Paula Reginatto , Giovanna de Jesus Agostinetto , Mário Litieri Teixeira , Saulo Fernandes de Andrade , Alexandre Meneghello Fuentefria
{"title":"Synergistic activity of clioquinol with voriconazole and amphotericin B against fungi of interest in eye infections","authors":"Paula Reginatto , Giovanna de Jesus Agostinetto , Mário Litieri Teixeira , Saulo Fernandes de Andrade , Alexandre Meneghello Fuentefria","doi":"10.1016/j.mycmed.2024.101462","DOIUrl":"10.1016/j.mycmed.2024.101462","url":null,"abstract":"<div><p><span>Keratoplasty<span><span> represents a risk factor for fungal eye infections, despites the antibacterial actives in the corneal tissue preservation means, it does not contain active substances with </span>antifungal action. Among the most commonly associated fungal agents are the species belonging to the genera </span></span><span><em>Fusarium</em></span> and <em>Candida</em><span><span><span><span><span>. These agents can trigger an infectious process characterized by swift progression associated with high rates of morbidity, causing irreversible damage. Polyene and </span>azole antifungals are the main agents of ocular therapy, however, they demonstrate some limitations, such as their toxicity and fungal resistance. In this context, </span>drug repositioning<span> and the combination of antifungals may be an alternative. Hence, the goal of this study was to investigate the potential activity of clioquinol (CLQ), a derivative of 8-hydroxyquinoline with previously described antifungal activity, along with its triple and quadruple combinations with antifungal agents commonly used in </span></span>ophthalmic fungal therapy, </span>natamycin<span> (NAT), voriconazole<span><span><span> (VRC), and amphotericin B (AMB), against main fungal </span>pathogens in eye infections. The MICs for </span>CLQ ranged from 0.25 to 2.0 μg/mL, for NAT from 4.0 to 32.0 μg/mL, for AMB it ranged from 0.25 to 16.0 μg/mL and for VRC from 0.03125 to 512.0 µg/mL. Among the tested combinations, the VRC-AMB-CLQ combination stands out, which showed a synergistic effect for more than 50 % of the tested strains and did not present antagonistic results against any of them. Toxicity data were similar to those antifungals already used, even with lower potential toxicity. Therefore, both clioquinol and the triple combination VCR-AMB-CLQ exhibited promising profiles for use as active components in corneal tissue preservation medium.</span></span></span></p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 1","pages":"Article 101462"},"PeriodicalIF":3.6,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139552019","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}
Lara Baccarin Ianiski , Aline Fontanella Maciel , Ana Carolina Nolasco Colla , Caroline Quintana Braga , Luis Antônio Sangioni , Mahendra Pal , Daniela Isabel Brayer Pereira , Janio Morais Santurio , Sônia de Avila Botton
{"title":"Pythium insidiosum: In vitro oomicidal evaluation of telithromycin and interactions with azithromycin and amorolfine hydrochloride","authors":"Lara Baccarin Ianiski , Aline Fontanella Maciel , Ana Carolina Nolasco Colla , Caroline Quintana Braga , Luis Antônio Sangioni , Mahendra Pal , Daniela Isabel Brayer Pereira , Janio Morais Santurio , Sônia de Avila Botton","doi":"10.1016/j.mycmed.2024.101460","DOIUrl":"10.1016/j.mycmed.2024.101460","url":null,"abstract":"<div><p><span>This study evaluated the repositioning of the ketolide<span> antibacterial telithromycin<span> (TLT) against the oomycete </span></span></span><span><em>Pythium insidiosum</em></span><span> and verified the combination of TLT and the antimicrobials azithromycin<span> (AZM) and amorolfine hydrochloride (AMR), which have known anti-</span></span><em>P. insidiosum</em> activity. Susceptibility tests of <em>P. insidiosum</em> isolates (<em>n</em><span> = 20) against the drugs<span> were carried out according to CLSI protocol M38-A2, and their combinations were evaluated using the checkerboard microdilution method. The minimum inhibitory concentrations were 0.5–4 µg/mL for TLT, 2–32 µg/mL for AZM, and 