JACC. Cardiovascular imaging最新文献

{"title":"Predictors for Vulnerable Plaque in Functionally Significant Lesions","authors":"Seokhun Yang MD ,&nbsp;Doyeon Hwang MD ,&nbsp;Koshiro Sakai MD, PhD ,&nbsp;Takuya Mizukami MD, PhD ,&nbsp;Jonathon Leipsic MD ,&nbsp;Marta Belmonte MD ,&nbsp;Jeroen Sonck MD, PhD ,&nbsp;Bjarne L. Nørgaard MD, PhD ,&nbsp;Hiromasa Otake MD, PhD ,&nbsp;Brian Ko MD, PhD ,&nbsp;Michael Maeng MD, PhD ,&nbsp;Jesper Møller Jensen MD, PhD ,&nbsp;Dimitri Buytaert MSc ,&nbsp;Daniel Munhoz MD, PhD ,&nbsp;Daniele Andreini MD, PhD ,&nbsp;Hirofumi Ohashi MD, PhD ,&nbsp;Toshiro Shinke MD, PhD ,&nbsp;Charles A. Taylor PhD ,&nbsp;Emanuele Barbato MD, PhD ,&nbsp;Bernard De Bruyne MD, PhD ,&nbsp;Bon-Kwon Koo MD, PhD","doi":"10.1016/j.jcmg.2024.07.021","DOIUrl":"10.1016/j.jcmg.2024.07.021","url":null,"abstract":"<div><h3>Background</h3><div>Vulnerable plaque presents prognostic implications in addition to functional significance.</div></div><div><h3>Objectives</h3><div>The aim of this study was to identify relevant features of vulnerable plaque in functionally significant lesions.</div></div><div><h3>Methods</h3><div>In this multicenter, prospective study conducted across 5 countries, including patients who had invasive fractional flow reserve (FFR) ≤0.80, a total of 95 patients with available pullback pressure gradient (PPG) and plaque analysis on coronary computed tomographic angiography and optical coherence tomography were analyzed. Vulnerable plaque was defined as the presence of plaque rupture or thin-cap fibroatheroma on optical coherence tomography. Among the 25 clinical characteristics, invasive angiographic findings, physiological indexes, and coronary computed tomographic angiographic findings, significant predictors of vulnerable plaque were identified.</div></div><div><h3>Results</h3><div>Mean percentage diameter stenosis, FFR, and PPG were 77.8% ± 14.6%, 0.66 ± 0.13, and 0.65 ± 0.13, respectively. Vulnerable plaque was present in 53 lesions (55.8%). PPG and FFR were identified as significant predictors of vulnerable plaque (<em>P &lt;</em> 0.05 for all). PPG &gt;0.65 and FFR ≤0.70 were significantly related to a higher probability of vulnerable plaque after adjustment for each other (OR: 6.75 [95% CI: 2.39-19.1]; <em>P &lt;</em> 0.001] for PPG &gt;0.65; OR: 4.61 [95% CI: 1.66-12.8]; <em>P =</em> 0.003 for FFR ≤0.70). When categorizing lesions according to combined PPG &gt;0.65 and FFR ≤0.70, the prevalence of vulnerable plaque was 20.0%, 57.1%, 66.7%, and 88.2% in the order of PPG ≤0.65 and FFR &gt;0.70, PPG ≤0.65 and FFR ≤0.70, PPG &gt;0.65 and FFR &gt;0.70, and PPG &gt;0.65 and FFR ≤0.70 (<em>P</em> for trend &lt; 0.001), respectively.</div></div><div><h3>Conclusions</h3><div>Among low-FFR lesions, the presence of vulnerable plaque can be predicted by PPG combined with FFR without additional anatomical or plaque characteristics. (Precise Percutaneous Coronary Intervention Plan [P3] Study; <span><span>NCT03782688</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 195-206"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231788","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":"Impact of Right Ventricular Pressure Overload on Myocardial Stiffness Assessed by Natural Wave Imaging","authors":"Maelys Venet MD ,&nbsp;Aimen Malik MSc ,&nbsp;Samantha Gold BSc ,&nbsp;Naiyuan Zhang MSc ,&nbsp;Josh Gopaul BSc ,&nbsp;John Dauz MSc ,&nbsp;Kana Yazaki MD ,&nbsp;Matteo Ponzoni MD ,&nbsp;John G. Coles MD, PhD ,&nbsp;Jason T. Maynes MD, PhD ,&nbsp;Mei Sun MD, PhD ,&nbsp;Alison Howell MD ,&nbsp;Rajiv Chaturvedi MD, PhD ,&nbsp;Luc Mertens MD, PhD ,&nbsp;Dariusz Mroczek MSc ,&nbsp;Kiyoshi Uike MD ,&nbsp;Jerome Baranger PhD ,&nbsp;Mark K. Friedberg MD, PhD ,&nbsp;Olivier Villemain MD, PhD","doi":"10.1016/j.jcmg.2024.06.020","DOIUrl":"10.1016/j.jcmg.2024.06.020","url":null,"abstract":"<div><h3>Background</h3><div>Right ventricular (RV) hemodynamic performance determines the prognosis of patients with RV pressure overload. Using ultrafast ultrasound, natural wave velocity (NWV) induced by cardiac valve closure was proposed as a new surrogate to quantify myocardial stiffness.