International Journal of Legal Medicine最新文献

{"title":"Biochemical analysis of catecholamine and cortisol for the evaluation of the fetal distress in third trimester stillbirths.","authors":"Arianna Giorgetti, Maria Paola Bonasoni, Elena Lacchè, Giuseppina Comitini, Costanza Migliavacca, Alice Ferretti, Carla Galeone, Alessandra Polese, Giovanna Stridi, Francesca Monari, Beatrice Melis, Susi Pelotti","doi":"10.1007/s00414-024-03303-2","DOIUrl":"10.1007/s00414-024-03303-2","url":null,"abstract":"<p><strong>Background: </strong>Stress hormones like catecholamine and cortisol are thought to reflect the magnitude of physical stress in adults and were studied in relationship to the cause of death and agony time. Intrauterine distress, intrapartum events, and modes of delivery can affect the fetal endocrine stress response, as reflected by biochemical analyses. The aim of the present study was to evaluate the role of catecholamines and cortisol as markers of ante-mortem fetal distress. The role of cortisol as a marker of circadian timing of delivery was also assessed.</p><p><strong>Methods: </strong>A 2-year prospective cohort-comparison inclusion of stillbirths and newborns took place with collection of antemortem data, labor parameters, neonatal outcome, post-mortem data and blood samples. Stillbirths were classified as acute or chronic on the basis of a multidisciplinary evaluation. Heart blood of stillbirths and cord blood of newborns were analyzed by high pressure liquid chromatography (HPLC) for adrenaline and noradrenaline and by immunoassay for cortisol determination.</p><p><strong>Results: </strong>Fifteen stillbirths and 46 newborns, as a comparison group, delivered by spontaneous vaginal birth, elective, and emergency cesarean sections were included. Stillbirths' main cause of death was cord thrombosis. Levels of adrenaline and noradrenaline (median: 14,188 pg/ml and 230.5 pg/ml, respectively) were significantly higher (p < 0.001) in stillbirths than in newborns and were also higher in acute compared to chronic distress. Cortisol levels were significantly higher (p < 0.05) in spontaneous vaginal delivery (median: 18.2 μg/dl) compared to elective cesarean sections (median: 3.8 μg/dl). No difference in cortisol concentrations was detected between newborns delivered at morning and at afternoon/evening.</p><p><strong>Conclusion: </strong>Our results suggest that the biochemical measurement of adrenaline and noradrenaline levels might reflect a marked physical stress response during the process of death in stillbirths. On the contrary, the elevation of cortisol levels could mirror the elevation in maternal cortisol level during vaginal delivery. For the post-mortem evaluation of stillbirths, the analysis of CA levels could provide additional data on the duration of distress, useful to integrate the forensic diagnosis.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated Assessment of GFAP and UCH-L1 for their utility in severity assessment and outcome prediction in Traumatic Brain Injury.","authors":"Deepu Mathew, Purvi Purohit, Ashita Gadwal, Abhishek Anil, Raghavendra Kumar Sharma, Vikas P Meshram, Puneet Setia","doi":"10.1007/s00414-024-03287-z","DOIUrl":"10.1007/s00414-024-03287-z","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore the potential of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) as biomarkers for diagnosis and prognosis in mild and severe TBI cases, including TBI-related deaths.</p><p><strong>Methods: </strong>This prospective cohort study includes 40 cases each of mild, severe, fatal TBI cases, and 40 healthy controls. Serum samples were collected from live patients at 8 and 20 h post injury for UCH-L1 and GFAP respectively, and from deceased patients within 6 h of death.</p><p><strong>Results: </strong>Elevated levels of both GFAP and UCH-L1 were observed in patients with severe and fatal TBI cases. These biomarkers exhibited promising potential for predicting various Glasgow Outcome Scale Extended (GOSE) categories. Combining GFAP and UCH-L1 yielded higher predictive accuracy both for diagnosis and prognosis in TBI cases. The study additionally established specific cut-off levels for GFAP and UCH-L1 stratified according to the severity and prognosis.</p><p><strong>Conclusion: </strong>GFAP and UCH-L1 individually demonstrated moderate to good discrimination capacity in predicting TBI severity and functional outcomes. However, combining these biomarkers is recommended for improved diagnostic and prognostic utility. This precision tool can enhance patient care, enabling tailored treatment plans, ultimately reducing morbidity and mortality rates in TBI cases.