JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Contralateral Tonsil in p16-Positive Tonsil Squamous Cell Carcinoma.","authors":"Louis-Xavier Barrette, Michelle Gentile, Karthik Rajasekaran","doi":"10.1001/jamaoto.2025.2410","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2410","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300930","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":"Reflux Medication and Supraglottoplasty in Infant Laryngomalacia.","authors":"Toluwaniose Nafiu","doi":"10.1001/jamaoto.2025.3560","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3560","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300925","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":"Observation or Otolaryngology Surveillance After Ventilation Tube Insertion in Children: The ConVenTu Noninferiority Randomized Clinical Trial.","authors":"Rikki Yahiro, Bjarne Austad, Anne-S Helvik, Ann Helen Nilsen, Øyvind Salvesen, Wenche Moe Thorstensen","doi":"10.1001/jamaoto.2025.2880","DOIUrl":"10.1001/jamaoto.2025.2880","url":null,"abstract":"<p><strong>Importance: </strong>Middle-ear ventilation tube (VT) insertion is the most common ambulatory surgery in children. Follow-up for these patients may continue for 2 or more years and consume a great deal of health care resources. Research into the appropriate level of care for such controls is lacking.</p><p><strong>Objective: </strong>To determine whether observation by general practitioners (GPs) yielded noninferior audiometric outcomes 2 years after VT insertion compared to otorhinolaryngology (ear, nose, and throat [ENT]) follow-up by specialist health care services.</p><p><strong>Design, setting, and participants: </strong>In the multicenter ConVenTu (Control of Ventilation Tubes) noninferiority randomized clinical trial, patients from 6 Norwegian ENT departments were assessed for eligibility from August 15, 2017, to August 30, 2021. Children between 3 and 10 years of age requiring VT insertion were eligible for the study. Patients with comorbidities or hearing loss exceeding 50 dB in at least 1 ear were excluded. The data were analyzed between February 19, 2024, and May 24, 2024.</p><p><strong>Intervention: </strong>Observation by the patient's GP.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the difference between the means of pure-tone averages (PTAs) measured at inclusion and 2 years after VT insertion. Children were randomized in blocks of varying sizes with an allocation ratio of 1:1 stratified by study center. Differences were compared between observation and ENT follow-up groups using linear mixed model analysis. Analyses were by intention-to-treat, and a margin of 5 dB was used in the determination of noninferiority. The audiographers responsible for audiometric testing were blinded to patient allocation. Secondary outcomes included audiometric and tympanometric resolution as well as complications registered at control.</p><p><strong>Results: </strong>A total of 305 children requiring VT insertion (median [IQR] age, 4 [3-6] years; 185 [60.7%] male) were included in the trial (153 in GP arm and 152 in ENT arm). Of these, 145 children in each group completed audiometric control at 2 years. Audiometric outcomes of the observation group were found to be noninferior to those who routinely followed up with ENT (0.16 dB [1-sided 97.5% CI lower bound, -1.52 dB]) 2 years after VT insertion, well within the noninferiority threshold of 5 dB. There was also no difference in the total number of patients with complications (odds ratio, 0.67 [1-sided 97.5% CI lower bound, 0.39]).</p><p><strong>Conclusion and relevance: </strong>In this randomized clinical trial, postoperative observation in general practice was noninferior to routine follow-up of patients who underwent VT surgery in Norway in terms of audiometric outcomes 2 years after VT insertion in otherwise healthy children. These findings may help guide the allocation of resources in the follow-up of these patients.</p><p><strong>Trial registration: </st","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reevaluation of Enlarged Vestibular Aqueduct.","authors":"Shasha Huang, Xue Gao, Yi Jiang, Chang Guo, Xiaoge Li, Guojian Wang, Mingyu Han, Xin Zhang, Suyan Yang, Qiuquan Wang, Chaoyue Zhao, Jinyuan Yang, Dongyang Kang, Pu Dai, Yongyi Yuan","doi":"10.1001/jamaoto.2025.2866","DOIUrl":"10.1001/jamaoto.2025.2866","url":null,"abstract":"<p><strong>Importance: </strong>Enlarged vestibular aqueduct (EVA), the most prevalent inner ear malformation causing hearing loss (HL) in various populations, is predominantly genetically mediated. Despite advancements in genetic diagnostics, the comprehensive phenotypic and genotypic spectrum of EVA remains insufficiently characterized.