International Journal of Antimicrobial Agents最新文献

{"title":"Pharmacodynamic insights to support pneumonia treatment in a patient co-infected with two carbapenem-resistant bacteria","authors":"Brooke N. Curry ,&nbsp;Nidhi Singh ,&nbsp;Alan E. Gross ,&nbsp;Jackson V. Watkins ,&nbsp;Egon A. Ozer ,&nbsp;Arunkumar Karunanidhi ,&nbsp;Kayley Sherwood ,&nbsp;Osayamen Obanor ,&nbsp;Nahed Ismail ,&nbsp;Alan R. Hauser ,&nbsp;Zackery P. Bulman","doi":"10.1016/j.ijantimicag.2025.107633","DOIUrl":"10.1016/j.ijantimicag.2025.107633","url":null,"abstract":"<div><div>Identifying optimal antibiotic therapy for patients infected with extensively resistant bacteria is challenging, particularly when there are multiple organisms at the infection site. Personalized time-kill assays (TKAs) can be used to test the pharmacodynamic activity of clinically relevant antibiotic combinations to help select appropriate therapy for these difficult-to-treat infections. We report a case of ventilator-associated pneumonia due to <em>Pseudomonas aeruginosa</em> and <em>Providencia stuartii</em> that were each carbapenem resistant<em>.</em> Due to the complex resistance phenotypes, the isolates were analysed via TKAs during the patient’s hospitalization to evaluate the activity of relevant antibiotic combinations. Using the patient’s isolates, the TKAs showed that a combination of ceftazidime/avibactam and a polymyxin was synergistic against the <em>P. aeruginosa</em> whereas ceftazidime/avibactam plus aztreonam was slightly more active than ceftazidime/avibactam alone against the <em>P. stuartii.</em> The results of the TKAs helped to validate the patient’s treatment regimen of aztreonam, ceftazidime/avibactam, and colistin (inhaled), which successfully treated the infection. Whole genome sequencing later revealed that the <em>P. stuartii</em> harbored a <em>bla</em>_OXA-48 carbapenemase while the mechanism of carbapenem resistance in the <em>P. aeruginosa</em> was likely due to OprD loss combined with extended-spectrum β-lactamase expression. The putative mechanism of cefiderocol resistance in the <em>P. stuartii</em> isolate was identified as a premature stop codon in the <em>cirA</em>-like gene combined with the presence of β-lactamases. The patient’s carbapenem-resistant coinfection was successfully treated with agents that were validated in real time using personalized TKAs. TKAs may be useful to optimize combination antibiotic therapy for patients infected with extensively resistant bacteria.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107633"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective evaluation of a vancomycin dosing bundle in paediatric intensive care","authors":"Michael A. Stokes ,&nbsp;Tony Lai ,&nbsp;Lana Reiter ,&nbsp;Bradley Rockliff ,&nbsp;Deirdre Hahn ,&nbsp;Marino S. Festa ,&nbsp;Indy Sandaradura","doi":"10.1016/j.ijantimicag.2025.107638","DOIUrl":"10.1016/j.ijantimicag.2025.107638","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the impact of a real-world, vancomycin dosing bundle (‘the bundle’), on vancomycin-associated nephrotoxicity (VAN) rates in critically ill children in a single paediatric intensive care unit (PICU).</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted in an Australian tertiary PICU from January 2020 to December 2022. The study included all patients who received vancomycin for two or more doses with an associated vancomycin level. During the study period, a staggered implementation was undertaken entailing three interventions on vancomycin prescribing (the bundle): (1) employment of a pharmacist to the PICU, (2) model-informed precision dosing (MIPD), and (2) a reduction in initial vancomycin dosing (15 mg/kg 6 hourly, to 15 mg/kg for the first dose then 10 mg/kg 6 hourly thereafter) alongside a reduction in target trough concentrations from 10–20 to 7–15 mg/L. Data on dosing, vancomycin concentrations, and patient characteristics were collected, and AUC₂₄ was calculated using MIPD software. VAN was defined as a creatinine increase of 0.5 mg/dL or 50% from baseline on two consecutive measurements. Statistical analysis explored associations between time and VAN outcomes.</div></div><div><h3>Results</h3><div>A total of 648 vancomycin courses were analysed, across 477 unique patients, with a median treatment length of 44.59 h. MIPD represented 18% of the total courses, increasing from 2% to 37% over the study period. VAN occurred in 11.3% of courses, with a consistent rate over the years (13% in 2020, 12% in 2021, and 9% in 2022). Severe VAN rates decreased from 8.6% in 2020 to 3.9% in 2022. The reduction in both severe (<em>P</em> = 0.16) and total (<em>P</em> = 0.4) VAN did not achieve statistical significance.