Infection Control and Hospital Epidemiology最新文献

{"title":"Dilution dysfunction: evaluation of automated disinfectant dispenser systems in 10 hospitals demonstrates a need for improved monitoring to ensure that correct disinfectant concentrations are delivered.","authors":"Jennifer L Cadnum, Claire E Kaple, Elizabeth C Eckstein, Elie A Saade, Amy J Ray, Trina F Zabarsky, Bernardino J Guerrero, Mohamed H Yassin, Curtis J Donskey","doi":"10.1017/ice.2024.148","DOIUrl":"https://doi.org/10.1017/ice.2024.148","url":null,"abstract":"<p><p>Automated dispensers that dilute concentrated disinfectants with water are commonly used in healthcare facilities. In a point-prevalence product evaluation, 9 of 10 (90%) hospitals using dilutable disinfectants had 1 or more malfunctioning dispensers. Twenty-nine of 107 (27.1%) systems dispensed product with lower-than-expected concentrations, including 15 (14.0%) with no detectable disinfectant.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464402","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 invasive group A streptococcal puerperal sepsis in Calgary, Alberta: clinical consequences and policy implications.","authors":"Amro Qaddoura, Megan McQuiston, Gregory Tyrrell, Matthew Croxen, Vincent Li, Rhonda Demarco, Suzanne Pinfield, Ruziyya Ramazanova, Karen Hope, Edith-Rose Cairns, Judy MacDonald, Jia Hu, Oscar Larios, Joseph Kim, Bayan Missaghi, Joseph Vayalumkal, Irene Martin, Valerie Marsten, Jennifer Soucie, Robert Douglas Wilson, Colin Birch, John Conly","doi":"10.1017/ice.2024.154","DOIUrl":"10.1017/ice.2024.154","url":null,"abstract":"<p><p>We analyzed invasive group A streptococcal puerperal sepsis cases in a large health zone in Alberta, Canada between 2013 and 2022. Of the 21 cases, 85.7% were adjudicated as hospital/delivery-acquired, with 2 clusters having identical isolates found through whole genome sequencing. We implemented policy interventions across Alberta aimed at preventing future infections.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11518661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464397","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":"Risk of rehospitalization due to <i>Clostridioides difficile</i> infection among hospitalized patients with <i>Clostridioides difficile</i>: a cohort study.","authors":"Emily N Drwiega, Stuart Johnson, Larry H Danziger, Andrew M Skinner","doi":"10.1017/ice.2024.155","DOIUrl":"10.1017/ice.2024.155","url":null,"abstract":"<p><strong>Background: </strong>Reducing rehospitalization has been a primary focus of hospitals and payors. Recurrence of <i>Clostridioides difficile</i> infection (CDI) is common and often results in rehospitalization. Factors that influence rehospitalization for CDI are not well understood.</p><p><strong>Objective: </strong>To determine the risk factors that influence rehospitalization caused by CDI.</p><p><strong>Design: </strong>A retrospective cohort study from January 1, 2018, to December 31, 2018, of patients aged ≥18 who tested positive for <i>C. difficile</i> while hospitalized.</p><p><strong>Setting: </strong>Academic hospital.</p><p><strong>Methods: </strong>The risk of rehospitalization was assessed across exposures during and after the index hospitalization using a Cox proportional hazards model. The primary outcome of this study was 60-day CDI-related rehospitalization.</p><p><strong>Results: </strong>There were 559 hospitalized patients with a positive CD test during the study period, and 408 patients were included for analysis. All-cause rehospitalization was 46.1% within 60 days of the index hospital discharge. Within 60 days of discharge, 68 patients developed CDI, of which 72.5% (49 of 68) were rehospitalized specifically for the management of CDI. The risk of rehospitalization in patients with CDI was higher among patients who were exposed to systemic antibiotics ([adjusted hazard ratio] aHR: 2.78; 95% CI, 1.36-5.64) and lower among patients who had post-discharge follow-up addressing <i>C. difficile</i> (aHR: 0.53; 95% CI, 0.28-0.98).</p><p><strong>Conclusions: </strong>Exposure to systemic antibiotics increased the risk of rehospitalization due to CDI, while post-discharge follow-up decreased the risk of rehospitalization due to CDI. Comprehensive transitions of care for hospitalized patients with <i>C. difficile</i> may reduce the risk of CDI-related rehospitalization.