16–64 µg/mL for AMR. For the TLT+AZM combination, 52.75 % of interactions were indifferent, 43.44 % were antagonistic, and 9.70 % were synergistic. As for interactions of the TLT+AMR combination, 60.43 % were indifferent, 39.12 % were antagonistic, and 10.44 % synergistic interactions. This study is the first to evaluate the repositioning of the antibacterial TLT against mammalian pathogenic oomycetes, and our results show that its isolated action is superior to its combinations with either AZM or AMR. Therefore, we recommend including TLT in future research to evaluate therapeutic approaches in different clinical forms of human and animal pythiosis.</span></span></p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 1","pages":"Article 101460"},"PeriodicalIF":3.6,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139420811","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}
Vivianny Aparecida Queiroz Freitas , Andressa Santana Santos , Ana Laura Sene Amâncio Zara , Rosiane Andrade da Costa , Cristine Chaves Barreto , Renata de Bastos Ascenço Soares , Cassia Silva de Miranda Godoy , Maria do Rosário Rodrigues Silva
{"title":"Lodderomyces elongisporus as causative organism of oropharyngeal infections - Two case reports","authors":"Vivianny Aparecida Queiroz Freitas , Andressa Santana Santos , Ana Laura Sene Amâncio Zara , Rosiane Andrade da Costa , Cristine Chaves Barreto , Renata de Bastos Ascenço Soares , Cassia Silva de Miranda Godoy , Maria do Rosário Rodrigues Silva","doi":"10.1016/j.mycmed.2023.101459","DOIUrl":"10.1016/j.mycmed.2023.101459","url":null,"abstract":"<div><p>We report two cases of patients with oropharyngeal infection by <em>Lodderomyces elongisporus</em><span><span>. The identification of the two isolates was confirmed after sequencing the ITS1 and ITS4 regions. The antifungal susceptibility test revealed low MIC values for the different </span>antifungals tested. This is the first reported case of L. </span><em>elongisporus</em> present during an oropharyngeal infection and describes the laboratory methodology employed in the diagnosis.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 1","pages":"Article 101459"},"PeriodicalIF":3.6,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139022677","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}
Katarzyna Góralska , Szymon Lis , Ewa Brzeziańska-Lasota
{"title":"Cell pleomorphism and changes in the enzymatic profile of selected Candida albicans strains in interaction with Escherichia coli – pilot study","authors":"Katarzyna Góralska , Szymon Lis , Ewa Brzeziańska-Lasota","doi":"10.1016/j.mycmed.2023.101458","DOIUrl":"10.1016/j.mycmed.2023.101458","url":null,"abstract":"<div><p>Interactions between <span><em>C. albicans</em></span><span><span> and the microbiota play an important role in maintaining the balance between commensal and </span>pathogenic organisms<span>. Although the exact role of bacteria in reducing the pathogenicity<span> of yeast remains poorly understood, a few examples have been documented so far: probiotics administration effectively reduces the formation of biofilm and bacterial metabolites inhibit the formation of hyphae.</span></span></span></p><p>The aim of the study was to analyze <em>C. albicans</em><span> virulence levels based on the changes in the morphological structure and enzymatic profile in experimental cultures mixed with </span><em>Escherichia coli.</em> Viable cell abundance, cell pleomorphism and enzymatic profile were analyzed in single and mixed cultures (<em>C. albicans + E. coli</em>).</p><p>The microscope analysis showed a large decrease in the number of viable <em>C. albicans</em> cells in mixed cultures with <em>E. coli</em> from 485.3±132.1 immediately after the establishment of the culture to 238.1±71.2 after an hour of incubation and 24.4±5.4 after 24 h. The length of <em>C. albicans</em> cells differed significantly between the single-species cultures and the mixed cultures for 24 h. Our present findings indicate a significant reduction in the secretion of several enzymes by fungi following contact with <em>E. coli</em><span>, including acid phosphatase<span>, N-acetyl-β-glucosaminidase, naphthol-AS-BI-phosphohydrolase and leucine<span> arylamidase.