</div></div><div><h3>Objectives</h3><div>This study aimed to assess RV NWV in rodent models and children with RV pressure overload vs control subjects and to correlate NWV with RV hemodynamic parameters.</div></div><div><h3>Methods</h3><div>Six-week-old rats were randomized to pulmonary artery banding (n = 6), Sugen hypoxia-induced pulmonary arterial hypertension (n = 7), or sham (n = 6) groups. They underwent natural wave imaging, echocardiography, and hemodynamic assessment at baseline and 6 weeks postoperatively. The authors analyzed NWV after tricuspid and after pulmonary valve closure (TVC and PVC, respectively). Conductance catheters were used to generate pressure-volume loops. In parallel, the authors prospectively recruited 14 children (7 RV pressure overload; 7 age-matched control subjects) and compared RV NWV with echocardiographic and invasive hemodynamic parameters.</div></div><div><h3>Results</h3><div>NWV significantly increased in RV pressure overload rat models (4.99 ± 0.27 m/s after TVC and 5.03 ± 0.32 m/s after PVC in pulmonary artery banding at 6 weeks; 4.89 ± 0.26 m/s after TVC and 4.84 ± 0.30 m/s after PVC in Sugen hypoxia at 6 weeks) compared with control subjects (2.83 ± 0.15 m/s after TVC and 2.72 ± 0.34 m/s after PVC). NWV after TVC correlated with both systolic and diastolic parameters including RV dP/dt_max (<em>r</em> = 0.75; <em>P</em> &lt; 0.005) and RV Ees (<em>r</em> = 0.81; <em>P</em> &lt; 0.005). NWV after PVC correlated with both diastolic and systolic parameters and notably with RV end-diastolic pressure (<em>r</em> = 0.65; <em>P</em> &lt; 0.01). In children, NWV after both right valves closure in RV pressure overload were higher than in healthy volunteers (<em>P</em> &lt; 0.01). NWV after PVC correlated with RV E/E' (<em>r</em> = 0.81; <em>P</em> = 0.008) and with RV chamber stiffness (<em>r</em> = 0.97; <em>P</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>Both RV early-systolic and early-diastolic myocardial stiffness show significant increase in response to pressure overload. Based on physiology and our observations, early-systolic myocardial stiffness may reflect contractility, whereas early-diastolic myocardial stiffness might be indicative of diastolic function.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 211-225"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035911","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":"Why Do Coronaries Spasm?","authors":"Thabo Mahendiran BMBCh, MD ,&nbsp;Bernard De Bruyne MD, PhD","doi":"10.1016/j.jcmg.2024.07.003","DOIUrl":"10.1016/j.jcmg.2024.07.003","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 240-241"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035913","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":"Parsing the Shades of Gray of Myocardial Fibrosis in Aortic Stenosis","authors":"Tom Kai Ming Wang MBChB, MD,&nbsp;Tiffany Dong MD","doi":"10.1016/j.jcmg.2024.09.006","DOIUrl":"10.1016/j.jcmg.2024.09.006","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 192-194"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620985","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-Gradient “Moderate” Aortic Stenosis","authors":"William A. Zoghbi MD","doi":"10.1016/j.jcmg.2024.10.013","DOIUrl":"10.1016/j.jcmg.2024.10.013","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 177-179"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140428","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":"Diffuse Interstitial Fibrosis of the Myocardium Predicts Outcome in Moderate and Asymptomatic Severe Aortic Stenosis","authors":"Hyun-Jung Lee MD, PhD ,&nbsp;Anvesha Singh MBChB, PhD ,&nbsp;Jaehyun Lim MD ,&nbsp;Neil Craig MD ,&nbsp;Rong Bing MD ,&nbsp;Lionel Tastet PhD ,&nbsp;Jun-Bean Park MD, PhD ,&nbsp;Hyung-Kwan Kim MD, PhD ,&nbsp;Yong-Jin Kim MD, PhD ,&nbsp;Marie-Annick Clavel DVM, PhD ,&nbsp;Bernhard L. Gerber MD, PhD ,&nbsp;Gerry P. McCann MBChB, MD ,&nbsp;Marc R. Dweck MD, PhD ,&nbsp;Phillipe Pibarot DVM, PhD ,&nbsp;Seung-Pyo Lee MD, PhD","doi":"10.1016/j.jcmg.2024.08.003","DOIUrl":"10.1016/j.jcmg.