JCR: Journal of Clinical Rheumatology最新文献

{"title":"Clinical Experience with TNF Inhibition and Longitudinal Image Monitoring in Osseous Sarcoidosis.","authors":"Seth J VanDerVeer, Erica M Hill","doi":"10.1097/RHU.0000000000002190","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002190","url":null,"abstract":"<p><strong>Background: </strong>In this case series, we present longitudinal imaging surveillance of 6 cases of osseous sarcoidosis, each of which was effectively treated with tumor necrosis factor (TNF) inhibition.</p><p><strong>Methods: </strong>We identified 6 patients from Brooke Army Medical Center with osseous sarcoidosis, who were treated with TNF inhibition and followed with longitudinal imaging studies. Cases of osseous sarcoidosis were defined as having pathologic evidence of noncaseating granulomas on bone biopsy and evidence of osseous lesions on imaging attributable to sarcoidosis by the radiologist, treating clinician, and reviewer. Clinical data were obtained through review of the military electronic medical record.</p><p><strong>Results: </strong>Longitudinal imaging with positron emission tomography/computed tomography, magnetic resonance imaging, and bone scintigraphy assisted in the identification of active disease and clinical remission. Imaging progression of asymptomatic lesions was associated with the eventual development of bone pain 1 to 3 years later. Clinical remission was achieved in all six cases of osseous sarcoidosis and effective doses for TNF inhibition were adalimumab 40 mg subcutaneously every 1 to 2 weeks and infliximab 5 mg/kg every 6 to 8 weeks. Time to complete imaging response ranged from 3 to 8 months.</p><p><strong>Conclusions: </strong>Longitudinal imaging with bone scintigraphy, positron emission tomography/computed tomography, and magnetic resonance imaging demonstrated several benefits including evaluation for occult disease, surveillance of asymptomatic lesions, and evaluation of treatment response. TNF inhibition with adalimumab or infliximab was successful in all cases, and complete resolution of osseous lesions was demonstrated in 5 of 6 patients. Discontinuation of TNF inhibition led to disease recurrence in 2 cases, which prompted the use of long-term immunosuppressive therapy in all treated patients.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Reliability of ChatGPT to Provide Guidance on Recombinant Zoster Vaccination for Patients With Rheumatic and Musculoskeletal Diseases.","authors":"Akhil Sood, Amanda Moyer, Pegah Jahangiri, Diane Mar, Prachaya Nitichaikulvatana, Nitya Ramreddy, Liya Stolyar, Janice Lin","doi":"10.1097/RHU.0000000000002198","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002198","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLMs) such as ChatGPT can potentially transform the delivery of health information. This study aims to evaluate the accuracy and completeness of ChatGPT in responding to questions on recombinant zoster vaccination (RZV) in patients with rheumatic and musculoskeletal diseases.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using 20 prompts based on information from the Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and the American College of Rheumatology (ACR). These prompts were inputted into ChatGPT 3.5. Five rheumatologists independently scored the ChatGPT responses for accuracy (Likert 1 to 5) and completeness (Likert 1 to 3) compared with validated information sources (CDC, ACIP, and ACR).</p><p><strong>Results: </strong>The overall mean accuracy of ChatGPT responses on a 5-point scale was 4.04, with 80% of responses scoring ≥4. The mean completeness score of ChatGPT response on a 3-point scale was 2.3, with 95% of responses scoring ≥2. Among the 5 raters, ChatGPT unanimously scored with high accuracy and completeness to various patient and physician questions surrounding RZV. There was one instance where it scored with low accuracy and completeness. Although not significantly different, ChatGPT demonstrated the highest accuracy and completeness in answering questions related to ACIP guidelines compared with other information sources.</p><p><strong>Conclusions: </strong>ChatGPT exhibits promising ability to address specific queries regarding RZV for rheumatic and musculoskeletal disease patients. However, it is essential to approach ChatGPT with caution due to risk of misinformation. This study emphasizes the importance of rigorously validating LLMs as a health information source.