</p><p><strong>Objectives: </strong>To characterize the natural history, clinical outcomes, phenotype, and genotype of EVA.</p><p><strong>Design, setting, and participants: </strong>This single-center, longitudinal, retrospective cohort study was conducted from March 2003 to October 2022, with follow-up until July 1, 2024. Patients with EVA who were seeking medical advice at the Chinese PLA General Hospital were included.</p><p><strong>Main outcomes and measures: </strong>This study presents a 21-year longitudinal analysis of Chinese patients with EVA, providing a systematic analysis of the natural history, phenotypic diversity, and molecular etiology of EVA.</p><p><strong>Results: </strong>Of 2774 patients, 1453 (52.4%) were female individuals, and the median (range) age was 8 (4 months to 45 years) years. This study identified that 124 of 341 patients (36.36%) with EVA received passing newborn hearing screening results, while 375 of 597 (62.8%) received a diagnosis through combined audiological and radiological assessments. Recurrent vertigo (256 of 597 [42.9%]) and goiter (38 of 597 [6.4%]) were common comorbidities. Genetic analysis revealed that 2661 of 2774 patients (95.9%) carried biallelic SLC26A4 variants, with 70 (2.5%) attributable to copy number variants and 13 (0.5%) to a deep-intronic variant (c.304 + 941C>T) that affected splicing. A de novo heterozygous FOXI1 variant (c.483_485delCAA) was identified in an EVA family, indicating an autosomal dominant inheritance pattern. A stepped genomic analysis strategy was associated with an improved molecular diagnosis rate of 95.9%, highlighting the necessity of comprehensive genetic testing beyond traditional coding regions.</p><p><strong>Conclusions and relevance: </strong>The results of this cohort study underscore the importance of periodic hearing surveillance and tailored genetic counseling for patients with EVA, offering substantial implications for prevention, management, and future gene therapy approaches. This study provides an extensive phenotypic and genotypic characterization of EVA, potentially advancing an understanding of its molecular underpinnings and clinical heterogeneity.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial vs Whole Laryngeal Radiotherapy for Clinical Stage T1-2N0M0/Tis Laryngeal Carcinoma.","authors":"Teeradon Treechairusame, Edward Christopher Dee, Caineng Cao, Yingzhi Wu, Yao Yu, Daphna Gelblum, Nadeem Riaz, Sean M McBride, Linda Chen, Achraf Shamseddine, Kaveh Zakeri, Chiaojung Jillian Tsai, Jung Julie Kang, Ian Ganly, Jennifer R Cracchiolo, Snehal Patel, Marc A Cohen, Richard J Wong, Nancy Y Lee","doi":"10.1001/jamaoto.2025.3214","DOIUrl":"10.1001/jamaoto.2025.3214","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The current standard treatment for clinical tumor stage 1 to 2 or in situ laryngeal carcinoma without node involvement or metastases (T1-2N0M0/Tis) is whole laryngeal radiotherapy (WLRT), whereas microsurgery typically resects only the tumor-involving vocal cord with a narrow margin. Clinical outcomes of partial laryngeal radiotherapy (PLRT) have not been quantified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the effectiveness and toxic effects of PLRT vs WLRT in patients with clinical stage T1-2N0/Tis laryngeal carcinoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a single-institution retrospective cohort study of patients with clinical stage T1-2N0M0/Tis squamous cell carcinoma of the larynx who underwent intensity-modulated RT from January 2013 to December 2024. Data were analyzed from January to February 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Long-term locoregional control, laryngectomy-free survival, distant metastasis, and overall toxic effects. Acute and late radiation toxic effects were graded using Common Terminology Criteria for Adverse Events, version 4.0. Patient-reported swallowing-related quality of life (MD Anderson Dysphagia Inventory) was collected at each visit when feasible.