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distribution of bone fragments in angled shots: an experimental study conducted on composite models containing artificial bone plates.","authors":"Dorothee Geisenberger, Markus Große Perdekamp, Matthieu Glardon, Jan Kromeier, Stefan Pollak, Annette Thierauf-Emberger","doi":"10.1007/s00414-024-03307-y","DOIUrl":"10.1007/s00414-024-03307-y","url":null,"abstract":"<p><p>In conventional gunshot injuries to targets containing bone the resulting osseous fragments do not precede but follow the bullet on its further way through adjacent soft tissues. The term \"secondary projectiles\" for the particles does not appear to be appropriate since they are not believed to have enough energy necessary for creating their own wound channels away from the temporary cavity. Former studies have shown that in angled shots to glass panes the bulk of splinters does not follow the bullet's trajectory: The majority of the glass fragments, especially the larger ones, move at right angles to the pane shot through. The aim of the presented study was to examine whether osseous fragments behave like glass splinters in angled shots to flat synthetic bone. In this context, it should also be assessed, whether the bone fragments might act as secondary projectiles in rare cases. To answer these questions, test shots were fired to composite models consisting of flat synthetic bone and ballistic gelatin. Pistol cartridges 9 mm Luger were used to fire the shots which were video-documented with a high-speed camera. Afterwards, the composite models underwent CT examination and macroscopic inspection. Video-documentation revealed that the larger bone particles from the perforation site move at a roughly right angle from the osseous sheet into the gelatin, causing an eccentric bulge of the temporary cavity. The smaller bone fragments were also lodged along the bullet's path, predominantly in the cracks radiating from the permanent wound channel.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewing hereditary connective tissue disorders: Proposals of harmonic medicolegal assessments.","authors":"Nicola Galante, Maria Francesca Bedeschi, Benedetta Beltrami, Paolo Bailo, Laura Alicia Silva Palomino, Andrea Piccinini","doi":"10.1007/s00414-024-03290-4","DOIUrl":"10.1007/s00414-024-03290-4","url":null,"abstract":"<p><p>Hereditary connective tissue disorders (HCTDs) are a heterogeneous group of inherited diseases. These disorders show genetic mutations with loss of function of primary components of connective tissue, such as collagen and elastic fibers. There are more than 200 conditions that involve hereditary connective tissue disorders, while the most known are Marfan syndrome, Osteogenesis Imperfecta, and Ehlers-Danlos syndromes. These disorders need continuous updates, multidisciplinary skills, and specific methodologic evaluations sharing many medicolegal issues. Marfan syndrome and Ehlers-Danlos syndromes show a high risk of early sudden death. As a consequence of this, postmortem genetic testing can identify novel genotype-phenotype correlations which help the clinicians to assess personalized cardiovascular screening programs among the ill subjects. Genetic testing is also essential to identify children suffering from Osteogenesis Imperfecta, especially when a physical abuse is clinically suspected. However, this is a well-known clinical problem even though there are still challenges to interpret genetic data and variants of unknown significance due to the current extensive use of new genetic/genomic techniques. Additionally, the more significant applications and complexities of genomic testing raise novel responsibilities on the clinicians, geneticists, and forensic practitioners as well, increasing potential liability and medical malpractice claims. This systematic review provides a detailed overview on how multidisciplinary skills belonging to clinicians, medicolegal consultants, radiologists, and geneticists can cooperate to manage HCTDs from autopsy or clinical findings to genetic testing. Thus, technical aspects need to be addressed to the medicolegal community since there is no consensus works or guidelines which specifically discuss these issues.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronological age estimation based on dental mineralization for Syrian population.","authors":"Ahed Alissa, Hans O Pinnschmidt, Hussam Mansour, Klaus Püschel","doi":"10.1007/s00414-024-03295-z","DOIUrl":"10.1007/s00414-024-03295-z","url":null,"abstract":"<p><p>Dental age assessment based on evaluating dental mineralization status is one of the most common methods used in forensic practice. The aim of this study is to enhance the accuracy of age diagnostics and provide reference data from the Syrian population for forensic application. After several selection steps, a total of 280 orthopantomograms (OPGs) from 140 males and 140 females from the Syrian population divided into 14 age groups between 12 and 25 years were analysed. Based on Demirjian's classification system, the mineralization stages of third molars (18, 28, 38 and 48) as well as lower second molars (37 and 47) were evaluated. Statistical investigations and evaluations were carried out to estimate the marginal probabilities of the subjects