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients with moderate or asymptomatic severe aortic stenosis (AS) are at risk of cardiovascular events.</div></div><div><h3>Objectives</h3><div>The authors investigated the utility of cardiac magnetic resonance (CMR) to identify drivers of outcome in patients with moderate or asymptomatic severe AS.</div></div><div><h3>Methods</h3><div>A prospective, international, multicenter cohort (n = 457) of patients with moderate (aortic valve area [AVA]: 1.0-1.5 cm²) or asymptomatic severe AS (AVA ≤1.0 cm² and NYHA functional class I-II) patients underwent CMR. Diffuse interstitial fibrosis and scar in the myocardium were analyzed with extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The outcome was a composite of mortality and heart failure admission.</div></div><div><h3>Results</h3><div>Median ECV% was 26.6% (IQR: 24.4%-29.9%), and LGE was present in 31.5% (median 0.8%; IQR: 0.1%-1.7%). Greater AS severity was associated with greater left ventricular mass and diastolic dysfunction, but not with ECV% or LGE. During a median 5.7 years of follow-up, 83 events occurred. Patients with events had higher ECV% (median ECV% 26.3% vs 28.2%; <em>P =</em> 0.003). Patients in the highest ECV% tertiles (ECV% &gt;28.6%) had worse outcomes both in the entire cohort and in those with NYHA functional class I moderate or severe AS, and ECV% was independently associated with outcome (adjusted HR: 1.05; <em>P =</em> 0.039). The ECV% had significant incremental prognostic value when added to parameters of AS severity and cardiac function, comorbidities, aortic valve replacement, and LGE (<em>P &lt;</em> 0.05).</div></div><div><h3>Conclusions</h3><div>Increased diffuse interstitial fibrosis of the myocardium is associated with poor outcomes in patients with moderate and asymptomatic severe AS and can help identify those who require closer surveillance for adverse outcomes.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 180-191"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347048","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":"Imaging Topic of the Year","authors":"Thomas H. Marwick MBBS, PhD, MPH (Executive Editor, JACC: Cardiovascular Imaging),&nbsp;Y. Chandrashekhar MD, DM (Editor-in-Chief, JACC: Cardiovascular Imaging)","doi":"10.1016/j.jcmg.2025.01.001","DOIUrl":"10.1016/j.jcmg.2025.01.001","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 248-250"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140363","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-Risk Lesion-Level Physiology and Morphology","authors":"Amir Ahmadi MD ,&nbsp;Jagat Narula MD, PhD","doi":"10.1016/j.jcmg.2024.09.013","DOIUrl":"10.1016/j.jcmg.2024.09.013","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 207-210"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965081","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":"Definition and Validation of Prognostic Phenotypes in Moderate Aortic Stenosis","authors":"Jonathan Sen MBBS ,&nbsp;Sudhir Wahi MD ,&nbsp;William Vollbon BS, BAppS, GradDipCardiac (Ultrasound) ,&nbsp;Marcus Prior HSC ,&nbsp;Alex G.C. de Sá PhD ,&nbsp;David B. Ascher PhD ,&nbsp;Quan Huynh BMed, PhD ,&nbsp;Thomas H. Marwick MBBS, PhD, MPH","doi":"10.1016/j.jcmg.2024.06.013","DOIUrl":"10.1016/j.jcmg.2024.06.013","url":null,"abstract":"<div><h3>Background</h3><div>Adverse outcomes from moderate aortic stenosis (AS) may be caused by progression to severe AS or by the effects of comorbidities. In the absence of randomized trial evidence favoring aortic valve replacement (AVR) in patients with moderate AS, phenotyping patients according to risk may assist decision making.</div></div><div><h3>Objectives</h3><div>This study sought to identify and validate clusters of moderate AS that may be used to guide patient management.</div></div><div><h3>Methods</h3><div>Unsupervised clustering algorithms were applied to demographics, comorbidities, and echocardiographic parameters in a training data set in patients with moderate AS (n = 2,469). External validation was obtained by assigning the defined clusters to an independent group with moderate AS (n = 1,358). The primary outcome, a composite of cardiac death, heart failure hospitalization, or aortic valve (AV) intervention after 5 years, was assessed between clusters in both data sets.