Journal of Anesthesia最新文献

{"title":"Involvement of anesthesiologists in pediatric sedation and analgesia outside the operating room in Japan: is it too late, or is there still time?","authors":"Soichiro Obara","doi":"10.1007/s00540-024-03431-4","DOIUrl":"10.1007/s00540-024-03431-4","url":null,"abstract":"<p><p>The global COVID-19 pandemic highlighted significant existing supply-demand imbalances in anesthesia workforce, particularly impacting non-operating room anesthesia. Despite documented risks and mortality rates associated with pediatric procedural sedation and analgesia (PPSA) outside the operating room (OR), there is a pressing need for improvements in safety infrastructure. Comparative analysis with international practices reveals that anesthesiologists' involvement is associated with fewer adverse events and improved outcomes. However, lower reimbursement rate for sedation and anesthesia workforce shortage, and decentralized health resources are contributing factors to limit their participation in PPSA outside the OR in Japan. Enhancing the involvement of anesthesiologists through the public health frameworks such as \"high-risk approach\" and \"population approach\" can contribute to improvement of the safety and quality of PPSA. By tackling these challenges and implementing effective solutions, anesthesiologists can play a key role in ensuring safer and more effective PPSA outside the OR. Future challenges include enhancing training, addressing reduced clinical exposure due to work style reform, and developing effective educational systems. Research on improved educational approaches and fundamental outcome indices is crucial for improving PPSA practices outside the OR.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"311-317"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Day surgery in children: 15-year analysis of unplanned admissions at a Japanese tertiary children's hospital.","authors":"Aya Sueda, Tetsuro Kagawa, Taiki Kojima","doi":"10.1007/s00540-024-03445-y","DOIUrl":"10.1007/s00540-024-03445-y","url":null,"abstract":"<p><strong>Purpose: </strong>Unplanned hospital admission following pediatric day surgery is a crucial quality indicator. This study examined the incidence, related risks, interventions, and outcomes of unplanned hospital admission following pediatric day surgery among children in Japan.</p><p><strong>Methods: </strong>This single-center, retrospective study analyzed data of 14,529 pediatric patients under the age of 18 years who underwent day surgery between August 2007 and December 2022. Unplanned hospital admission was defined as an overnight hospital stay that was not planned preoperatively, including patients who returned to the emergency department and required admission within 24 h of discharge. Reasons for unplanned hospital admission and interventions were categorized, and risk factors were identified using logistic regression.</p><p><strong>Results: </strong>The incidence of unplanned hospital admission was 0.19%. The most common reasons for unplanned hospital admission were anesthetic-related, particularly postoperative nausea and vomiting (36%), which was managed primarily with intravenous fluids (36%) and antiemetic medications (21%). Medical and surgical factors were next most common. Logistic regression identified longer operation time (adjusted Odds ratio 1.03; 95% confidence interval [1.01, 1.04]; P < 0.001) and exit from the operating room after 15:00 (adjusted Odds ratio 29.3; 95% confidence interval [7.09, 121]; P < 0.001) as significant risk factors for unplanned hospital admission.</p><p><strong>Conclusion: </strong>Unplanned hospital admission was most commonly anesthetic-related and was managed with intravenous fluids and antiemetic medications. Longer operation time and later exit from the operating room were significant risk factors. These findings can guide targeted strategies to further reduce unplanned hospital admission and improve pediatric day surgery quality.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"215-222"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"T2 high-signal-intensity zone of the spinal cord dorsal horn in patients treated with spinal cord stimulation for herpes zoster-associated pain: a retrospective case-control study.","authors":"Kyosuke Arakawa, Masayuki Nakagawa, Yoichiro Abe, Hiroshi Morimatsu","doi":"10.1007/s00540-025-03458-1","DOIUrl":"10.1007/s00540-025-03458-1","url":null,"abstract":"<p><strong>Purpose: </strong>In patients with herpes zoster-associated pain (ZAP), magnetic resonance imaging (MRI) has revealed T2 high-signal intensity zones (MRI T2 HIZ) in the dorsal horn of the spinal cord, associated with postherpetic neuralgia (PHN). We retrospectively analyzed the relationship between PHN and MRI T2 HIZ in patients with refractory ZAP in the subacute phase who underwent temporary spinal cord stimulation therapy (tSCS).