having attained ages 14 and 18 by generalized estimating equation models. Our results show that no significant differences can be revealed in the mineralization status with respect to jaw side and sex. In the Syrian population, third molars showing mineralization stage G provide evidence of reaching the age of 14 years with the highest standard of proof (\"beyond reasonable doubt\"). A completed mineralization in lower second molars (stage H) provides very high marginal probabilities (more than 90%) of the subjects having attained age 14 years. Nevertheless, this cannot exclude an age under 14 years. For the age threshold of 18 years, third molars showing incomplete root development (G dental stage or lower) are associated with a low probability (less than 40%) of the subject having reached 18 years of age. A person's probability of having attained 18 years of age is very high (82- 95%) when the roots of third molars are fully developed (stage H). Nevertheless, third molars at stage H do not conclusively exclude an age under 18 years.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Root canal widths of mandibular molars in predicting the legal age threshold 18 years in a sample of juveniles and sub-adults of south-indian origin: an orthopantomographic study.","authors":"Priyanka Vedula, Ashalata Gannepalli, Sudheer Babu Balla, Gayathri Ch, Anjum Bushra, Bhargavi Krishna Ayinampudi","doi":"10.1007/s00414-024-03300-5","DOIUrl":"10.1007/s00414-024-03300-5","url":null,"abstract":"<p><p>Pursuing a proficient age estimation methodology introducing novel radiographic methods remains an ongoing and demanding aspect of forensic and medicolegal research. In 2017, Roberts GJ et al. (J Forensic Sci 62(2):351-4, 2017) described a new radiographic method, i.e., root canal width (RCW) patterns to assign a subject to above 18-year-age threshold. Since then, few researchers have investigated the validity of this radiographic method in other populations. The present study aimed to test the usefulness of these RCW patterns in predicting 18 years in a sample of South Indian juveniles and sub-adults aged between 16 and 23. Descriptive analysis revealed that pattern-A was initially observed at a minimum age of 16.08 and 16.22 years in males and females. Pattern-B at 16.31 years in males and 16.22 years in females, while pattern-C was initially recorded at 18.73 years in males and 19.01 years in females, respectively. In summary, if an individual, regardless of sex, exhibits a fully-formed (apex closed) mandibular first, second, and third molars and concurrently displays RCW-C, there is a strong likelihood that the person has exceeded the legally relevant age of 18 years. However, due to higher rate of technically unacceptable errors (adults wrongly identified as individuals below 18 years), reliance on this method alone should be restricted, and it is advisable to combine it with other methods.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing tooth development timing between ethnic groups, excluding nutritional and environmental influences.","authors":"Patrick Thevissen, Janna Waltimo-Sirén, Hanna-Maija Saarimaa, Raija Lähdesmäki, Marjut Evälahti, Mari Metsäniitty","doi":"10.1007/s00414-024-03279-z","DOIUrl":"10.1007/s00414-024-03279-z","url":null,"abstract":"<p><p>The timing of dental development in ethnic Finns and Somalis, who were born and living in Finland, was compared, with efforts to minimize environmental bias. The developmental status of seven lower left permanent teeth were staged according to Demirjian et al., using panoramic radiographs from 2,100 Finnish and 808 Somali females and males, aged 2 to 23 years. For each tooth, a continuation-ratio model was constructed to analyze the allocated stages as a function of sex and ethnic origin. Several statistically significant differences in mean age of certain tooth developmental stage transitions were revealed. While Somalis generally displayed stage transitions at younger age, none of the seven teeth consistently showed earlier stage transitions in Somalis compared to Finns. Within each tooth, the lowest (or highest) mean age of stage transition varied without any discernible pattern between the two ethnic groups. Overall, the observed differences in mean age of stage transition between the groups was minimal, suggesting a low impact on clinical and forensic age assessment practice. In conclusion, the studied ethnic Finn and Somali groups with equal nutritional and /or environmental conditions exhibit similar timing in the development of all lower left permanent teeth.