</span></span></span></p><p>The interactions between fungi and bacteria appear to be extremely complex. On the one hand, during <em>C. albicans</em> with <em>E. coli</em><span> co-incubation, the bacteria stimulated the elongation of yeast cells<span>, leading to the formation of a filamentous form; however, the number of yeast cells and their enzymatic activity decreased significantly. Therefore, it can be concluded that while </span></span><em>E. coli</em><span> stimulates some pathogenic properties, e.g. cell elongation, it also inhibits other virulence features, e.g. enzymatic activity of </span><em>C. albicans</em>.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 1","pages":"Article 101458"},"PeriodicalIF":3.6,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138569903","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}
Ilham Ouaaziz , Antoine Marchand , Sophie Leducq , Christian Mirguet , Gonzague de Pinieux , Éric Bailly , Adélaïde Chesnay , Guillaume Desoubeaux
{"title":"Deep-seated dermatophytosis caused by Trichophyton rubrum in patient with Becker muscular dystrophy","authors":"Ilham Ouaaziz , Antoine Marchand , Sophie Leducq , Christian Mirguet , Gonzague de Pinieux , Éric Bailly , Adélaïde Chesnay , Guillaume Desoubeaux","doi":"10.1016/j.mycmed.2023.101456","DOIUrl":"https://doi.org/10.1016/j.mycmed.2023.101456","url":null,"abstract":"<div><p><span><em>Trichophyton rubrum</em></span><span> is a common fungal pathogen<span> that usually causes superficial infection limited to epidermis only, so called dermatophytosis<span>. However in immunocompromised patients, dermatophytosis can be exceptionally more invasive with extensive lesions involving deep tissues and generating sometimes systemic course. We report the case of a 43-year-old heart transplanted man, who presented with multiple deep-seated nodules and papules in the inguinal areas and in the buttocks. Involvement of </span></span></span><em>Trichophyton rubrum</em><span><span><span> was confirmed by culture, DNA sequencing and histological examination that showed </span>granulomatous </span>inflammatory infiltrates<span> with the presence of hyphae in the dermis<span>. Antifungal therapy<span> with oral terbinafine for four weeks was successful; in spite of initial remnant atrophic scars, the lesions were completely cleared after four month evolution. Deep-seated invasive dermatophytosis is rare, but should be considered with immunocompromised conditions, especially when history of previous superficial dermatophytosis is present.</span></span></span></span></p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 1","pages":"Article 101456"},"PeriodicalIF":3.6,"publicationDate":"2023-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138471924","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 resurgence of tinea cruris caused by Epidermophyton floccosum: An outbreak among Thai naval cadets","authors":"Sumanas Bunyaratavej , Punyawee Ongsri , Pattriya Jirawattanadon , Panyapat Buranaporn , Waranyoo Prasong , Chatisa Panyawong , Akkarapong Plengpanich , Charussri Leeyaphan","doi":"10.1016/j.mycmed.2023.101457","DOIUrl":"https://doi.org/10.1016/j.mycmed.2023.101457","url":null,"abstract":"<div><h3>Background</h3><p><span>A decreasing trend in tinea cruris caused by </span><span><em>Epidermophyton floccosum</em></span><span>, an anthropophilic dermatophyte, has been observed.</span></p></div><div><h3>Methods</h3><p>This retrospective study involved Thai naval cadets aged 18 years or older with suspected groin lesions. Both clinical evaluations and laboratory investigations were conducted.