https://doi.org/10.1007/s00059-024-05261-2","url":null,"abstract":"<p><strong>Background: </strong>Atrial flutter (AFL) and atrial fibrillation (AF) are the most commonly detected supraventricular arrhythmias and share similar pathophysiological mechanisms. After the successful ablation of AFL, AF frequently occurs in the long-term follow-up. As emphasized in some studies, certain mechanisms seem to predispose to the development of AF in AFL patients, and approximately 20% of these patients have accompanying AFL.</p><p><strong>Purpose: </strong>We aimed to analyze independent risk factors that predict the development of AF in patients who underwent typical AFL ablation.</p><p><strong>Methods: </strong>This was a multicenter, cross-sectional, and retrospective study. A total of 442 patients who underwent typical AFL ablation at three different centers between January 1, 2018 and January 1, 2022 were included retrospectively. After the ablation procedure the patients were divided into those who developed AF and those who did not. The patients were followed up for an average of 12 (4-20) months. In the post-procedural period, atrial arrhythmias were investigated with 24‑h Holter and ECG at 1 month, 6 months, and 12 months and then at 6‑month intervals thereafter.</p><p><strong>Results: </strong>Overall, AF developed in 206 (46.6%) patients in the long-term follow-up. Age, hypertension (HT), obstructive sleep apnea syndrome (OSAS), previous cerebrovascular accident (CVA), left atrium anteroposterior diameter, severe mitral regurgitation, hemoglobin, blood glucose, and HbA1c values were found to be significant in univariable analysis. According to multivariable analysis, HT (p = 0.014; HR: 1.483 [1.084-2.030]), OSAS (p = 0.008; HR: 1.520 [1.117-2.068]) and previous CVA (p = 0.038; HR: 1.749 [1.031-2.968]) were independently associated with the development of AF in AFL patients who underwent ablation procedure.</p><p><strong>Conclusion: </strong>In the present study, we found that HT, OSAS, and previous CVA were independently correlated with the development of AF in the long-term follow-up of patients who underwent typical AFL ablation. We consider that AFL patients with such risk factors should be followed up closely following cavotricuspid isthmus ablation for the development of AF.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975571","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":"Safety assessment of coronary arteries during left bundle branch area pacing.","authors":"Qiling Kong, Huolong Chen, Juan Hua, Ziyi Xiong, Shuyun Le, Jinwei Liu, Dandan Wang, Qi Chen","doi":"10.1007/s00059-024-05259-w","DOIUrl":"https://doi.org/10.1007/s00059-024-05259-w","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the safety of left bundle branch area pacing (LBBAP) by measuring the distance from the tip of the electrode to the nearby coronary artery with a nine-partition grid method.</p><p><strong>Methods: </strong>From January 2019 to October 2020, patients who underwent LBBAP and postoperative coronary angiography in the Second Affiliated Hospital of Nanchang University were included in the study. The patients' fluoroscopic images of LBBAP and coronary angiography were collected and analyzed. Changes in the ST‑T segment in the electrocardiogram (ECG), serum troponin, and myocardial enzyme profiles were observed before and after the LBBAP procedure.</p><p><strong>Results: </strong>A total of 50 patients were included in this study, of whom 46 patients underwent implantation with a pacemaker and 4 patients received an implantable cardioverter defibrillator (ICD). The pacing electrodes were confined to the posterior-middle (PM), median (M), Posterior inferior (PI), and middle inferior (MI) positions of the two-dimensional nine-square grid or in the junction area of the above positions, and were concentrated in the rectangle formed by the line of the center points of the four positions. The average vertical distances from the electrode tip to the left anterior descending branch artery (LAD), posterior descending branches (PD) and the left posterior ventricular branches (PL) were 19.69 ± 8.72 mm, 26.09 ± 8.02 mm, and 21.11 ± 7.86 mm, respectively; the minimum was 5.28 mm, 9.51 mm, and 8.69 mm, respectively. Coronary angiography in all patients showed no significant injury to the ventricular septal branch; however, we observed elevated serum troponin and changes in ST‑T segment in ECG.</p><p><strong>Conclusion: </strong>The study demonstrates that pacing electrodes in LBBAP can be safely implanted over a wide range. Coronary arteries are likely to be safe when the pacing electrodes are located within the rectangle formed by the line connecting the PM, M, PI, and MI zone centroids. The left bundle branch can be quickly captured and the safety of the coronary artery can be improved by locating the electrode in the posterior-mid zone. The potential risk of injury to the LAD from the electrode is greater compared with the PD.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893261","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":"Is an accurate self-perceived health risk beneficial for patients to minimize prehospital delay time at onset of a ST-segment elevated myocardial infarction (STEMI)?","authors":"Karl-Heinz Ladwig, Elisabeth Olliges, Loai Albarqouni, Sophia Hoschar, Wenlin Ma, Xiaoyan Fang","doi":"10.1007/s00059-024-05256-z","DOIUrl":"10.1007/s00059-024-05256-z","url":null,"abstract":"<p><p>High risk perception (HRP) is fundamental for adequate health behavior. However, its impact on rapid access to cardiac care after the onset of acute myocardial infarction (AMI) is not known. Conflicting evidence exists about sources that promote HRP. Data on sociodemographic and clinical characteristics of 588 AMI patients who participated in the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study were collected at the bedside. Adjusted multivariate logistic regression models identified factors associated with HRP. Only 13.4% (n = 79) of patients had a favorable HRP level. The HRP patients did not differ from those with low risk perception (LRP) in terms of sex, age, other sociodemographic features, and somatic risk factors. Among the univariate contributors to HRP were prodromal chest pain (p = 0.0004), symptom mismatch during AMI (p < 0.0001), depression (p = 0.01), and anxiety (p = 0.005). However, family history of AMI, a previous AMI, and knowledge of AMI remained significant in the multivariate regression model. Median delay time to reach a hospital-based emergency facility after the onset of AMI was 127 min (interquartile range [IQR]: 83-43, p = 0.02) in HRP patients and 216 min (IQR: 106-721) in LRP patients. An increasing risk perception score was associated with a corresponding stepwise decline in median delay time (p > 0.004). Self-perceived AMI risk is associated in a dose-response relationship with the time needed to reach coronary care emergency facilities. Recurrent AMI, family history of AMI, and sufficient knowledge of MI contribute to risk perception, whereas somatic risk factors do not.