JACC. Heart failure最新文献

{"title":"Efficacy and Safety of Finerenone in Heart Failure With Preserved Ejection Fraction","authors":"John W. Ostrominski MD ,&nbsp;Gerasimos Filippatos MD ,&nbsp;Brian L. Claggett PhD ,&nbsp;Zi Michael Miao MS ,&nbsp;Akshay S. Desai MD, MPH ,&nbsp;Pardeep S. Jhund MBChB, PhD, MSc ,&nbsp;Alasdair D. Henderson PhD ,&nbsp;Markus F. Scheerer PhD ,&nbsp;Katja Rohwedder MD ,&nbsp;Flaviana Amarante MD ,&nbsp;Meike Brinker MD ,&nbsp;James Lay-Flurrie MSc ,&nbsp;Carolyn S.P. Lam MBBS, PhD ,&nbsp;Michele Senni MD ,&nbsp;Sanjiv J. Shah MD ,&nbsp;Adriaan A. Voors MD PhD ,&nbsp;Faiez Zannad MD ,&nbsp;Peter Rossing MD ,&nbsp;Luis M. Ruilope MD PhD ,&nbsp;Stefan D. Anker MD ,&nbsp;Muthiah Vaduganathan MD, MPH","doi":"10.1016/j.jchf.2025.03.041","DOIUrl":"10.1016/j.jchf.2025.03.041","url":null,"abstract":"<div><h3>Background</h3><div>Pooling data from participants with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) from all completed outcomes trials evaluating finerenone to date may enhance understanding of its safety and efficacy in this high-risk and heterogeneous population.</div></div><div><h3>Objectives</h3><div>In this prespecified participant-level pooled analysis of the FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF trials (FINE-HEART), we evaluated the safety and efficacy of finerenone in individuals with HFmrEF/HFpEF.</div></div><div><h3>Methods</h3><div>The treatment effects of finerenone vs placebo on cardiovascular death or heart failure hospitalization were evaluated using Cox proportional hazards regression models stratified by trial. Additional endpoints included cardiovascular death, HF hospitalization, new-onset atrial fibrillation, and all-cause death.</div></div><div><h3>Results</h3><div>Among 18,991 pooled trial participants, 7,008 (36.9%) had HFmrEF/HFpEF (mean age, 71 ± 10 years; 44% female). Over a median follow-up of 2.5 years, finerenone reduced cardiovascular death or heart failure hospitalization compared with placebo (HR: 0.87 [95% CI: 0.78-0.96]; <em>P =</em> 0.008). Consistent effects were observed across trials (<em>P</em>_interaction = 0.24), key subgroups, and baseline estimated glomerular filtration rate (<em>P</em>_interaction = 0.47), urine albumin-to-creatinine ratio (<em>P</em>_interaction = 0.62), and glycated hemoglobin (<em>P</em>_interaction = 0.93). Finerenone additionally appeared to reduce heart failure hospitalization (HR: 0.84 [95% CI: 0.74-0.94]; <em>P =</em> 0.003) and new-onset atrial fibrillation (HR: 0.75 [95% CI: 0.58-0.97]; <em>P =</em> 0.030), but did not statistically significantly decrease cardiovascular death or all-cause death. Hyperkalemia was more common, and hypokalemia was less common, with finerenone vs placebo. Serious adverse events were similar between the treatment arms.</div></div><div><h3>Conclusions</h3><div>This participant-level pooled analysis of 3 large-scale outcomes trials supports the use of finerenone in individuals with HFmrEF/HFpEF across a broad range of cardiovascular-kidney-metabolic risk. (PROSPERO registration: CRD42024570467)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102497"},"PeriodicalIF":10.3,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261606","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":"Donor Selection for Heart Transplantation","authors":"Carlos Chamorro-Jambrina PhD ,&nbsp;José Alberto Silva-Obregón PhD ,&nbsp;José Luis Martínez-Melgar MD ,&nbsp;Miguel Ángel Romera-Ortega MD","doi":"10.1016/j.jchf.2025.03.043","DOIUrl":"10.1016/j.jchf.2025.03.043","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102501"},"PeriodicalIF":10.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240292","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":"Hypertrophic Cardiomyopathy With Midventricular Obstruction Is Not Nonobstructive Hypertrophic Cardiomyopathy","authors":"Hubert Seggewiss MD","doi":"10.1016/j.jchf.2025.03.044","DOIUrl":"10.1016/j.jchf.2025.03.044","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102503"},"PeriodicalIF":10.