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11663471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464353","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":"Exeporfinium chloride (XF-73) nasal gel significantly reduces <i>Staphylococcus aureus</i> nasal carriage in cardiac surgery patients throughout surgery and the early recovery period: results from a randomized placebo-controlled Phase 2 study.","authors":"Julie E Mangino, Michael S Firstenberg, William Rhys-Williams, James P Lees, Aaron Dane, William G Love, Jesus Gonzalez Moreno, Yuri Martina, Debra Barker","doi":"10.1017/ice.2024.122","DOIUrl":"https://doi.org/10.1017/ice.2024.122","url":null,"abstract":"<p><p><i>Staphylococcus aureus</i> nasal carriers were randomized (1:1) to XF-73 or placebo nasal gel, administered 5x over ∼24hrs pre-cardiac surgery. <i>S. aureus</i> burden rapidly decreased after 2 doses (-2.2log₁₀ CFU/mL; placebo -0.01log₁₀ CFU/mL) and was maintained to 6 days post-surgery. Among XF-73 patients, 46.5% received post-operative anti-staphylococcal antibiotics versus 70% in placebo (<i>P</i> = 0.045).</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464404","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":"Risk factors for central line-associated bloodstream infection in the pediatric intensive care setting despite standard prevention measures.","authors":"Kaitlyn T Marks, Katherine D Rosengard, Jennifer D Franks, Steven J Staffa, Jenny Chan Yuen, Jeffrey P Burns, Gregory P Priebe, Thomas J Sandora","doi":"10.1017/ice.2024.131","DOIUrl":"https://doi.org/10.1017/ice.2024.131","url":null,"abstract":"<p><strong>Objective: </strong>Identify risk factors for central line-associated bloodstream infections (CLABSI) in pediatric intensive care settings in an era with high focus on prevention measures.</p><p><strong>Design: </strong>Matched, case-control study.</p><p><strong>Setting: </strong>Quaternary children's hospital.</p><p><strong>Patients: </strong>Cases had a CLABSI during an intensive care unit (ICU) stay between January 1, 2015 and December 31, 2020. Controls were matched 4:1 by ICU and admission date and did not develop a CLABSI.</p><p><strong>Methods: </strong>Multivariable, mixed-effects logistic regression.</p><p><strong>Results: </strong>129 cases were matched to 516 controls. Central venous catheter (CVC) maintenance bundle compliance was >70%. Independent CLABSI risk factors included administration of continuous non-opioid sedative (adjusted odds ratio (aOR) 2.96, 95% CI [1.16, 7.52], <i>P</i> = 0.023), number of days with one or more CVC in place (aOR 1.42 per 10 days [1.16, 1.74], <i>P</i> = 0.001), and the combination of a chronic CVC with administration of parenteral nutrition (aOR 4.82 [1.38, 16.9], <i>P</i> = 0.014). Variables independently associated with lower odds of CLABSI included CVC location in an upper extremity (aOR 0.16 [0.05, 0.55], <i>P</i> = 0.004); non-tunneled CVC (aOR 0.17 [0.04, 0.63], <i>P</i> = 0.008); presence of an endotracheal tube (aOR 0.21 [0.08, 0.6], <i>P</i> = 0.004), Foley catheter (aOR 0.3 [0.13, 0.68], <i>P</i> = 0.004); transport to radiology (aOR 0.31 [0.1, 0.94], <i>P</i> = 0.039); continuous neuromuscular blockade (aOR 0.29 [0.1, 0.86], <i>P</i> = 0.025); and administration of histamine H2 blocking medications (aOR 0.17 [0.06, 0.48], <i>P</i> = 0.001).</p><p><strong>Conclusions: </strong>Pediatric intensive care patients with chronic CVCs receiving parenteral nutrition, those on non-opioid sedative infusions, and those with more central line days are at increased risk for CLABSI despite current prevention measures.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464351","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":"Changes in use of multiplex respiratory panel testing during the COVID-19 pandemic.","authors":"Jonathan D Baghdadi, Chih Chun Tung, J Kristie Johnson, Daniel J Morgan, Anthony D Harris","doi":"10.1017/ice.2024.163","DOIUrl":"https://doi.org/10.1017/ice.2024.163","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 changed the epidemiology of community-acquired respiratory viruses. We explored patterns of respiratory viral testing to understand which tests are most clinically useful in the postpandemic era.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of discharge data from PINC-AI (formerly Premier), a large administrative database. Use of multiplex nucleic acid amplification respiratory panels in acute care, including small (2-5 targets), medium (6-11), and large panels (>11), were compared between the early pandemic (03/2020-10/2020), late pandemic (11/2020-4/2021), and prepandemic respiratory season (11/2019 - 02/2020) using ANOVA.