</div></div><div><h3>Results</h3><div>Four distinct clusters—cardiovascular (CV)-comorbid, low-flow, calcified AV, and low-risk—with significant outcomes (log-rank <em>P &lt;</em> 0.0001 in both data sets) were identified and replicated. The highest risk was in the CV-comorbid cluster (validation HR: 2.00 [95% CI: 1.54-2.59]; <em>P &lt;</em> 0.001). The effect of AVR on cardiac death differed among the clusters. There was a significantly lower rate of outcomes after AVR in the calcified AV cluster (validation HR: 0.21 [95% CI: 0.08-0.57]; <em>P =</em> 0.002), but no significant effect on outcomes in the other 3 clusters. These analyses were limited by the low rate of AVR.</div></div><div><h3>Conclusions</h3><div>Moderate AS has several phenotypes, and multiple comorbidities are the key drivers of adverse outcomes in patients with moderate AS. Outcomes of patients with noncalcified moderate AS were not altered by AVR in these groups. Careful attention to subgroups of moderate AS may be important to define treatable risk.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 133-149"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995758","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":"Deep Learning Model of Diastolic Dysfunction Risk Stratifies the Progression of Early-Stage Aortic Stenosis","authors":"Márton Tokodi MD, PhD ,&nbsp;Rohan Shah MD ,&nbsp;Ankush Jamthikar MTech, PhD ,&nbsp;Neil Craig MD ,&nbsp;Yasmin Hamirani MD ,&nbsp;Grace Casaclang-Verzosa MD, MBA ,&nbsp;Rebecca T. Hahn MD ,&nbsp;Marc R. Dweck MD, PhD ,&nbsp;Philippe Pibarot DVM, PhD ,&nbsp;Naveena Yanamala MSc, PhD ,&nbsp;Partho P. Sengupta MD, DM","doi":"10.1016/j.jcmg.2024.07.017","DOIUrl":"10.1016/j.jcmg.2024.07.017","url":null,"abstract":"<div><h3>Background</h3><div>The development and progression of aortic stenosis (AS) from aortic valve (AV) sclerosis is highly variable and difficult to predict.</div></div><div><h3>Objectives</h3><div>The authors investigated whether a previously validated echocardiography-based deep learning (DL) model assessing diastolic dysfunction (DD) could identify the latent risk associated with the development and progression of AS.</div></div><div><h3>Methods</h3><div>The authors evaluated 898 participants with AV sclerosis from the ARIC (Atherosclerosis Risk In Communities) cohort study and associated the DL-predicted probability of DD with 2 endpoints: 1) the new diagnosis of AS; and 2) the composite of subsequent mortality or AV interventions. Validation was performed in 2 additional cohorts: 1) in 50 patients with mild-to-moderate AS undergoing cardiac magnetic resonance (CMR) imaging and serial echocardiographic assessments; and 2) in 18 patients with AV sclerosis undergoing ¹⁸F-sodium fluoride (NaF) and ¹⁸F-fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT) to assess valvular inflammation and calcification.</div></div><div><h3>Results</h3><div>In the ARIC cohort, a higher DL-predicted probability of DD was associated with the development of AS (adjusted HR: 3.482 [95% CI: 2.061-5.884]; <em>P &lt;</em> 0.001) and subsequent mortality or AV interventions (adjusted HR: 7.033 [95% CI: 3.036-16.290]; <em>P &lt;</em> 0.001). The multivariable Cox model (incorporating the DL-predicted probability of DD) derived from the ARIC cohort efficiently predicted the progression of AS (C-index: 0.798 [95% CI: 0.648-0.948]) in the CMR cohort. Moreover, the predictions of this multivariable Cox model correlated positively with valvular ¹⁸F-NaF mean standardized uptake values in the PET/CT cohort (<em>r</em> = 0.62; <em>P =</em> 0.008).</div></div><div><h3>Conclusions</h3><div>Assessment of DD using DL can stratify the latent risk associated with the progression of early-stage AS.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"18 2","pages":"Pages 150-165"},"PeriodicalIF":12.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287685","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}