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Unique Documented Case of Undifferentiated Connective Tissue Disease Presenting With Isolated Right Knee Monarthritis.","authors":"Angelo Nigro","doi":"10.1097/RHU.0000000000002195","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002195","url":null,"abstract":"","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salivary β2-Microglobulin, Na+, and Cortisol Levels, and Salivary Glands' Uptakes in Sialoscintigraphy in Sjögren Disease.","authors":"Shigeko Inokuma, Makoto Ishida, Yoshitaka Uchida","doi":"10.1097/RHU.0000000000002199","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002199","url":null,"abstract":"<p><strong>Objective: </strong>For early diagnosis and inquiry into the pathophysiology of Sjögren disease (SjD), salivary secretion and component levels, and salivary glands' uptakes in sialoscintigraphy were examined, in this cross-sectional study.</p><p><strong>Methods: </strong>Patients who visited our hospital with suspected SjD between April 2016 and March 2020 were checked for unstimulated salivary secretion and β2-microglobulin, Na+, and cortisol levels in saliva. The patients who showed any abnormal salivary test results underwent sialoscintigraphy; the uptakes in the parotid, submandibular, and thyroid glands were compared using paired t test.</p><p><strong>Results: </strong>Sixty-five patients (female/male 51/14, 64.5 ± 13.7 years) were checked for saliva. The secretion was 0.39 ± 0.43 mL/min. The component levels were 1.98 ± 1.45 mg/dL for β2-microglobulin (n = 61), 15.9 ± 15.3 mEq/L for Na+ (n = 61), and 0.20 ± 0.18 μg/dL for cortisol (n = 56). A significant negative correlation was observed between the secretion and each component level. A significant positive correlation was found between the 2 out of the 3 component levels. Sialoscintigraphy of 52 patients showed significantly lower uptake in the submandibular glands than in the parotid glands (submandibular/parotid ratio: 0.51 ± 0.36, left; 0.54 ± 0.39, right). The total uptake in the 4 salivary glands was lower, but not significantly, than that in the thyroid gland.</p><p><strong>Conclusions: </strong>In patients with suspected SjD, a decreased salivary secretion correlated with a high level of any of β2-microglobulin, Na+, and cortisol; the 2 of the 3 levels correlated positively. Sialoscintigraphy showed that the submandibular glands were involved to a greater extent than the parotid glands were. The total salivary gland uptake may be lower than that in thyroid.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Clinical Profiles and Biologic Treatment Approaches for Autoimmune Rheumatic Diseases Across Regions in Mexico: An Analysis of the BIOBADAMEX Cohort.","authors":"Vijaya Rivera Terán, Miguel Ángel Saavedra, Iris Jazmín Colunga Pedraza, David Vega Morales, Fedra Irazoque Palazuelos, Sandra Carrillo Vázquez, Daniel Xibillé Friedmann, Angel Alejandro Castillo Ortiz, Estefanía Torres Valdez, Sandra Sicsik Ayala, Dafhne Miranda Hernández, Julio César Casasola Vargas, Omar Muñoz Monroy, Luis Francisco Valdés Corona, Samara Mendieta Zerón, Javier Merayo Chalico, Sergio Durán Barragán, Azucena Ramos Sánchez, Aleni Paz Viscarra, Erick Zamora Tehozol, Alfonso Torres Jiménez, Jiram Torres-Ruiz, Deshiré Alpízar Rodríguez","doi":"10.1097/RHU.0000000000002191","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002191","url":null,"abstract":"<p><strong>Objective: </strong>Being Mexico a very diverse developing country, the access to health care varies among geographical regions. We aimed to assess the differences in clinical features and treatment prescription in 3 regions of Mexico using data from the Mexican Adverse Events Registry (BIOBADAMEX).</p><p><strong>Methods: </strong>We included all BIOBADAMEX patients from 2016 to 2023, compared the prescription patterns, the sociodemographic, clinical, and treatment characteristics between the northern (NR), central (CR), and southern regions (SR), and addressed the treatment survival by calculating hazards ratios (HRs).