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analyses included 233 consecutive patients with T1-2N0M0/Tis squamous cell carcinoma of the larynx who were treated with intensity modulated radiotherapy (176 with WLRT vs 57 with PLRT). The median (IQR) follow-up in the WLRT group was 60 (28-87) months, and in the PLRT group, 31 (16-64) months. The largest tumor stage-related difference in WLRT was observed in T1b (100%) and Tis (50%) disease, with an absolute difference of 50% (95% CI, 25.4% to 73.2%). There were no important clinical differences between PLRT and WLRT in 3-year locoregional control rates (85.4% vs 90.8%; rate difference, -5.4%; 95% CI, -13.5% to 6.9%), laryngectomy-free survival (93.2% vs 94%; rate difference, -0.8%; 95% CI, -9.1% to 7.5%), distant metastasis-free survival (100% vs 97.6%; rate difference, 2.4%; 95% CI, -0.3% to 4.9%), and overall survival (91.4% vs 88.9%; rate difference, 2.5%; 95% CI, -6.8% to 12.8%). There was no contralateral vocal-fold failure in the PLRT group. There was a large difference in the 3-year locoregional control in T2 tumors between the WLRT (85.1%) and PLRT groups (66.7%), with a difference of 18.4% (95% CI, -5.8% to 21.3%). The incidence of acute dysphagia was lower in the PLRT than in the WLRT group (73.7% vs 92.6%; difference, 18.9%; 95% CI, 6.9% to 30.9%). Median composite scores on the MD Anderson Dysphagia Inventory at 3 and 6 months postradiotherapy were higher in the PLRT group (86 vs 77; difference, 8; 95% CI, 2 to 14; and 96 vs 81; difference, 4; 95% CI, -2 to 8; respectively), although the observed differences may not be clinically important.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cohort study found that there were no","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Head and Neck Cancer Salvage Surgery in the Era of Immunotherapy and Beyond: A Review.","authors":"Nabil F Saba, Nader G Zalaquett, Saad Rashid, Karthik N Rao, Robert P Takes, Carol Bradford, Remco de Bree, Jonathan J Beitler, Arlene A Forastiere, Jan B Vermorken, Anthea L Hammond, Yong Teng, Nicole C Schmitt, Alfio Ferlito","doi":"10.1001/jamaoto.2025.3204","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3204","url":null,"abstract":"<p><strong>Importance: </strong>Head and neck squamous cell carcinoma (HNSCC) is a challenging malignant condition associated with significant morbidity and mortality. Salvage surgery, in addition to other available treatment modalities, constitutes an important therapeutic intervention for locoregionally recurrent HNSCC, offering the potential for improved locoregional control and survival outcomes. However, the indications for salvage surgery remain diverse and poorly standardized, with reported 5-year survival outcome rates ranging from 10% to 61%. In recent years, the incorporation of immunotherapy into the management of recurrent and locally advanced HNSCC has shown promising potential. Although preoperative immunotherapy has resulted in improved outcomes in other malignant neoplasms, such as non-small cell lung cancer, its integration into HNSCC surgical protocols whether in the primary or salvage setting is still in its early stages. Early single-institution trials suggest combining immunotherapy with salvage surgery may enhance survival, reduce recurrence rates, and improve other outcomes for patients with recurrent or persistent HNSCC.</p><p><strong>Observations: </strong>This review explores the evolving landscape of HNSCC salvage surgery in the era of immunotherapy by assessing current evidence, clinical implications, and future directions for this integrated approach.</p><p><strong>Conclusions and relevance: </strong>Advances in immunotherapy and the development of future clinical trials incorporating immunotherapy in the HNSCC salvage setting have the potential to enhance patient selection and optimize surgical outcomes.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206259","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":"Potential Benefit of Inferior Turbinate Reduction With Adenotonsillectomy for Obstructive Sleep Apnea.","authors":"Smile Kajal","doi":"10.1001/jamaoto.2025.3163","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3163","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206312","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":"Optimizing Otolaryngology Training Through Sports Psychology-The Mental Game.","authors":"W Jack Palmer, Dylan Bertoni, Arielle Thal, Elizabeth E Cottrill, Colin T Huntley","doi":"10.1001/jamaoto.2025.2896","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2896","url":null,"abstract":"<p><strong>Importance: </strong>Otolaryngologists share many important characteristics with elite athletes, including specialized skill development through rigorous training, complex motor activity under pressure, and performance with high stakes. Applied sports psychology emerged to help athletes develop the intangible skills necessary to succeed in this environment. This body of literature represents a valuable opportunity for the otolaryngology community, where mental training is yet to be fully integrated. Today's otolaryngologists can particularly benefit from these lessons, as they contend with an increasing workload and expanding responsibilities in an ever-evolving health care landscape.