JACC. Clinical electrophysiology最新文献

{"title":"Lead Integrity and Failure Evaluation in Left Bundle Branch Area Pacing (LIFE-LBBAP) Study.","authors":"Jan De Pooter, Alexander Breitenstein, Emine Özpak, Andreas Haeberlin, Daniel Hofer, Jean-Benoit Le Polain de Waroux, Aurélien Wauters, Tae-Hoon Kim, So-Ryoung Lee, Young Jun Park, Michael Gobitz, Grzegorz Kiełbasa, Dipen Zalavadia, Heli Tolppanen, David Žižek, Francesco Zanon, Lina Marcantoni, Shunmuga Sundaram Ponnusamy, Jarkko Karvonen, Oscar Cano, Marek Jastrzebski, Pugazhendhi Vijayaraman, Haran Burri","doi":"10.1016/j.jacep.2024.09.020","DOIUrl":"10.1016/j.jacep.2024.09.020","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) has gained increased adoption globally with the use of both lumenless leads (LLLs) and stylet-driven leads (SDLs). As these leads have been developed for conventional endocardial pacing sites, concerns remain regarding the lead integrity with LBBAP.</p><p><strong>Objectives: </strong>This study evaluates lead integrity of pacing leads used for LBBAP in a large, real-world cohort of patients with LBBAP.</p><p><strong>Methods: </strong>Patients with successful LBBAP from 17 international centers were enrolled in this observational study. Data on overall lead integrity, fracture rates, and locations of fractures were collected.</p><p><strong>Result: </strong>The study enrolled 8,255 patients with LBBAP (age 73 ± 13 years, 42% female, 68% LLLs, and 32% SDLs). Overall lead survival rate was 99.7% with median follow-up of 16.4 (Q1-Q3: 6.4-28.8) months. Lead fracture occurred in 12 of 8,255 (0.15%) patients. Lead fracture rates of LLLs occurred in 2 of 5,609 (0.04%) vs 10 of 2,646 (0.4%) patients for SDLs, during a follow-up of 19.5 (Q1-Q3: 9.7-33) and 10.3 (Q1-Q3: 2.9-19.7) months, respectively (P < 0.001). SDL fractures occurred at 13.9 (Q1-Q3: 6.1-17.7) months after implant, whereas 2 LLL fractures occurred at 21 and 31.4 months. SDL and LLL conductor fractures were observed in 7 of 17 and 2 of 17 centers, respectively. Confirmed fractures of the SDL lead originated within the interelectrode lead segment, whereas LLL fractures occurred proximal to the ring.</p><p><strong>Conclusions: </strong>LBBAP lead performance of LLLs and SDLs is high at midterm follow-up. SDLs exhibit higher rates of fracture compared to LLLs. Hot spots for conductor fracture are the distal interelectrode segment in SDLs and the segment proximal to the ring electrode in LLLs.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Power Short-Duration Radiofrequency Application for Faster and Safer Pulmonary Vein Isolation: The POWER-FAST III Trial.","authors":"Sergio Castrejón-Castrejón, Marcel Martínez Cossiani, Nuria Basterra Sola, Javier David Romero Roldán, José Luis Ibáñez Criado, Joaquín Osca, Ivo Roca-Luque, Angel Moya, Aurelio Quesada, Víctor Manuel Hidalgo Olivares, Nicasio Pérez Castellano, Juan Manuel Fernández-Gómez, Rosa Macías-Ruiz, Bruno Bochard Villanueva, Nerea Gonzalo Bada, Consuelo Froilán Torres, Beatriz Sanz Verdejo, Paula Sánchez Somonte, Carlos Escobar Cervantes, Raúl Moreno, José Luis Merino","doi":"10.1016/j.jacep.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.10.009","url":null,"abstract":"<p><strong>Background: </strong>The optimal radiofrequency application (RFa) parameters for safe and durable pulmonary vein isolation (PVI) are debated. High-power short-duration (HPSD) has been used as an alternative to conventional power delivery (CPD).</p><p><strong>Objectives: </strong>This study sought to compare HPSD 70 W/9-10 s (HPSD-70) with CPD 25-40 W in patients undergoing PVI.</p><p><strong>Methods: </strong>Patients were randomized to HPSD-70 or CPD (25-40). The primary outcomes were freedom from atrial arrhythmia recurrences and the incidence of esophageal thermal lesions (EDELs) after ablation.