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240748","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":"Transferrin Saturation Is a Better Predictor Than Ferritin of Metabolic and Hemodynamic Exercise Responses in HFpEF","authors":"Sujin Lee MD, MS ,&nbsp;Nicholas E. Houstis MD, PhD ,&nbsp;Thomas F. Cunningham MD ,&nbsp;Liana C. Brooks BA ,&nbsp;Kailin Chen MPH ,&nbsp;Charles L. Slocum MD ,&nbsp;Katrina Ostrom BA ,&nbsp;Claire Birchenough BA ,&nbsp;Elizabeth Moore BA ,&nbsp;Helena Tattersfield BA ,&nbsp;Haakon Sigurslid BA ,&nbsp;Yugene Guo BA ,&nbsp;Isabela Landsteiner MD ,&nbsp;Jennifer N. Rouvina BA ,&nbsp;Gregory D. Lewis MD ,&nbsp;Rajeev Malhotra MD, MS","doi":"10.1016/j.jchf.2025.02.024","DOIUrl":"10.1016/j.jchf.2025.02.024","url":null,"abstract":"<div><h3>Background</h3><div>Iron is a critical factor in cardiac function, oxygen carrying capacity in the blood, and mitochondrial function in skeletal muscle, all of which are key elements of oxygen uptake and utilization during exercise. However, the impact of iron status on hemodynamic responses to exercise and component variables of peak oxygen consumption in patients with heart failure with preserved ejection fraction (HFpEF) is unknown.</div></div><div><h3>Objectives</h3><div>The authors sought to determine the relationship between markers of iron status and comprehensive exercise response patterns and clinical outcomes in patients with HFpEF.</div></div><div><h3>Methods</h3><div>Cardiopulmonary exercise testing using cycle ergometry with invasive hemodynamic assessment was performed in 372 patients with HFpEF. Serum iron, transferrin saturation (Tsat), hepcidin, and ferritin were measured at the time of cardiopulmonary exercise testing, and additionally the Tsat/hepcidin ratio was used as a measure of iron homeostasis and hepcidin dysregulation, with low values reflecting inappropriate elevation in hepcidin level relative to iron bioavailability.</div></div><div><h3>Results</h3><div>In this cohort, 66% had iron deficiency defined as ferritin &lt;100 μg/L or ferritin 100-300 μg/L with Tsat &lt;20%. Higher peak oxygen consumption was associated with higher Tsat% (ρ = 0.33; <em>P</em> &lt; 0.0001), Tsat/hepcidin ratio (ρ = 0.23; <em>P</em> &lt; 0.0001), and serum iron (ρ = 0.30; <em>P</em> &lt; 0.0001) but was not associated with ferritin level. After adjustment for age, hypertension, diuretic use, hemoglobin level, and cardiac index at rest, the association between higher peak oxygen consumption with higher Tsat, Tsat/hepcidin, and iron remained significant (<em>P</em> ≤ 0.006 for all). Tsat, Tsat/hepcidin, and iron were also associated with lower pulmonary artery pressure/cardiac output slope and pulmonary capillary wedge pressure/cardiac output slope, whereas ferritin did not correlate with these exercise hemodynamic measures. Finally, Tsat independently predicted heart failure-free survival, with every higher tertile of Tsat corresponding to an HR of 0.60 (<em>P =</em> 0.002), whereas ferritin was not associated with outcomes.</div></div><div><h3>Conclusions</h3><div>In patients with HFpEF, Tsat%, but not ferritin levels, relates to more favorable overall metabolic and hemodynamic responses to exercise and better outcomes.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102478"},"PeriodicalIF":10.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255211","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":"Regulatory Ghosts?","authors":"John Onsy Louca MB BChir ,&nbsp;Beatriz Domínguez-Gil González MD, PhD ,&nbsp;Guillaume Lebreton MD, PhD ,&nbsp;Stephen Pettit MD, PhD ,&nbsp;Sai Bhagra MRCP","doi":"10.1016/j.jchf.2025.04.010","DOIUrl":"10.1016/j.jchf.2025.04.010","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102499"},"PeriodicalIF":10.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240291","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":"Obesity and Risk of Kidney Outcomes in Heart Failure With Preserved Ejection Fraction","authors":"Mats C.H. Lassen MD ,&nbsp;John W. Ostrominski MD ,&nbsp;Brian L. Claggett PhD ,&nbsp;Brendon L. Neuen MBBS, MSc, PhD ,&nbsp;Iris E. Beldhuis MD ,&nbsp;Jawad Butt MD, PhD ,&nbsp;Tor Biering-Sørensen MD, PhD, MPH, MSc ,&nbsp;Akshay S. Desai MD ,&nbsp;Eldrin F. Lewis MD, MPH ,&nbsp;Pardeep S. Jhund MBChB, MSc, PhD ,&nbsp;Finnian Mc Causland MBBCh, MMSc ,&nbsp;Inder S. Anand MD ,&nbsp;Marc A. Pfeffer MD, PhD ,&nbsp;Bertram Pitt MD ,&nbsp;Faiez Zannad MD, PhD ,&nbsp;Michael R. Zile MD ,&nbsp;John J.V. McMurray MD ,&nbsp;Scott D. Solomon MD ,&nbsp;Muthiah Vaduganathan MD, MPH","doi":"10.1016/j.jchf.2025.03.042","DOIUrl":"10.1016/j.jchf.2025.03.042","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is prevalent among patients with heart failure with preserved ejection fraction (HFpEF).