</p></div><div><h3>Results</h3><p><span>In total, 86 male participants with a median age of 19 years who presented with groin rash were enrolled in the study. Branching septate hyphae from KOH examination were found in 55 patients (64.0 %). Fungal identifications were </span><em>Epidermophyton floccosum</em> (42 cases; 76.4 %), <span><em>Trichophyton</em><em> mentagrophytes</em></span> complex (3 cases; 5.5 %), and no growth (10 cases; 18.2 %). An <em>E. floccosum</em><span> outbreak was identified, with a prevalence of 76.4 %. Most lesions exhibited admixed erythema and hyperpigmentation<span>. Approximately two-thirds displayed prominent, easily visible scaling. Scrotal involvement was absent in 95.2 % of lesions, with 87.2 % presenting bilaterally. A gradual symptom onset lasting up to 2 months was observed in 78.9 % of cases. Lesion morphologies included annular (73.8 %), patchy (14.3 %), and polycyclic (9.5 %). Severe itching disrupting daily activities was reported by only 7.1 % of participants. Approximately two-thirds used over-the-counter (OTC) topical medications without consulting a physician. Risk factors related to clothing included sharing clothes (59.5 %), wearing sweaty clothes (100 %), and reusing unwashed clothes (81.0 %).</span></span></p></div><div><h3>Conclusions</h3><p>The <em>E. floccosum</em><span> tinea cruris outbreak among naval cadets was characterized by a gradual onset and mild symptoms. OTC medication use without physician consultation was prevalent.</span></p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 1","pages":"Article 101457"},"PeriodicalIF":3.6,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138489701","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}
Na Ma , Yufei Zhao , Mingze Tang , Han Xia , Deyuan Li , Guoyan Lu
{"title":"Concurrent infection of Exophiala dermatitidis and Angiostrongylus cantonensis in central nervous system of a child with inherited CARD9 deficiency: A case report and literature review","authors":"Na Ma , Yufei Zhao , Mingze Tang , Han Xia , Deyuan Li , Guoyan Lu","doi":"10.1016/j.mycmed.2023.101455","DOIUrl":"https://doi.org/10.1016/j.mycmed.2023.101455","url":null,"abstract":"<div><p><em>Exophiala dermatitidis</em> is a relatively common environmental black yeast with a worldwide distribution that rarely causes fungal infection. Here, we report a case of a 6-year-old girl with central nervous system (CNS) encephalitis caused by <em>E. dermatitidis</em> and <em>Angiostrongylus cantonensis. E. dermatitidis</em> was identified by both cerebrospinal fluid culture and metagenomic next-generation sequencing (mNGS). <em>Angiostrongylus cantonensis</em> infection was confirmed by an enzyme linked immunosorbent assay (ELISA). Whole exome sequencing showed that this previously healthy girl carried a homozygous CARD9 mutation for c.820dupG (p.D274Gfs*61) that underlies invasive fungal and parasite infections. We chose glucocortieoid pulse therapy and anti-infective therapy based on the initial results of laboratory examination and cranial MRI images. With the aggravation of the disease and the evidence of the subsequent etiologic test, the combination of antifungal antiparasitic treatments (voriconazole, fluorocytosine and amphotericin B) were actively used. Unfortunately, the girl finally died due to severe systemic infection. mNGS performs a potential value for diagnosing rare CNS infections, and autosomal recessive <em>CARD9</em> deficiency should be considered in patient with fatal invasive fungal infections.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 1","pages":"Article 101455"},"PeriodicalIF":3.6,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1156523323000999/pdfft?md5=a9f387999c0ce2fd69ce80a05dbd7d64&pid=1-s2.0-S1156523323000999-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138471925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Lefranc , S. Fourmond , A. Jabet , A-C Normand , D. Girard , I. Accoceberry , F. Gabriel , L. Delhaes , S. Imbert