</p><p><strong>Results: </strong>Among 304 patients randomized, 301 remained in the study (median age: 61 years; Q1-Q3: 53-69 years; 72% men): 294 patients (97.7%) underwent ablation, 285 (94.7%) underwent endoscopy, and 290 (98.6%) completed the follow-up. At 12 months, 100 patients (73.5%) in the CPD (25-40) group and 87 patients (67%) in the HPSD-70 group were free from recurrences off antiarrhythmic drugs (HR: 1.28; 95% CI: 0.82-1.99; P = 0.28). The incidences of EDELs were 2.7% in the CPD (25-40) group and 3.6% in the HPSD-70 group (P = 0.94). Median left atrial dwell (153 vs 137 min; P = 0.03) and total RF times for definitive PVI (31 vs 11.2 min; P < 0.001) were shorter with HPSD-70 ablation. Four symptomatic embolic events (2 strokes, 1 transient ischemic attack, and 1 splenic infarct) occurred with HPSD-70 and none with CPD (25-40) RFa (P = 0.056).</p><p><strong>Conclusions: </strong>HPSD-70 RFa was noninferior to prevent arrhythmia recurrences, and the incidence of EDELs was similar compared with CPD (25-40) RFa. The embolic events were numerically higher in the HPSD-70 group. (High Radiofrequency Power for Faster and Safer Pulmonary Vein Ablation Trial [POWER FAST III]; NCT04153747).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted Ganglionated Plexi Ablation With Nanoformulated Calcium Suppresses Postoperative AF Via Vagosympatholytic and Anti-Inflammatory Effects.","authors":"Ehsan Jafree, Michael O'Quinn, Pouria Shoureshi, Brianna Rose, Li Wang, Na Nguyen, Tam Nguyen, Kenneth J Dormer, Kytai T Nguyen, Anindita Das, Mohammed Quader, Vigneshwar Kasirajan, Karoly Kaszala, Kenneth A Ellenbogen, Jose F Huizar, Alex Y Tan","doi":"10.1016/j.jacep.2024.09.035","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.09.035","url":null,"abstract":"<p><strong>Background: </strong>The mechanisms underlying postoperative atrial fibrillation (POAF) remain unclear.</p><p><strong>Objectives: </strong>The aim of this study was to test the hypothesis that targeted chemical ganglionated plexi (GP) modulation of all major left atrial-pulmonary vein GP using novel nanoformulated calcium chloride (nCaCl₂) can reverse postoperative neuroelectrical remodeling by suppressing vagosympathetic nerve activity and the localized inflammatory process, both critical substrates of POAF.</p><p><strong>Methods: </strong>In a novel canine model of POAF with serial thoracopericardiotomies, sympathetic nerve activity (SNA), vagal nerve activity (VNA) and GP nerve activity (GPNA) were recorded; spontaneous and in vivo AF vulnerability were assessed; and atrial and circulating inflammatory markers and norepinephrine (NE) were measured to determine the neuroelectrical remodeling that promotes POAF and its subsequent modulation with nCaCl₂ GP treatment (n = 6) vs saline sham controls (n = 6).</p><p><strong>Results: </strong>The first 3 postpericardiotomy weeks demonstrated increased plasma C-reactive protein (P = 0.034) and NE (P = 0.033), decreased atrial effective refractory period (P = 0.002), and increased AF vulnerability (P = 0.0008). Subsequent nCaCl₂ GP treatment reversed atrial effective refractory period remodeling 6 weeks later (P < 0.001) and decreased AF vulnerability (P = 0.0002) and spontaneous AF burden (P = 0.03). nCaCl₂ GP treatment acutely (3 days) and chronically (6 weeks) suppressed GPNA (P = 0.008 and P = 0.04), SNA (P = 0.048 and P = 0.041), and VNA (P = 0.041 and P = 0.046) and increased mean RR interval (P = 0.046 and P = 0.034). In sham controls, the opposite changes occurred (increased GPNA [P = 0.035 and P = 0.02], SNA [P = 0.048 and P = 0.042], and VNA [P = 0.041 and P = 0.042] and decreased mean RR interval [P = 0.041 and P = 0.046]). Plasma NE (P = 0.044), left atrial interleukin-6 (P = 0.008), nerve growth factor (P < 0.001), and sympathetic nerve levels (P < 0.001) were reduced, along with apoptosis of GP neurons in the nCaCl₂ GP group.</p><p><strong>Conclusions: </strong>Targeted GP modulation with nCaCl₂ durably suppresses POAF by inducing apoptosis of GP neurons and inhibiting GP and vagosympathetic nerve activity. This exerts a localized anti-inflammatory effect to reverse the proarrhythmic neural-electrical remodeling following thoracopericardiotomy without myocardial damage or compensatory neural regrowth.