</p><p><strong>Methods: </strong>This single-center, case-control study included patients who underwent tSCS for refractory ZAP between 2010 and 2018. MRIs were re-assessed for the presence of T2 HIZ in the dorsal horn of the spinal cord. Patients were divided into T2 HIZ( +) and T2 HIZ(-) groups. Patients with a numerical rating score (NRS) ≥ 3 at the last visit were defined as PHN. The NRS values and the incidence rate of PHN were compared between the two groups.</p><p><strong>Results: </strong>Of the 67 cases extracted, 38 were included in the analysis: 22 in T2 HIZ( +) group and 16 in T2 HIZ(-) group. No significant differences were observed in background factors between the two groups. However, the T2 HIZ( +) group had a significantly higher NRS at the final visit (T2 HIZ( +):3.8 ± 2.1, T2 HIZ(-):1.4 ± 1.5; P < 0.05) and had significantly more patients with PHN than the T2 HIZ(-) group (T2 HIZ( +) vs. T2 HIZ(-), 15/22 (68%) vs. 3/16 (19%); odds ratio = 8.67; 95% confidence interval, 1.7-63.3).</p><p><strong>Conclusion: </strong>T2HIZ is detected in more than half of refractory ZAP, and pain is more likely to remain after tSCS treatment in the T2HIZ( +) group.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"273-281"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the postoperative analgesic efficacy of the ultrasound-guided erector spinae plane block and intrathecal morphine in patients undergoing total abdominal hysterectomy under general anesthesia: a randomized controlled trial.","authors":"Tarek Mohamed Ashoor, Ibrahim Mamdouh Esmat, Mohammad Abdalsalam Algendy, Noha Refaat Mohamed, Sahar Mohamed Talaat, Amal Hamed Rabie, Ahmed Mohammed Elsayed","doi":"10.1007/s00540-025-03466-1","DOIUrl":"10.1007/s00540-025-03466-1","url":null,"abstract":"<p><strong>Purpose: </strong>Total abdominal hysterectomy (TAH) is a common surgical procedure. Erector spinae plane block (ESPB) and intrathecal morphine (ITM) provide adequate postoperative (PO) analgesia. However, ITM side effects may limit its use. Researchers investigated the efficacy of bilateral ultrasound-guided ESPB on PO pain and analgesic consumption compared to ITM in the first 24 h following TAH under general anesthesia.</p><p><strong>Methods: </strong>120 patients premedicated with 3 mg intravenous granisetron were randomized into three equal groups: bilateral ultrasound-guided ESPB, ITM or control group. The primary outcome of this study was the time to first request for a rescue analgesic (tramadol).</p><p><strong>Results: </strong>Compared to the control group, the ESPB and ITM groups showed higher time to first request for a rescue analgesic and lower total tramadol consumption 24 h following surgery (P < 0.001) with significant differences between the ESPB and ITM groups (P < 0.001). The ITM group showed lower pain scores and lower readings of both serum glucose and cortisol levels compared to the other two groups 24 h after surgery (P < 0.001). The ITM group also had higher incidences of nausea and pruritus 24 h after surgery (P < 0.001). The use of a single intrathecal injection of 0.3 mg morphine did not show any respiratory depression.</p><p><strong>Conclusion: </strong>0.3 mg intrathecal morphine was superior to erector spinae plane block for postoperative pain relief, 24 h after surgery, regarding attenuated stress response, lower pain scores at rest and on coughing and lower tramadol consumption. IRB: IRB 00006379//31-1-2022.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov Identifier: NCT05218733.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"299-310"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualization of primary afferent-evoked excitation of spinal dorsal horn neurons using an intracellular Ca²⁺ imaging technique in adult rat spinal cord slices.","authors":"Hiroshi Baba, Nobuko Ohashi","doi":"10.1007/s00540-024-03451-0","DOIUrl":"10.1007/s00540-024-03451-0","url":null,"abstract":"<p><strong>Purpose: </strong>Intracellular Ca²⁺ imaging is a valuable tool for studying neuronal activity; however, its application in the spinal cord of mature animals remains underdeveloped. This study aimed to establish an intracellular Ca²⁺ imaging method in adult rat spinal cord slices without complex genetic modifications and characterize primary afferent-evoked intracellular Ca²⁺ responses in spinal dorsal horn neurons.</p><p><strong>Methods: </strong>L5 lumbar spinal cord slices from adult rats were stained with a Ca²⁺ indicator. The relationship between intracellular Ca²⁺ signals and electrophysiological responses induced by dorsal root stimulation was examined. Additionally, the effects of analgesics, anesthetics, and hyperalgesics on the Ca²⁺ responses were analyzed.