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonmetric sex estimation in a contemporary Indonesian population: a validation study using clinical pelvic MSCT scans.","authors":"Ridhwan Lye, Zuzana Obertová, Nur Amelia Bachtiar, Daniel Franklin","doi":"10.1007/s00414-024-03266-4","DOIUrl":"10.1007/s00414-024-03266-4","url":null,"abstract":"<p><p>Klales et al. (2012) is a popular standard for the estimation of skeletal sex. Since its publication, a number of studies have demonstrated that population-specific applications of Klales improve classification accuracy. However, it has also been shown that age appears to affect the expression of dimorphism in the pelvis across the lifespan. As such, the present study examines the accuracy of Klales, and the modified global standard of Kenyhercz et al. (2017), in a contemporary Indonesian population, including quantifying the effect of age. Pelvic multi-slice CT scans of 378 individuals (213 female; 165 male) were analysed in OsiriX®. Both standards were tested and Indonesian-specific models thereafter derived.When applied to the Indonesian sample, both the Klales and Kenyhercz standards resulted in lower classification accuracy relative to the original studies. In considering the Indonesian-specific models, the ventral arc was the most accurate for the classification of sex, at 93.3% with a - 3.0% sex bias. The accuracy of the three-trait model was 94.4%, with a - 5.5% sex bias. Age was shown to significantly affect the distribution of pelvic trait scores. As such, age-dependent models were also derived, with the standard for individuals between 30 and 49 years the most accurate, at 93.1% and a sex bias of - 4.0%. Accuracy was lower in individuals aged ≥ 50 years, at 91.3% and a sex bias of 4.1%. These findings support the importance of establishing population-specific standards and to facilitate improved accuracy and capabilities for forensic practitioners in Indonesia.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of cooling on biomechanical time since death estimations using ovine brain tissue.","authors":"Johann Zwirner, Pavithran Devananthan, Paul D Docherty, Benjamin Ondruschka, Natalia Kabaliuk","doi":"10.1007/s00414-024-03267-3","DOIUrl":"10.1007/s00414-024-03267-3","url":null,"abstract":"<p><p>The significance of biomechanical analyses for forensic time since death estimations has recently been demonstrated. Previous biomechanical analyses successfully discriminated post-mortem brain tissue from tissue with a post-mortem interval of at least one day when held at 20 °C. However, the practical utility of such analyses beyond day one at 20 °C was limited. This study investigates the storage, loss, and complex shear modulus of various brain regions in sheep stored at 4 °C in 24-hour intervals over four days post-mortem using rheometry tests. The aim is to identify the critical biomechanical tissue property values to predict post-mortem time and assess the temperature sensitivity of the rheometry method by comparing results to recent findings at 20 °C. Thirty sheep brains were examined, including the frontal lobe, parietal lobe, anterior and posterior deep brain, superior colliculi, pons, medulla, and cerebellum. Rheometry tests were conducted, and receiver operator characteristic analyses were employed to establish cut-off values. At 4 °C storage, all investigated biomechanical properties of the examined brain regions remained stable for at least one day post-mortem. Using cerebellar samples stored at 4 °C, a post-mortem interval of at least two days could be determined with excellent diagnostic ability. Complex shear modulus values below 1435 Pa or storage modulus values below 1313 Pa allowed prediction of two or more days post-mortem. Comparisons between 4 °C and 20 °C revealed brain region-specific results. For instance, the complex shear moduli of the anterior deep brain at 4 °C were significantly higher on all individual testing days when compared to 20 °C. In contrast, the combined medulla and pons samples were similar on each day. Rheometry testing of brain tissue consistently stored at 4 °C since death proved valuable for forensic time since death estimations starting from two days after death.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An atypical case of fatal 'esophageal apoplexy': post-mortem findings and differential diagnosis.","authors":"Hans H de Boer, Chris O'Donnell","doi":"10.1007/s00414-024-03280-6","DOIUrl":"10.1007/s00414-024-03280-6","url":null,"abstract":"<p><p>Forensic pathologists need to have comprehensive knowledge of a large variety of causes of sudden natural death. We describe a case of sudden and unexpected death in woman in her sixties due to rupture of a large paraesophageal hematoma. The post-mortem examination and differential diagnosis are discussed. The combined findings of whole-body post-mortem CT imaging (PMCT), targeted PMCT angiography, autopsy, and histology are most in keeping with 'esophageal apoplexy'; a rare cause of hemorrhage in the esophageal wall. A review of the literature indicates that most cases of esophageal apoplexy are self-limiting and that fatal complications are exceedingly rare. Our case demonstrates that esophageal apoplexy can present as sudden unexpected death.</p>","PeriodicalId":14071,"journal":{"name":"International Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}