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Endothelialization of Left Atrial Appendage Closure Device: Discordance Between Computed Tomography and Angioscopy.","authors":"Akira Kimata, Hiro Yamasaki, Hiroaki Watabe, Tomoko Ishizu","doi":"10.1016/j.jacep.2024.10.016","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.10.016","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Right Ventricular Sensing During Cardiac Device Implantation to Diagnose Cardiac Amyloidosis.","authors":"David Hamon, Rosanna Landes, Thibaut Moulin, Jocelyn Inamo, Carole Maupain, Silvia Oghina, Mounira Kharoubi, Françoise Hidden-Lucet, Estelle Gandjbakhch, Emmanuel Teiger, Thibaud Damy, Nicolas Lellouche","doi":"10.1016/j.jacep.2024.09.041","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.09.041","url":null,"abstract":"<p><strong>Background: </strong>Cardiac amyloidosis (CA) is an underdiagnosed disease, often presenting with electrical conduction abnormalities or ventricular arrhythmias, prompting implantation of cardiac implantable electrical devices (CIEDs).</p><p><strong>Objectives: </strong>This study sought to evaluate the performance of right ventricular sensing (RVSens) during implantation of CIEDs in patients presenting with increased left ventricular (LV) wall thicknesses (ILVWT) and preserved LV function to predict the diagnosis of CA.</p><p><strong>Methods: </strong>All consecutive patients with ILVWT (maximal LV wall thickness ≥12 mm), preserved LV function and no significant aortic stenosis who underwent implantation of CIEDs at 2 French referral centers for rare and inheritable cardiac diseases were retrospectively evaluated. Clinical history, imaging, biological data, histologic data, and pacing lead parameters at the time of implantation were collected. Diagnostic categorization of ILVWT (CA, sarcomeric hypertrophic cardiomyopathy, or hypertensive heart disease) was determined according to guidelines.</p><p><strong>Results: </strong>We included 218 patients with ILVWT, of which 150 had CA and 68 had sarcomeric hypertrophic cardiomyopathy or hypertensive heart disease. Ten patients (4.6%) had their device implanted before ILVWT diagnosis, 131 (60.1%) had their device implanted during the same hospitalization, and 77 (35.3%) in a subsequent hospitalization. An RVSens ≤11 mV was independently associated with CA diagnosis with a sensitivity of 84% and a specificity of 79.4% (AUC: 0.878).</p><p><strong>Conclusions: </strong>In patients with ILVWT, a relatively low RVSens (≤11 mV) during device implantation was independently associated with CA diagnosis, prompting further evaluation to rule out CA if the diagnosis is uncertain.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Multivariable Prediction Model to Estimate Probability of Sleep-Disordered-Breathing in Patients With AF: MOODS-AF.","authors":"Kadhim Kadhim, Adrian D Elliott, Melissa E Middeldorp, Chrishan J Nalliah, R Doug McEvoy, Nicholas A Antic, Rajeev K Pathak, Mehrdad Emami, Dennis H Lau, Jonathan M Kalman, Dominik Linz, Prashanthan Sanders","doi":"10.1016/j.jacep.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.10.013","url":null,"abstract":"<p><strong>Background: </strong>Sleep-disordered breathing (SDB) is common in patients with atrial fibrillation (AF) and negatively impacts treatment outcomes. Optimal tools for AF patient selection for SDB testing are lacking.</p><p><strong>Objectives: </strong>This study sought to develop and validate a prediction tool to detect patients who have AF with moderate-to-severe SDB.</p><p><strong>Methods: </strong>Prospectively collected data on 442 consecutive ambulatory patients with AF who were undergoing polysomnography were used as the derivation sample. Performance was externally validated on a test cohort of 409 patients. Significant SDB was defined as an apnea-hypopnea-index ≥15/h. Multivariable logistic regression was used to construct a prediction model and calculate individual SDB probabilities.