</p><p><strong>Results: </strong>Monophasic intracellular Ca²⁺ responses were observed with A-fiber intensity stimulation, while biphasic responses were noted with C-fiber intensity stimulation. These responses were not photobleached after repeated measurements (n = 12). The rising phase of Ca²⁺ responses coincided with action potential generation, whereas the falling phase did not. Dorsal root stimulation-induced Ca²⁺ responses were significantly suppressed by morphine (10 μM, 43.9 ± 4.9% of control, n = 8) but not by remimazolam (10 μM, 98.0 ± 2.0% of control, n = 8). Conversely, bicuculline (40 μM, 288.4 ± 48.4% of control, n = 10) and high concentrations of tranexamic acid (3, 10 mM, 132.6 ± 19.9%, 152.6 ± 25.3%, respectively, n = 8) significantly enhanced Ca²⁺ responses.</p><p><strong>Conclusion: </strong>This is a simple and effective approach to examining the effects of drugs that target the spinal cord and investigating nociceptive transmission and modulation mechanisms in the spinal dorsal horn.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"231-247"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of inflationary oscillometric blood pressure measurement in the presence of atrial fibrillation: comparison to sinus rhythm.","authors":"Yuichi Maki, Yasumasa Sakamoto, Risa Abe, Kohei Morozumi, Daisuke Toyoda, Yoshifumi Kotake","doi":"10.1007/s00540-025-03462-5","DOIUrl":"10.1007/s00540-025-03462-5","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to compare the success rate, measurement duration and the accuracy of inflationary non-invasive blood pressure (iNIBP, Nihon Koden Corp, Tokyo, Japan) during general anesthesia between the subjects with sinus rhythm (SR) and atrial fibrillation (AF) against invasive arterial pressure (IAP).</p><p><strong>Methods: </strong>iNIBP was determined every 5 min and IAP was continuously monitored in 30 subjects with sinus rhythm and 30 subjects with atrial fibrillation. The outcomes of this study were the success rate, the measurement duration of iNIBP and the accuracy of iNIBP in reference to IAP and 5 pair of data from each subject. The accuracy was assessed with concordance correlation coefficient and Bland-Altman method.</p><p><strong>Results: </strong>The success rate of iNIBP was 45% and 59% (p < 0.01) with AF and SR, respectively. Measurement duration of iNIBP was not different between AF and SR group. The Lin concordance correlation coefficient of mean blood pressure of iNIBP against IAP of SR group and AF group was 0.83 and 0.77, respectively. The mean bias (SD) of mean blood pressure of iNIBP against IAP of SR group and AF group was 5.8 (8.9) mmHg and 7.1 (11.5) mmHg, respectively. The precision was significantly wider in AF group.</p><p><strong>Conclusion: </strong>Presence of AF decreased the incidence of successful determination of blood pressure during cuff inflation. The accuracy of mean blood pressure determination was not considerably affected except for the wider limits of agreement.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"292-298"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulse oximeters, new places, best signals?","authors":"F Guillermo Lema","doi":"10.1007/s00540-024-03405-6","DOIUrl":"10.1007/s00540-024-03405-6","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"325"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriate tourniquet pressure for peripherally inserted central catheter placement in the upper arm.","authors":"Mami Tsubota, Marechika Tsubouchi, Yuka Miyazaki, Kenji Iwai, Tetsu Miyoshi, Tsukasa Yajima, Ryohei Matsui, Yota Yamagishi, Asako Matsushima, Tomonori Hattori, Hiroshi Sasano","doi":"10.1007/s00540-024-03440-3","DOIUrl":"10.1007/s00540-024-03440-3","url":null,"abstract":"<p><strong>Purpose: </strong>A peripherally inserted central catheter (PICC) placement often requires ultrasound guidance. Previous studies using an adult blood pressure cuff have suggested that veins do not easily collapse at the tourniquet pressure from diastolic to systolic blood pressure. When inserting a PICC into the basilic vein of the upper arm, a narrow blood pressure cuff should be used as a tourniquet to avoid concealing the puncture site. The aim of this study was to determine the appropriate tourniquet pressure using a narrow cuff when inserting a PICC into the upper arm.</p><p><strong>Methods: </strong>We measured the upper arm's blood pressure of seven healthy participants using a pediatric cuff and applied pressure to the upper arm with the pediatric cuff at six levels: 0 mmHg (0), half of the diastolic pressure (D/2), diastolic pressure (D), pressure obtained by combining the systolic and diastolic pressures and dividing by two (DS), systolic pressure (S), and blood pressure as the pulse wave disappears (S + α). An ultrasound probe compressed the basilic vein through the skin. The pressure at which the vein collapsed at each tourniquet pressure was examined.