</div></div><div><h3>Conclusions</h3><div>Implementation of a staggered pharmacist-led vancomycin dosing bundle did not result in a statistically significant reduction in VAN rates over time. However, the observed reduction in severe VAN and associated reduction in AUC₂₄ warrant further investigation with a prospective study design in the high-risk PICU cohort.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107638"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One Health: Virtual Special Issue in the International Journal of Antimicrobial Agents","authors":"Reema Singh ,&nbsp;Yonghong Xiao","doi":"10.1016/j.ijantimicag.2025.107645","DOIUrl":"10.1016/j.ijantimicag.2025.107645","url":null,"abstract":"","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107645"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, treatment and outcomes of bloodstream infections due to MBL-producing enterobacterales in France: A retrospective study","authors":"Benoît Pilmis ,&nbsp;Laurent Dortet","doi":"10.1016/j.ijantimicag.2025.107630","DOIUrl":"10.1016/j.ijantimicag.2025.107630","url":null,"abstract":"<div><h3>Objectives</h3><div>Bloodstream infections (BSI) due to metallo-β-lactamase (MBL)-producing Enterobacterales are linked to high mortality, but data from France remain limited.</div></div><div><h3>Methods</h3><div>We conducted a retrospective multicentre study in 86 French hospitals including 156 adult patients with confirmed BSI due to MBL-producing Enterobacterales (January 2023–February 2025). The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality and resistance profiles. Clinical features, treatment, and mortality risk factors were assessed.</div></div><div><h3>Results</h3><div>Day-7, 30-day and in-hospital mortality rates were 11.5%, 23.1% and 26.3%, respectively. Common treatments were ceftazidime-avibactam plus aztreonam (<em>n</em> = 91), cefiderocol (<em>n</em> = 24), and other active antibiotics (<em>n</em> = 21). Independent predictors of mortality were ICU admission (aOR 2.96, 95% CI [1.12–7.88]), delay in active therapy (aOR per day 1.19, 95% CI [1.02–1.40]), and lack of source control (aOR 4.0, 95% CI [1.14–14.3]). Among patients receiving active therapy, 30-day mortality did not differ by regimen. Cefiderocol resistance (27.9%) was mainly seen in NDM-producing <em>E. coli</em> strains harbouring penicillin-binding protein 3 (PBP3) modifications and CMY-type β-lactamases.</div></div><div><h3>Conclusions</h3><div>MBL-producing Enterobacterales BSIs are associated with high mortality. Early appropriate therapy and source control are critical. Resistance to last-line agents such as cefiderocol and aztreonam-avibactam calls for optimised empirical treatment guided by rapid diagnostics.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107630"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Membrane-disrupting medium-chain fatty acids reduce Staphylococcus aureus persister cell survival during antibiotic treatment","authors":"Yena Seo ,&nbsp;Minjun Kim ,&nbsp;Dae-Youn Kim ,&nbsp;Ji-Won Park ,&nbsp;Hyun Jung Kim ,&nbsp;Kyun Heo ,&nbsp;Tae-Jong Kim","doi":"10.1016/j.ijantimicag.2025.107648","DOIUrl":"10.1016/j.ijantimicag.2025.107648","url":null,"abstract":"<div><h3>Objective</h3><div>Eliminating persister cells is essential to improve treatment of chronic infections and to limit the emergence of resistant strains. Medium-chain fatty acids (MCFAs) are widely used in cosmetics and antibiotic ointments where <em>Staphylococcus aureus</em> is a common commensal. This study evaluated the potential of MCFAs to eradicate <em>S. aureus</em> persister cells and investigated their mechanisms of action.</div></div><div><h3>Methods</h3><div>The bactericidal activity of MCFAs against <em>S. aureus</em> persisters was assessed after treatment with three antibiotics – ciprofloxacin, oxacillin, and tobramycin. Membrane permeability was analysed by fluorescence microscopy and ATP leakage assays.</div></div><div><h3>Results</h3><div>Octanoic, decanoic, and lauric acids at 10, 1, and 0.1 mM, respectively, significantly reduced antibiotic-surviving cells in persister-enriched populations, independent of antibiotic class. In contrast, myristic acid did not eliminate persisters up to 10 mM, although it was active against exponentially growing cells. The bactericidal activity of MCFAs increased with chain length from octanoic to lauric acid. Killing correlated with enhanced membrane permeability, whereas changes in membrane fluidity or transmembrane potential were not predictive.