</p><p><strong>Results: </strong>Significant SDB was present in 34% and 54% of patients in the derivation and validation cohorts, respectively. The prediction model comprised age, sex, body mass index (BMI), diabetes, and previous stroke or transient ischemic attack. Following calibration, the model had a good discrimination ability for significant SDB on external validation (C-statistic: 0.75; 95% CI: 0.71-0.80). A simplified composite score (MOODS, range 0-8) comprised male sex (1 point), overweight (BMI: 25-29.9 kg/m², 1 point) or obesity (BMI: ≥30 kg/m², 3 points), diabetes (2 points), and stroke/transient ischemic attack (2 points) had good discrimination on external validation (C-statistic: 0.73; 95% CI: 0.68-0.77). As a rule-out or a rule-in test, a MOODS score of ≤1 had a 100% sensitivity and score of ≥5 had a 96% specificity for detecting significant SDB, respectively.</p><p><strong>Conclusions: </strong>The MOODS score provides an individualized and accurate probability of significant SDB in patients with AF. MOODS has the potential to aid clinical decision making and allow efficient resource allocation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncommon Conduction Disturbances After Transcatheter Aortic Valve Replacement.","authors":"Bernard Belhassen, Oholi Tovia-Brodie, Marcelo Elizari, Yoav Michowitz","doi":"10.1016/j.jacep.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.10.022","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Size Adjustable Cryoballoon Ablation Catheter for Atrial Fibrillation: Multicenter Experience of Over 500 Cases.","authors":"Yosuke Hayashi, Shinsuke Miyazaki, Junichi Nitta, Osamu Inaba, Yuichiro Sagawa, Shinsuke Iwai, Yukio Sekiguchi, Yukihiro Inamura, Yasuteru Yamauchi, Tetsuo Sasano","doi":"10.1016/j.jacep.2024.10.018","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.10.018","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image Integration of 3-Dimensional Computed Tomography Papillary Muscle Model to Support Ablation of Papillary Muscle Arrhythmias.","authors":"Johanna B Tonko, Anthony Chow, Martin Lowe, Mehul B Dhinoja, Pier D Lambiase","doi":"10.1016/j.jacep.2024.09.039","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.09.039","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of Structural Abnormalities of Papillary Muscles to the Site of Origin of Ventricular Arrhythmias.","authors":"Nithi Tokavanich, Anurut Huntrakul, Miki Yokokawa, Boldizsar Kovacs, Michael Ghannam, Jackson L Liang, Anil Attili, Hubert Cochet, Rakesh Latchamsetty, Krit Jongnarangsin, Fred Morady, Frank Bogun","doi":"10.1016/j.jacep.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.10.004","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmias originating from papillary muscles (PAPs) can be challenging when targeted with catheter ablation. The prevalence and impact of structural abnormalities on PAPs in patients with focal PAP arrhythmias is unknown.</p><p><strong>Objectives: </strong>The purpose of this study was to analyze, in a consecutive patient series with focal PAP arrhythmias, the impact of structural abnormalities detected by multimodality imaging.</p><p><strong>Methods: </strong>In a series of 43 consecutive patients with focal PAP arrhythmias referred for ablation, the prevalence and location of structural abnormalities on PAPs were assessed with cardiac magnetic resonance imaging, computed tomographic angiography and intracardiac echocardiography (ICE). Sites of origin of ventricular arrhythmias (VAs) were correlated with structural abnormalities.</p><p><strong>Results: </strong>On PAPs, late gadolinium enhancement (LGE) was present on cardiac magnetic resonance imaging in 19 of 43 patients, calcifications on computed tomography in 2 of 43 and on ICE in 3 of 43 patients, and increased echogenicity on ICE in 39 of 43 patients. A total of 141 focal PAP arrhythmias were identified, and VA target sites were localized adjacent to areas with increased echogenicity on ICE for 59 of 141 (44%) VAs, adjacent to LGE for 35 of 141 (25%) VAs, and adjacent to calcifications for 14 of 141 (10%) VAs. At least one VA target site was localized to areas of structural abnormalities in 32 of 43 (74%) patients.</p><p><strong>Conclusions: </strong>Multimodality imaging identifies arrhythmogenic PAPs preprocedurally and in real time during the ablation procedure in most patients. Increased echogenicity, LGE, and calcifications are often seen on PAPs in patients with focal PAP arrhythmias and can indicate the site of origin.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}