</p><p><strong>Results: </strong>A total of 1084 patients were included: 389 (35.9%) from the NR, 569 (52.5%) from the CR, and 126 (11.6%) from the SR. The most common diagnosis was rheumatoid arthritis (61.0%). Patients from NR had longer disease duration (p = 0.03); those from SR had higher BMI (p < 0.001), DAS28 (p < 0.001), BASDAI scores (p = 0.02), and used more frequently glucocorticoids (p < 0.001). Patients from CR had more comorbidities (p = 0.001) and more regularly used conventional DMARDs (p = 0.007). Among patients with at least 2 assessments (n = 441), treatment with bDMARDs and tsDMARDs was discontinued in 247 (56%), 53% due to lack of efficacy. There was no association between the country region and treatment survival, but the main factors related to treatment discontinuation were disease duration (HR, 0.9; 95% confidence interval, 0.6-0.9) and lack of response (HR, 1.4; 95% confidence interval, 1.2-1.7).</p><p><strong>Conclusions: </strong>In Mexico, patients with rheumatic diseases show regional differences in their clinical features and prescription patterns, which may be related to regional disparities in health care access and sociodemographic characteristics.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Associated Factors of Sarcopenia in Thai Rheumatoid Arthritis Patients: A Cross-Sectional Study.","authors":"Wanitcha Gumtorntip, Phichayut Phinyo, Nuntana Kasitanon, Worawit Louthrenoo","doi":"10.1097/RHU.0000000000002194","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002194","url":null,"abstract":"<p><strong>Background/objectives: </strong>Sarcopenia associates with poor health-related quality of life (HRQoL). This study aimed to determine prevalence and factors associated with sarcopenia in rheumatoid arthritis (RA) patients. The HRQoL between RA patients with and without sarcopenia also was compared.</p><p><strong>Methods: </strong>This cross-sectional study recruited RA patients, aged ≥20 years, at Chiang Mai University Hospital between May and November 2023. Their skeletal muscle mass (bioelectrical impedance analysis), grip strength (hand dynamometer), and physical performance (gait speed test) were evaluated. Sarcopenia was defined according to the Asian Working Group for Sarcopenia. Patient characteristics, disease activity, physical disability (HAQ-DI), HRQoL (SF-36), nutrition (mini nutrition assessment), and medications were recorded.</p><p><strong>Results: </strong>Of 299 patients (89.0% female; age 61.3 ± 11.6 years; disease duration 13.9 ± 8.6 years), 37.5% had sarcopenia (27.4% severe sarcopenia). In multivariable analysis, body mass index (odds ratio [95% confidence interval] 1.46/1 unit decrease [1.27, 1.68], p < 0.001), disease duration (1.89/10 years increase [1.27, 2.83], p = 0.002), deformity of hands/feet (3.80 [1.50, 9.61], p = 0.005), mini nutritional assessment score (1.21/1 score decrease [1.04, 1.40], p = 0.012), and high C-reactive protein (CRP) (1.94 [1.02, 3.69], p = 0.044) were independent factors associated with sarcopenia. There was no relationship between sarcopenia and disease activity (DAS-28-ESR or CRP) or medication use. RA patients with sarcopenia had higher HAQ score than those without, but potentially lower scores in physical function domain of SF-36 with adjusted mean difference of 0.2 (95% confidence interval 0.03, 0.32, p = 0.022) and -5.9 (-12.24, 0.38, p = 0.066), respectively.</p><p><strong>Conclusions: </strong>About one third of the Thai RA patients in this center had sarcopenia. Low body mass index, long disease duration, joint deformity, malnutrition, and high CRP were independent factors associated with sarcopenia. Sarcopenia affects physical capabilities and the physical function domain of the HRQoL.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rituximab Treatment in Adult Patients With Idiopathic Inflammatory Myositis: A Systematic Review and Meta-analysis.","authors":"Lilian Otalora Rojas, Karishma Ramsubeik, Luis Sanchez-Ramos, Shastri Motilal, Jasvinder A Singh, Gurjit S Kaeley","doi":"10.1097/RHU.0000000000002151","DOIUrl":"10.1097/RHU.0000000000002151","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis assess the efficacy and safety of rituximab (RTX) in treating idiopathic inflammatory myositis (IIM).</p><p><strong>Methods: </strong>PubMed and Embase were systematically searched for trials and observational studies involving RTX use in IIM. Data were analyzed using a random-effects model to generate pooled estimates for overall response, complete remission, partial response, and adverse events, with subgroup analyses by myositis type and RTX dosage (PROSPERO registered number CRD42022353740). Risk of bias assessments were done using the Newcastle-Ottawa Scale for observational studies and risk of bias 1 tool for trials.