</div></div><div><h3>Conclusions</h3><div>MCFAs, particularly lauric acid at low concentrations, effectively eradicate <em>S. aureus</em> persisters and may enhance skin health when incorporated into topical products. Their activity increases with chain length and is linked to membrane permeability disruption. Myristic acid, while effective against metabolically active cells, is ineffective against persisters, highlighting physiological differences between growth states.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107648"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helicobacter pylori eradication enters the adjunctive era: Insights from global clinical trials","authors":"Yang Liu ,&nbsp;Chunyan He ,&nbsp;Yilong Liu ,&nbsp;Chan Lu ,&nbsp;Jingwei Shi","doi":"10.1016/j.ijantimicag.2025.107653","DOIUrl":"10.1016/j.ijantimicag.2025.107653","url":null,"abstract":"","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107653"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced endotoxin release by select generic meropenem formulations in Pseudomonas aeruginosa","authors":"Masato Kawamura ,&nbsp;Tetsuji Aoyagi ,&nbsp;Shigeru Fujimura","doi":"10.1016/j.ijantimicag.2025.107593","DOIUrl":"10.1016/j.ijantimicag.2025.107593","url":null,"abstract":"","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107593"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population pharmacokinetics and pharmacodynamics of eravacycline in patients with complicated intra-abdominal infections and community acquired bacterial pneumonia: Support for a fixed-dose treatment regimen","authors":"Yuancheng Chen ,&nbsp;Xiaojie Wu ,&nbsp;Size Li ,&nbsp;Jicheng Yu ,&nbsp;Yi Jin ,&nbsp;Jufang Wu ,&nbsp;Shuyan Yu ,&nbsp;Jufang Shen ,&nbsp;Jianzhong Tang ,&nbsp;Yaoxuan Fu ,&nbsp;Xu Zhu ,&nbsp;Jing Zhang","doi":"10.1016/j.ijantimicag.2025.107603","DOIUrl":"10.1016/j.ijantimicag.2025.107603","url":null,"abstract":"<div><div>Eravacycline is a tetracycline used for the treatment of complicated intra-abdominal infections (cIAI) and has the potential to treat community-acquired bacterial pneumonia (CABP). The approved regimen for cIAI is 1 mg/kg (Q12h). However, studies have reported the inconvenience of drug preparation based on body weight (BW) and wastage of the drug, because the specification is 50 mg per vial. A fixed-dose regimen based on population pharmacokinetic/pharmacodynamic (PK/PD) modeling and simulations may address these limitations. Three clinical trials were performed in healthy Chinese participants and patients with cIAI and CABP. A PopPK model was developed using nonlinear mixed-effects modeling. A fixed-dose regimen in patients with a BW of 40–175 kg was recommended by the Monte Carlo simulation. The probability of target attainment and the cumulative fraction of response (CFR) were calculated. Overall, 79 participants were included in the study. BW, sex, albumin level, and subject type were covariates on PK. When patients received a fixed-dose, AUC_0-12 _h,ss was 80–125% in patients with BW 60 kg receiving 1 mg/kg eravacycline. The PK/PD cutoff and CFR for the fixed-dose regimens were close to those of 1 mg/kg. The recommended fixed-doses (body weight range) were 50 mg (40–60 kg), 75 mg (60–100 kg), 100 mg (100–125 kg), 125 mg (125–150 kg), and 150 mg (150–175 kg). This should be used with caution in patients with BW &gt;137 kg because the actual PK data were not collected. Nonetheless, fixed dosing is more convenient for drug preparation, avoids drug waste, and reduces medical costs compared with weight-based dosing.</div><div>Trial Registration Number: ChiCTR1900022906, ChiCTR1900022060, and ChiCTR2200055666.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107603"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Model-informed precision dosing of vancomycin in Chinese adult patients receiving renal replacement therapy: Systematic evaluation of published pharmacokinetic models and dosing regimen simulations","authors":"Ping Yang ,&nbsp;Huifang Zhang ,&nbsp;Mengting Chen ,&nbsp;Wanqiu Yang ,&nbsp;Fangqing Zhou ,&nbsp;Yuancheng Chen ,&nbsp;Ruilan Wang ,&nbsp;Hailan Wu ,&nbsp;Yan Chen ,&nbsp;Beining Guo ,&nbsp;Xiaofen Liu ,&nbsp;Yaxin Fan ,&nbsp;Jing Zhang","doi":"10.1016/j.ijantimicag.2025.107608","DOIUrl":"10.1016/j.ijantimicag.2025.107608","url":null,"abstract":"<div><h3>Objectives</h3><div>The pharmacokinetics of renally cleared vancomycin are significantly altered in critically ill patients undergoing renal replacement therapy (RRT), affecting the achievement of therapeutic targets. We evaluated the predictive performance of RRT patient-based PopPK models for model-informed precision dosing and subsequently simulated optimal dosing regimens for this population.