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"270-276"},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534315","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":"Environmental and climate cardiology: some environmental issues highlighted at the annual meetings of the German Society for Cardiology (DGK) from 2007 to 2023.","authors":"Omar Hahad","doi":"10.1007/s00059-023-05223-0","DOIUrl":"10.1007/s00059-023-05223-0","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"309-312"},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11286620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138176001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological burden in patients with angina and unobstructed coronary arteries-underestimated, underexplored, undertreated.","authors":"Peter Ong, Astrid Hubert, Zineb Moussaoui, Raffi Bekeredjian, Frank Vitinius, Karl-Heinz Ladwig","doi":"10.1007/s00059-024-05253-2","DOIUrl":"10.1007/s00059-024-05253-2","url":null,"abstract":"<p><p>Patients with angina and unobstructed coronary arteries (ANOCA) are frequently encountered in clinical practice. These cases represent a diagnostic and therapeutic challenge and are often characterized by a long patient journey until a diagnosis of coronary vasomotor disorders is established. Moreover, the unsatisfactory management of such patients leads to insecurity, ongoing symptoms, and psychological sequelae such as anxiety or depression. Currently, the psychological burden in patients with ANOCA is underestimated, underexplored, and undertreated. This review gives a new perspective on the pathophysiology of coronary vasomotor disorders including psychological risk factors and calls for comprehensive care by interdisciplinary ANOCA clinics.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"277-281"},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418586","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 predictive value of PRECISE-DAPT score for long-term mortality in patients with acute coronary syndrome complicated by cardiogenic shock.","authors":"Sukru Akyuz, Ali Nazmi Calik, Tolga Onuk, Baris Yaylak, Zeynep Kolak, Semih Eren, Feyza Mollaalioglu, Furkan Durak, Mustafa Cetin, Ibrahim Halil Tanboga","doi":"10.1007/s00059-023-05231-0","DOIUrl":"10.1007/s00059-023-05231-0","url":null,"abstract":"<p><strong>Background: </strong>Besides its primary clinical utility in predicting bleeding risk in patients with acute coronary syndrome (ACS), the PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-Platelet Therapy) score may also be useful for predicting long-term mortality in ACS patients presenting with cardiogenic shock (CS) since several studies have reported an association between the score and certain cardiovascular conditions or events. The aim of the present study was to evaluate the utility of the PRECISE-DAPT score for predicting the long-term all-cause mortality in patients (n = 293) with ACS presenting with CS.</p><p><strong>Methods: </strong>The PRECISE-DAPT score was calculated for each patient who survived in hospital, and the association with long-term mortality was studied. Median follow-up time was 2.7 years. The performance of the final model was determined with measurements of its discriminative power (Harrell's and Uno's C indices and time-dependent area under the receiver operating characteristic curve [AUC]) and predictive accuracy (coefficient of determination [R²] and likelihood ratio χ²). Hazard ratios (HRs) were used to assess the relationship between the variables of the model and long-term all-cause death.</p><p><strong>Results: </strong>All-cause death occurred in 197 patients (67%). There was a positive association between the PRECISE-DAPT score (change from 17 to 38 was associated with an HR of 2.42 [95% CI: 1.59-3.68], R² = 0.209, time-dependent AUC = 0.69) and the risk of death such that in the adjusted survival curve, the risk of mortality increased as the PRECISE-DAPT score increased.</p><p><strong>Conclusion: </strong>The PRECISE-DAPT score may be a useful easy-to-use tool for predicting long-term mortality in patients with ACS complicated by CS.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"302-308"},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139086579","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":"[Lower extremity arterial disease (LEAD)].","authors":"Christine Espinola-Klein","doi":"10.1007/s00059-024-05252-3","DOIUrl":"10.1007/s00059-024-05252-3","url":null,"abstract":"<p><p>Peripheral arterial occlusive disease (PAOD) is a frequent manifestation of atherosclerosis with a high risk of cardiovascular events (myocardial infarction, stroke, amputation, cardiovascular death). A distinction is made between the stable form of intermittent claudication and chronic limb-threatening ischemia (CLTI, pain at rest, wounds). The most frequent risk factors are diabetes mellitus and smoking. As the disease is often asymptomatic early diagnostic necessary. Measurement of the ankle-brachial index (ABI) is suitable for screening. Consistent treatment of cardiovascular risk factors and antithrombotic medication are important. At the stage of intermittent claudication, exercise training should be performed. In CLTI early endovascular or surgical revascularization must be performed to avoid amputation of the extremity.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"313-318"},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446075","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}