</p><p><strong>Results: </strong>Seventeen studies (1 randomized controlled trial and 16 observational studies), encompassing 362 patients, were included. The overall pooled response rate was 70% (95% confidence interval [CI]: 57%-82%; I2 = 74%, p < 0.001). Complete remission occurred in 13% (95% CI: 3%-25%; I2 = 79%, p < 0.001) and partial response in 48% (95% CI: 30%-67%; I2 = 87%, p < 0.001), both with significant heterogeneity. Subgroup analysis revealed high response rates across all myositis types: polymyositis 69%, dermatomyositis 67%, antisynthetase syndrome 70%, juvenile dermatomyositis 60%, and immune-mediated necrotizing myopathy 86%. Response rates were similar between RTX induction doses of 1 g IV on days 0 and 14 (68%) and 375 mg/m 2 weekly for 4 weeks (71%). Reported adverse events totaled 120, including infusion reactions (18.5%) and infections (12.4%).</p><p><strong>Conclusions: </strong>RTX shows a favorable clinical response in IIM treatment, though response rates vary. There was a significant heterogeneity in treatment effect estimates that are based on a small number of patients. The incidence of infusion reactions and infections highlights the need for careful monitoring. Further controlled trials are essential to refine treatment protocols and evaluate long-term outcomes for RTX's role in IIM.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":"33-39"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scleroderma Renal Crisis and Musculoskeletal Corticosteroid Injections.","authors":"Maheswari Muruganandam, Eyerusalem B Akpan, Matthew K McElwee, N Suzanne Emil, Meredith C Keller, Adarsh S Vangala, Fatmah Dihowm, Sharon E Nunez, James I Gibb, Frank X O'Sullivan, Roderick A Fields, Wilmer L Sibbitt","doi":"10.1097/RHU.0000000000002168","DOIUrl":"10.1097/RHU.0000000000002168","url":null,"abstract":"<p><strong>Background/objective: </strong>Inflammatory arthritis frequently affects patients with systemic sclerosis (SSc) but musculoskeletal corticosteroid (MSKC) injections are often avoided due to concerns of scleroderma renal crisis (SRC). This study investigated the incidence of SRC following MSKC injections.</p><p><strong>Methods: </strong>In a 136-SSc cohort, 46 subjects underwent a total of 330 MSKC injections each receiving a significant dosage of triamcinolone acetonide (mean, 95.2 ± 44.2 mg per injection session). Data on blood pressure (BP), serum creatinine and glucose, urine protein, and complications were obtained before and after injection from the patients' medical records.</p><p><strong>Results: </strong>MSKC and control subjects were similar in age (MSKC: 58.9 ± 12.1 vs. 55.5 ± 14.9 years), female (MSKC: 97.8% [45/46] vs. 89.9% [81/90]), antinuclear antibody (MSKC: 71.7% [33/46] vs. 81.1% [73/90]), anti-centromere antibody (MSKC: 47.8% [22/46] vs. 37.8% [34/90]), anti-topoisomerase antibody (MSKC: 26.1% [12/46] vs. 26.7% [24/90]), and anti-RNA polymerase III antibody (MSKC: 17.4.1% [8/46] vs. 24.4% [22/90]) (all p > 0.05). Pre- and post-MSKC demonstrated nonsignificant changes in systolic BP (pre: 127 ± 22 vs. post: 127 ± 21 mm Hg, p = 1.0), diastolic BP (pre: 71 ± 13 vs. post: 71 ± 11 mm Hg, p = 1.0), creatinine (pre: 0.78 ± 0.56 vs. post: 0.76 ± 0.20 mg/dL, p = 0.64), glucose (pre: 100 ± 21 vs. post: 99 ± 24 mg/dL, p = 0.67), and urine protein-creatinine ratio (pre: 0.14 ± 0.12 vs. post: 0.12 ± 0.11 mg/mg, p = 0.41). One case of SRC with mortality occurred in the controls and none in the MSKC group. No infections, hematologic abnormalities, or tendon rupture were noted.</p><p><strong>Conclusion: </strong>MSKC injections in established SSc are generally safe with low incidences of SRC and complications. However, it is still prudent to monitor high-risk individuals and recent-onset SSc post-MSKC injection.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":"12-19"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypervirulent Klebsiella pneumoniae in Rheumatoid Arthritis on Abatacept.","authors":"Atsuhiko Sunaga, Takuya Inoue","doi":"10.1097/RHU.0000000000002167","DOIUrl":"10.1097/RHU.0000000000002167","url":null,"abstract":"","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":"e4"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myophosphorylase Deficiency.","authors":"Justine K Weksel, Stephen Soloway","doi":"10.1097/RHU.0000000000002164","DOIUrl":"10.1097/RHU.0000000000002164","url":null,"abstract":"","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":"e3"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}