</div></div><div><h3>Methods</h3><div>Six adult PopPK models were systematically identified and evaluated using a dataset of 226 concentrations from 23 adult patients on RRT from two study centers. Predictive performance was assessed using simulation and prediction-based diagnostics for a priori dosing based on patient characteristics and Bayesian dosing incorporating more than one measured trough concentration.</div></div><div><h3>Results</h3><div>The Oda model showed the best performance in prediction-based evaluation, with a median prediction error of –8.4%. Bayesian forecasting incorporating at least one measured trough concentration improved predictive capability, and the inclusion of dialysis filter characteristics in the model may further enhance its performance. For a 70 kg patient under this scenario: A 1 g loading dose during the first dialysis session achieves target concentrations within 24–48 h. Subsequent 0.5 g maintenance dose should be administered post-dialysis. Dose escalation is required for extended dialysis sessions (≥12 h).</div></div><div><h3>Conclusion</h3><div>The Oda model demonstrated the best predictive capability for dose prediction among the tested models in Chinese adult patients receiving RRT. However, its F20 and F30 values were undershot compared to the standard external evaluation criteria of F20 ≥35% and F30 ≥50%, highlighting the need for further study to optimize the model or collect additional data to validate its performance.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107608"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of tenofovir alafenamide fumarate–based therapy compared with tenofovir disoproxil fumarate- and abacavir-based therapy in children and young people living with HIV in Europe","authors":"The Epidemiology of Pregnancy and Paediatric Infections International Cohort Collaboration (EPPICC) study group","doi":"10.1016/j.ijantimicag.2025.107634","DOIUrl":"10.1016/j.ijantimicag.2025.107634","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to describe the uptake of TAF, and to compare the effectiveness and safety of tenofovir alafenamide fumarate (TAF)-based therapy with tenofovir disoproxil fumarate (TDF)- and abacavir (ABC)-based therapy among children and young people living with HIV (CYPLHIV) in real-world settings, using data from the Epidemiology of Pregnancy and Paediatric Infections International Cohort Collaboration (EPPICC) study.</div></div><div><h3>Methods</h3><div>The effectiveness and safety outcomes were compared between those on tenofovir TAF, TDF or ABC, among CYPLHIV aged 6 to &lt;25 years.</div></div><div><h3>Results</h3><div>We included 577 CYPLHIV who received TAF, 428 TDF, and 426 ABC. Among them, 96%, 83% and 55% were ART experienced, the median age at drug start was 15.8, 14.6 and 12.5 years, and the median duration of follow-up was 1.6, 2.3 and 3.0 years, respectively. Among all ART-experienced CYPLHIV at drug start, there was no difference in the proportion virologically suppressed at 48 weeks. However, in those suppressed at drug start, the proportion suppressed at 48 weeks was higher on TDF than on TAF (<em>P</em> = 0.008). There was no difference in time to suppression (amongst unsuppressed at start) or to viral failure. Among those on TAF, there were four serious adverse events, of which one (renal colic) was considered related to TAF and led to drug discontinuation. The rate of treatment-emergent grade ≥1 laboratory events was highest on TAF (adjusted incidence rate ratio vs. TAF: TDF 0.74 (0.56–0.99, <em>P</em> = 0.046); ABC 0.69 (0.53–0.88), <em>P</em> = 0.004). Rates of grade ≥1 low-density lipoprotein and total cholesterol events on TAF were comparable on ABC, but higher than TDF, with no difference in bone/renal markers. There was no significant difference in grade ≥3 events (<em>P</em> &gt; 0.5), although the numbers were small. The risk of discontinuation (for reasons other than optimisation/simplification/unknown reason) was lowest for TAF.</div></div><div><h3>Conclusions</h3><div>Virological outcomes were similar across drugs. Rates of any grade laboratory events were highest on TAF, driven by higher rates of lipid events. As TAF uptake increases, studies with long-term follow-up are required.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"66 6","pages":"Article 107634"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}