</p><p><strong>Results: </strong>A median of 160.5 facilities contributed testing data per quarter (IQR 155.5-169.5). Prepandemic, facilities averaged 103 respiratory panels monthly (sd 138), including 79 large (sd 126), 7 medium (sd 31), and 16 small panels (sd 73). Relative to prepandemic, utilization decreased during the early pandemic (62 panels monthly/facility; sd 112) but returned to the prepandemic baseline by the late pandemic (107 panels monthly/facility; sd 211). Relative to prepandemic, late pandemic testing involved more small panel use (58 monthly/facility, sd 156) and less large panel use (47 monthly/facility, sd 116). Comparisons among periods demonstrated significant differences in overall testing (<i>P</i> < 0.0001), large panel use (<i>P</i> < 0.0001), and small panel use (<i>P</i> < 0.0001).</p><p><strong>Conclusions: </strong>Postpandemic, clinical use of respiratory panel testing shifted from predominantly large panels to predominantly small panels. Factors driving this change may include resource availability, costs, and the clinical utility of targeting important pathogenic viruses instead of testing \"for everything.\"</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390335","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":"Leveraging real-time patient data during the COVID-19 pandemic.","authors":"John C O'Horo, Douglas W Challener, Cory Kudrna, Jason R Buckmeier, Steve G Peters, Daryl J Kor, Mark W Matson, Andrew D Badley, Charles D Burger, Rajeev Chaudhry","doi":"10.1017/ice.2024.118","DOIUrl":"https://doi.org/10.1017/ice.2024.118","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390338","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":"Healthcare-associated infections in Japanese hospitals: results from a large-scale multicenter point-prevalence survey in Aichi, 2020.","authors":"Hiroshi Morioka, Yusuke Koizumi, Keisuke Oka, Masami Okudaira, Yuka Tomita, Yumi Kojima, Toshitaka Watariguchi, Koichi Watamoto, Yoshikazu Mutoh, Takeshi Tsuji, Manabu Yokota, Junichi Shimizu, Chihiro Hasegawa, Susumu Iwata, Masatoshi Nagaoka, Yuji Ito, Shohei Kawasaki, Hiroki Kato, Yuichi Kitagawa, Takuya Goto, Yasuhiro Nozaki, Kenji Akita, Shinsuke Shimizu, Masanori Nozawa, Munehiro Kato, Masamitsu Ishihara, Kenta Ito, Tetsuya Yagi","doi":"10.1017/ice.2024.130","DOIUrl":"https://doi.org/10.1017/ice.2024.130","url":null,"abstract":"<p><strong>Objective: </strong>Healthcare-associated infections (HAIs) pose significant challenges to healthcare systems worldwide. Epidemiological data are essential for effective HAI control; however, comprehensive information on HAIs in Japanese hospitals is limited. This study aimed to provide an overview of HAIs in Japanese hospitals.</p><p><strong>Methods: </strong>A multicenter point-prevalence survey (PPS) was conducted in 27 hospitals across the Aichi Prefecture between February and July 2020. This study encompassed diverse hospital types, including community, university, and specialized hospitals. Information on the demographic data of the patients, underlying conditions, devices, HAIs, and causative organisms was collected.</p><p><strong>Results: </strong>A total of 10,199 patients (male: 5,460) were included in this study. The median age of the patients was 73 (interquartile range [IQR]: 56-82) years, and the median length of hospital stay was 10 (IQR: 4-22) days. HAIs were present in 6.6% of patients, with pneumonia (1.83%), urinary tract infection (1.09%), and surgical site infection (SSI) (0.87%) being the most common. The prevalence of device-associated HAIs was 0.91%. <i>Staphylococcus aureus</i> (17.3%), <i>Escherichia coli</i> (17.1%), and <i>Klebsiella pneumoniae</i> (7.2%) were the primary pathogens in 433 organisms; 29.6% of the <i>Enterobacterales</i> identified showed resistance to third-generation cephalosporins. Pneumonia was the most prevalent HAI in small-to-large hospitals (1.69%-2.34%) and SSI, in extra-large hospitals (over 800 beds, 1.37%).</p><p><strong>Conclusions: </strong>This study offers vital insights into the epidemiology of HAIs in hospitals in Japan. These findings underscore the need for national-level PPSs to capture broader epidemiological trends, particularly regarding healthcare challenges post-COVID-19.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390337","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":"Importance of risk adjusting central line-associated bloodstream infection rates in children.","authors":"Lakshmi Srinivasan, Ashley Oliver, Yuan-Shung V Huang, Di Shu, Kait M Donnelly, Cecelia Harrison, Amy L Roberts, Ron Keren","doi":"10.1017/ice.2024.111","DOIUrl":"https://doi.org/10.1017/ice.2024.111","url":null,"abstract":"<p><strong>Objective: </strong>Central line-associated bloodstream infection (CLABSI) is one of the most prevalent pediatric healthcare-associated infections and is used to benchmark hospital performance. Pediatric patients have increased in acuity and complexity over time. Existing approaches to risk adjustment do not control for individual patient characteristics, which are strong predictors of CLABSI risk and vary over time. Our objective was to develop a risk adjustment model for CLABSI in hospitalized children and compare observed to expected rates over time.