</p><p><strong>Results: </strong>The venous collapse pressure was higher when the tourniquet pressure was D, DS, or S.</p><p><strong>Conclusion: </strong>D to S is appropriate for PICC placement in the basilic vein of the upper arm in terms of venous collapse.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"183-188"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current practice and awareness of perioperative do-not-attempt-resuscitation orders: a single-center retrospective survey and complete questionnaire survey.","authors":"Keisuke Shimizu, Kyoko Komatsu, Hiroshi Uchida, Mizuki Nawata, Ryo Kubota","doi":"10.1007/s00540-024-03447-w","DOIUrl":"10.1007/s00540-024-03447-w","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated whether patients who have been issued a do-not-attempt-resuscitation order (DNAR) preoperatively (hereafter, DNAR patients) are informed of the DNAR code change when they undergo anesthesia. We also conducted a survey of the awareness of medical staff regarding perioperative DNARs, and investigated the current situation at a single-center in Japan.</p><p><strong>Methods: </strong>For DNAR patients managed by anesthesiologists from January 2019 to September 2022, we retrospectively investigated whether the patient was informed of the DNAR code change or the DNAR was automatically suspended without explanation. Next, in July 2023, a questionnaire survey on perioperative DNARs was conducted among all medical staff at our center.</p><p><strong>Results: </strong>Among the 4,164 cases managed by anesthesiologists during the study period, 100 DNAR patients (2.4%) were identified. Of these, 27 patients received an explanation about the DNAR code change before surgery. Multivariate analysis showed that female patients (odds ratio [OR] 5.3, 95% confidence interval [CI] 3.8-6.7; p = 0.023) and patients with low Barthel Index (OR 0.98, 95% CI 0.96-0.99; p = 0.010) tended to receive explanations about DNAR code changes. In the questionnaire survey, 25% of the 1,051 respondents answered that DNAR code changes should be explained to patients before surgery.</p><p><strong>Conclusion: </strong>In clinical practice, 27% of DNAR patients were informed of DNARs code change before surgery. Perioperative advance care planning should be further promoted in clinical practice by creating guidelines and training programs regarding perioperative DNARs.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"223-230"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of preoperative fibrinogen/albumin ratio with morbidity following advanced-age hip fractures: an observational study.","authors":"Emine Dizem Sunal Altın, Nur Canbolat, Mehmet I Buget, Yekta Furkan Altın, Serkan Bayram, Kemalettin Koltka","doi":"10.1007/s00540-024-03444-z","DOIUrl":"10.1007/s00540-024-03444-z","url":null,"abstract":"<p><strong>Purpose: </strong>Given the occurrence of comorbidities in geriatric patients, the postoperative period of hip fractures may progress with high morbidity and mortality. Recently, several inflammatory markers have been used to evaluate the treatment course. Herein, we prospectively followed-up and examined the relationship between preoperative fibrinogen/albumin ratio(FAR) and morbidity/mortality in elderly patients with hip fracture.</p><p><strong>Methods: </strong>Patients aged ≥ 85 years who underwent hip fracture surgery under unilateral spinal anesthesia were included in this prospective observational study. The patients' preoperative FAR, age-adjusted Charlson comorbidity index(AACCI) score, Nottingham Hip Fracture Score, and Clinical Frailty Scale score were calculated. In addition, data on patients' morbidity, 3-month mortality, and lengths of intensive care unit (ICU) and hospital stay were recorded. The patients were categorized into two groups based on the FAR cutoff value of 0.102. A total of 108 patients participated in the study, with 43 assigned to Group 1(FAR < 0.102) and 65 to Group 2(FAR ≥ 0.102).</p><p><strong>Results: </strong>A significant difference was found in the risk of death within 3-months between patients with high and low FAR scores(p = 0.018). Patients with higher FAR scores were more likely to die within 3 months. A significantly positive association was observed between the FAR and AACCI score, with the AACCI score of Group2 being significantly higher than that of Group 1(p = 0.029). The lengths of hospital(p = 0.044) and ICU(p = 0.013) stay were significantly higher in Group2 than in Group1.</p><p><strong>Conclusion: </strong>Preoperative FAR, which is an inexpensive and readily available test, is a promising index for predicting mortality and complications in patients with hip fracture.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"205-214"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}