</div></div><div><h3>Objectives</h3><div>This study aims to evaluate whether anthropometrics including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) are associated with kidney outcomes in patients with HFpEF.</div></div><div><h3>Methods</h3><div>In this participant-level pooled analysis of DELIVER, PARAGON-HF, TOPCAT Americas, and I-PRESERVE, we evaluated the impact of adiposity-related anthropometrics on risk of kidney outcomes (sustained eGFR reduction of ≥50%, end-stage kidney disease, or kidney-related death). BMI was collected in all trials and WC was collected in PARAGON-HF and TOPCAT. Multivariable Cox models stratified by trial and treatment were used.</div></div><div><h3>Results</h3><div>Overall, 16,919 participants were included in the analysis (71.9 ± 8.7 years of age; 50.7% women). Of these, 18% were normal/underweight, 35% had overweight, and 47% had obesity as assessed by BMI. WC data was available in 6,177 (105 cm; Q1-Q3: 95-116 cm), and 95% had an elevated WHtR (≥0.5). During follow-up (2.3 years; Q1-Q3: 0.6-2.9 years), 339 kidney outcome events accrued. In multivariable models, higher BMI was not associated with incident kidney events (HR: 0.99; 95% CI: 0.96-1.02; <em>P =</em> 0.45, per 1 kg/m²). However, higher WHtR and WC were positively and linearly associated with the risk of kidney outcomes (WC per 10 cm: HR: 1.15 [95% CI: 1.01-1.31]; <em>P =</em> 0.03; WHtR per 0.1 unit: HR: 1.32 [95% CI: 1.07-1.62]; <em>P =</em> 0.01).</div></div><div><h3>Conclusions</h3><div>In this participant-level pooled analysis of 4 large-scale HFpEF outcome trials, obesity and excess abdominal adiposity were highly prevalent. WC and WHtR were associated with an increased risk of kidney outcomes, while BMI was not. (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure [DELIVER]; <span><span>NCT03619213</span><svg><path></path></svg></span>) (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; <span><span>NCT01920711</span><svg><path></path></svg></span>) (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; <span><span>NCT00094302</span><svg><path></path></svg></span>) (Irbesartan in Heart Failure With Preserved Systolic Function [I-PRESERVE]; <span><span>NCT00095238</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102498"},"PeriodicalIF":10.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240747","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":"Association of the 2018 U.S. Heart Allocation Policy Change and the Survival Benefit of Heart Transplantation","authors":"Stratton B. Tolmie BA ,&nbsp;Robert D. Gibbons PhD ,&nbsp;Allen S. Anderson MD ,&nbsp;Kiran K. Khush MD, MAS ,&nbsp;Kaveri Chhikara MA ,&nbsp;Matthew Churpek MD, MPH, PhD ,&nbsp;William F. Parker MD, PhD","doi":"10.1016/j.jchf.2025.02.026","DOIUrl":"10.1016/j.jchf.2025.02.026","url":null,"abstract":"<div><h3>Background</h3><div>In 2018, the U.S. heart allocation policy underwent a major change designed to increase the transplantation of the most medically urgent candidates.</div></div><div><h3>Objectives</h3><div>This study aims to determine the association between the 2018 policy change and the survival benefit of heart transplantation.</div></div><div><h3>Methods</h3><div>Observational study of the 23,043 U.S. adult heart transplant candidates listed before the policy change (October 2013 to October 2016) and a seasonally matched cohort listed after the policy change (October 2018 to October 2021). The main study outcome was the survival benefit of transplantation as defined by the increase in average days alive within 3 years following transplantation. The authors estimated survival with and without heart transplantation using a mixed-effects Cox proportional hazards model with transplant and status as time-dependent covariates and a random center-level intercept and transplant effect.