{"title":"Severe kerion Celsi caused by Trichophyton quinckeanum","authors":"M. Lefranc , S. Fourmond , A. Jabet , A-C Normand , D. Girard , I. Accoceberry , F. Gabriel , L. Delhaes , S. Imbert","doi":"10.1016/j.mycmed.2023.101453","DOIUrl":"https://doi.org/10.1016/j.mycmed.2023.101453","url":null,"abstract":"<div><p><span><span>We report a severe case of kerion Celsi of the </span>scalp in a previously healthy 13-year-old girl due to </span><span><em>Trichophyton</em><em> quinckeanum,</em></span><span> an emerging dermatophyte<span><span> species in Europe. The species was definitely identified by DNA sequencing and the patient was successfully treated by oral </span>terbinafine for 6 weeks.</span></span></p><p><span>Kerion Celsi is a severe inflammatory form of tinea capitis<span>, which is characterised by a purulent discharge and alopecia </span></span><span>[1]</span>. It typically occurs in children infected with zoophilic dermatophytes, such as <em>Trichophyton mentagrophytes</em>, and an increasing number of cases caused by other <em>Trichophyton</em> species has recently been reported <span>[2]</span>. Herein we report a severe case of kerion Celsi of the scalp caused by the emerging species <em>Trichophyton quinckeanum</em><span>, which was successfully treated by oral antifungal.</span></p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 1","pages":"Article 101453"},"PeriodicalIF":3.6,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138471923","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}
Stefanie Bressan Waller , Márcia Kutscher Ripoll , Renata Marques Pierobom , Paulo Ricardo Centeno Rodrigues , Paula Priscila Correia Costa , Francisco das Chagas Lima Pinto , Otília Deusdênia Loiola Pessoa , Angelita dos Reis Gomes , Renata Osório de Faria , Marlete Brum Cleff
{"title":"Screening of alkaloids and withanolides isolated from Solanaceae plants for antifungal properties against non-wild type Sporothrix brasiliensis","authors":"Stefanie Bressan Waller , Márcia Kutscher Ripoll , Renata Marques Pierobom , Paulo Ricardo Centeno Rodrigues , Paula Priscila Correia Costa , Francisco das Chagas Lima Pinto , Otília Deusdênia Loiola Pessoa , Angelita dos Reis Gomes , Renata Osório de Faria , Marlete Brum Cleff","doi":"10.1016/j.mycmed.2023.101451","DOIUrl":"10.1016/j.mycmed.2023.101451","url":null,"abstract":"<div><p><span>Antifungal resistance<span><span> has often been found in animal sporotrichosis in Southern Brazil. The biological potential of compounds from plants of the </span>Solanaceae family against infectious diseases is known, however, it is still unknown against </span></span><em>Sporothrix brasiliensis</em>. This study evaluated the anti-<em>Sporothrix brasiliensis</em><span> activity, synergism, cytotoxicity, and action mechanism of steroidal lactones<span> (withanolides) and alkaloids isolated from these plants. Pure compounds of withanolide D (WNOD), physalin F (PHYF), withanicandin (WNIC), nicandin B (NICB), solasonine (SSON), and solamargine (SMAR) were tested against 12 </span></span><em>Sporothrix brasiliensis</em> isolated from cats (<em>n</em> = 11) and dogs (<em>n</em><span><span><span> = 2) through M38-A2 CLSI. For the compounds with the best activity, a checkerboard assay for synergism, sorbitol<span><span> protection, and ergosterol effect for action mechanism; and MTT test for cytotoxicity were performed. The </span>withanolides WNOD, PHYF, WNIC, and NICB were not </span></span>antifungal, but SSON (MIC 0.125–1 mg/mL) and SMAR (MIC 0.5–1 mg/mL) were both fungistatic and fungicidal (MFC 0.5–1 mg/mL for both) against wild-type (WT) and non-WT isolates. The activity of SSON and SMAR was indifferent when combined with </span>itraconazole<span><span>. In the mechanism of action, cell wall and plasma membrane by complexation with ergosterol seemed to be two target structures of SSON and SMAR. SSON was selected for cytotoxicity, whose cell viability in </span>MDBK cells<span> ranged from 28.85 % to 101.75 %, and was higher than 87.49 % at concentrations ≤0.0015 mg/ml. Only the steroidal alkaloids SSON and SMAR were active against non-WT isolates, being promising antifungal candidates for the treatment of feline and canine sporotrichosis with low susceptibility to itraconazole.</span></span></span></p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 1","pages":"Article 101451"},"PeriodicalIF":3.6,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135516827","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}