</p><p><strong>Observations: </strong>Mental imagery, mindfulness, and growth mindset are 3 core techniques with demonstrated benefits in sports and increasing evidence in surgery. Mental imagery helps establish preoperative confidence and neural preparedness. Mindfulness bolsters focus during performance and resilience throughout one's career. A growth mindset fosters adaptability and perseverance in response to setbacks. Randomized studies have shown these interventions can enhance technical performance, mitigate stress, and prevent burnout in surgical trainees. Evidence suggests that residency programs can best teach these techniques through formal instruction and expert-led practice. There may also be a benefit to training educators in growth-focused coaching.</p><p><strong>Conclusions and relevance: </strong>As the field of otolaryngology continues to advance clinically and technologically, it must also innovate in how it educates its surgeons. Mental skills training is a feasible, evidence-based method to optimize surgical performance and surgeon well-being. These skills promote confidence, adaptability, focus, and resilience-all qualities that enable safer patient care and more sustainable careers. By embracing these insights from sports psychology, otolaryngology programs can better prepare their trainees to meet the demands of modern practice.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206228","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":"Factors Associated With Dizziness Among Patients With Vestibular Schwannoma.","authors":"Tyler Wilson, Dorina Kallogjeri, Belinda Sinks, Lauren English, Pawina Jiramongkolchai, Matthew Shew, Jacques Herzog, Craig Buchman, Jay Piccirillo, Nedim Durakovic","doi":"10.1001/jamaoto.2025.2849","DOIUrl":"10.1001/jamaoto.2025.2849","url":null,"abstract":"<p><strong>Importance: </strong>Patients with vestibular schwannoma (VS) commonly present with neurological symptoms such as hearing loss, tinnitus, and dizziness. However, factors associated with dizziness at presentation are not well understood.</p><p><strong>Objective: </strong>To evaluate the baseline features of adults diagnosed with VS associated with subjective dizziness using a validated instrument.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included adults with radiologically diagnosed VS who completed vestibular testing at Washington University (St Louis, Missouri) between June 2004 and January 2025. Baseline dizziness was measured using the Dizziness Handicap Inventory (DHI).</p><p><strong>Exposures: </strong>Anxiety associated with a VS diagnosis.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was severity of dizziness based on DHI score.</p><p><strong>Results: </strong>A total of 109 patients were included; the mean (SD) age was 61 (14) years, 57 (52%) were female, and 52 (48%) were male. The mean (SD) DHI score was 27 (24) points. Participants with a history of anxiety had a DHI score that was 13.7 points (95% CI, 4.2-23.2 points) higher than those with no such history. For every additional point in severity of anxiety measured using the Generalized Anxiety Disorder-7 (GAD-7) scale, DHI score increased 2.6 points (95% CI, 2.0-3.3 points). After controlling for covariates, for every 1-point increase in GAD-7, DHI score increased by a mean of 1.9 points (95% CI, 1.3-2.6 points). On average, patients with a history of anxiety had a DHI score 10.6 points (95% CI, 2.4-18.7 points) higher than those with no such history.</p><p><strong>Conclusions and relevance: </strong>This retrospective cohort study suggests a psychological association between anxiety and dizziness might exist among patients with VS that has not previously been explored. Further studies examining this association are needed in this patient population.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Benefit of Inferior Turbinate Reduction With Adenotonsillectomy for Obstructive Sleep Apnea-Reply.","authors":"Derek J Lam","doi":"10.1001/jamaoto.2025.3166","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3166","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206290","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}