</div></div><div><h3>Results</h3><div>Of the 11,022 candidates in the pre-policy cohort and 12,021 candidates in the post-policy cohort across 111 centers, 7,165 (65.0%) in the pre-policy cohort and 8,941 (74.4%) in the post-policy cohort underwent heart transplantation. Absolute 3-year survival benefit among the highest priority status candidates more than doubled after the policy change (327.8 days pre-policy vs 699.8 days post-policy; <em>P</em> &lt; 0.001). All statuses experienced a positive long-run survival benefit of transplantation. The average 3-year survival benefit across all statuses increased from 217.1 days to 241.2 days per donor heart (<em>P &lt;</em> 0.001). Overall, during the first 3 years after implementation, the 2018 heart allocation policy change was associated with an additional 1,645 life-years saved from transplantation (4,259 vs 5,904; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The 2018 heart allocation policy change has led to better stratification and prioritization of candidates by clinical acuity, resulting in higher survival benefit of transplantation performed. Combined with higher transplantation rates, the 2018 heart allocation policy has saved thousands of life-years and achieved one of its major goals.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 7","pages":"Article 102480"},"PeriodicalIF":10.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204627","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":"Vasoplegia Syndrome After Cardiac Surgery","authors":"Francesco Castagna MD, MSc ,&nbsp;Mandeep R. Mehra MD, MSc ,&nbsp;Christoph G.S. Nabzdyk MD ,&nbsp;Michael M. Givertz MD","doi":"10.1016/j.jchf.2025.02.028","DOIUrl":"10.1016/j.jchf.2025.02.028","url":null,"abstract":"<div><div>Vasoplegia syndrome is a specific form of vasodilatory shock encountered in patients who undergo cardiac surgery, most commonly with cardiopulmonary bypass, which is characterized by severe hypotension in the presence of normal or increased cardiac output with abnormal tissue perfusion. Although numerous risk factors have been identified, the pathophysiology remains incompletely understood, and the therapeutic strategies are limited with a consequent poor prognosis. Current research on mechanisms and treatment has focused on targeting disequilibrium in the biological mediators of vasodilation and vasoconstriction that leads to profound hypotension and end-organ malperfusion. The morbidity and mortality rates are high, making vasoplegia syndrome a clinical area of unmet need. Looking ahead, use of standardized definitions and reporting of prospective outcomes as well as investigations into new mechanisms will be critical to identifying novel therapeutic targets and reducing the burden of vasoplegia syndrome.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 7","pages":"Article 102482"},"PeriodicalIF":10.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196475","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":"Exclusion of Liver Disease and Underutilization of Liver-Specific Endpoints in Heart Failure Trials","authors":"Muhammad Shahzeb Khan MD, MSc ,&nbsp;Ahmed Mustafa Rashid MBBS ,&nbsp;Harriette G.C. Van Spall MD, MPH ,&nbsp;Nicolas Girerd MD, PhD ,&nbsp;Nicholas W.S. Chew MBBS ,&nbsp;Michael L. Volk MD ,&nbsp;Javed Butler MD, MPH, MBA ,&nbsp;Arun J. Sanyal MD ,&nbsp;Faiez Zannad MD, PhD","doi":"10.1016/j.jchf.2025.03.036","DOIUrl":"10.1016/j.jchf.2025.03.036","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 7","pages":"Article 102490"},"PeriodicalIF":10.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196476","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":"Promoting Representation in Heart Failure Clinical Trials","authors":"Megha Gupta BS ,&nbsp;Mona Fiuzat PharmD ,&nbsp;Matthew Dimond BS ,&nbsp;Vanessa Blumer MD ,&nbsp;Mariell Jessup MD ,&nbsp;Nasrien Ibrahim MD ,&nbsp;Philip Adamson MD, MSc ,&nbsp;Muthiah Vaduganathan MD, MPH ,&nbsp;JoAnn Lindenfeld MD ,&nbsp;Clyde Yancy MD, MSc ,&nbsp;Christopher O’Connor MD ,&nbsp;Orly Vardeny PharmD, MS","doi":"10.1016/j.jchf.2025.03.033","DOIUrl":"10.1016/j.jchf.2025.03.033","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 7","pages":"Article 102485"},"PeriodicalIF":10.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196477","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}