</p><p><strong>Design and setting: </strong>We conducted a prospective cohort study using electronic health record data at a quaternary Children's Hospital.</p><p><strong>Patients: </strong>We included hospitalized children with central catheters.</p><p><strong>Methods: </strong>Risk factors identified from published literature were considered for inclusion in multivariable modeling based on association with CLABSI risk in bivariable analysis and expert input. We calculated observed and expected (risk model-adjusted) annual CLABSI rates.</p><p><strong>Results: </strong>Among 16,411 patients with 520,209 line days, 633 patients experienced 796 CLABSIs. The final model included age, behavioral health condition, non-English speaking, oncology service, port catheter type, catheter dwell time, lymphatic condition, total parenteral nutrition, and number of organ systems requiring ICU level care. For every organ system receiving ICU level care the odds ratio for CLABSI was 1.24 (95% CI 1.12-1.37). Although not statistically different, observed rates were lower than expected rates for later years.</p><p><strong>Conclusions: </strong>Failure to adjust for patient factors, particularly acuity and complexity of disease, may miss clinically significant differences in CLABSI rates, and may lead to inaccurate interpretation of the impact of quality improvement efforts.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380670","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":"Postoperative outcomes after receipt of ertapenem antimicrobial prophylaxis for colon surgery: a multicenter retrospective cohort study.","authors":"Christopher J Hostler, Jay Krishnan, Alice Parish, Allison Baroco, Penny Cooper, Onofre Donceras, Ebbing Lautenbach, Pam Tolomeo, Tracy Sansossio, Carlos A Q Santos, David Schwartz, Helen Zhang, Sharon Welbel, Yuliya Lokhnygina, Deverick J Anderson","doi":"10.1017/ice.2024.99","DOIUrl":"10.1017/ice.2024.99","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate postoperative outcomes among patients undergoing colon surgery who receive perioperative prophylaxis with ertapenem compared to other antibiotic regimens.</p><p><strong>Design and setting: </strong>Multicenter retrospective cohort study among adults undergoing colon surgery in seven hospitals across three health systems from 1/1/2010 to 9/1/2015.</p><p><strong>Methods: </strong>Generalized linear mixed logistic regression models were applied to assess differential odds of select outcomes among patients who received perioperative prophylaxis with ertapenem compared to other regimens. Postoperative outcomes of interest included surgical site infection (SSI), <i>Clostridioides difficile</i> infection (CDI) and clinical culture positivity for carbapenem-resistant <i>Enterobacteraciae</i> (CRE). Inverse probability weights were applied to account for differing covariate distributions across ertapenem and non-ertapenem groups.</p><p><strong>Results: </strong>A total of 2,109 patients were included for analysis. The odds of postoperative SSI was 1.56 times higher among individuals who received ertapenem than among those receiving other perioperative antimicrobial prophylaxis regimens in our cohort (46 [3.5%] vs 20 [2.5%]; IPW-weighted OR 1.56, [95% CI, 1.08-2.26], <i>P</i> = .02). No statistically significant differences in odds of postoperative CDI (24 [1.8%] vs 16 [2.0%]; IPW-weighted OR 1.07 [95% CI, .68-1.68], <i>P</i> = .78) were observed between patients who received ertapenem prophylaxis compared to other regimens. Clinical CRE culture positivity was rare in both groups (.2%-.5%) and did not differ statistically.</p><p><strong>Conclusions: </strong>Ertapenem use for perioperative prophylaxis was associated with increased odds of SSI among patients undergoing colon surgery in our study population, though no differences in CDI or clinical CRE culture positivity were identified. Further study and replication of these findings are needed.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11611502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371756","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}