Journal of Heart and Lung Transplantation最新文献

{"title":"Severe early graft dysfunction post-heart transplantation: Two clinical trajectories and diastolic perfusion pressure as a predictor of mechanical circulatory support","authors":"Hoong Sern Lim MD ,&nbsp;Sai Bhagra MRCP ,&nbsp;Marius Berman FRCS ,&nbsp;Chun Shing Kwok PhD ,&nbsp;Colin Chue PhD ,&nbsp;Aaron Ranasinghe MD ,&nbsp;Stephen Pettit PhD","doi":"10.1016/j.healun.2024.09.002","DOIUrl":"10.1016/j.healun.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Severe early graft dysfunction (EGD) is defined by mechanical circulatory support (MCS) &lt;24 hours of heart transplantation (HT). We classified severe EGD based on timing of post-HT MCS: ‘‘Immediate’’ intra-operative vs ‘‘Delayed’’ post-operative MCS (after admission into intensive care unit (ICU) from operating theater). We hypothesized that (1) risk factors and clinical course differ between ‘‘Immediate’’ and ‘‘Delayed’’ MCS; and (2) diastolic perfusion pressure (DPP<!--> <!-->=<!--> <!-->diastolic blood pressure-central venous pressure) and Norepinephrine equivalents (NE<!--> <!-->=<!--> <!-->sum of vasopressor doses), as measures of vasoplegia are related to ‘‘Delayed’’ MCS.</div></div><div><h3>Methods</h3><div>Two-center study of 216 consecutive patients who underwent HT. Recipient, donor, vasopressor doses and hemodynamic data at T0 and T6 (on admission and 6 hours after admission into ICU) were collected.</div></div><div><h3>Results</h3><div>Of the 216 patients, 67 patients had severe EGD (‘‘Immediate’’ MCS: <em>n</em> = 43, ‘‘Delayed’’ MCS: <em>n</em> = 24). The likelihood of ‘‘immediate’’ MCS but not ‘‘delayed’’ MCS increased with increasing warm ischemic and cardiopulmonary bypass times on multinomial regression analysis with ‘‘no MCS’’ as the referent group. One-year mortality was highest in ‘‘Immediate’’ MCS vs ‘‘no MCS’’ and ‘‘delayed’’ MCS (34.9% vs 3.4% and 8% respectively, <em>p</em> &lt; 0.001). Of the patients who had no immediate post-transplant MCS, DPP and NE at T6 were independently associated with subsequent ‘‘delayed’’ MCS. Sensitivity and specificity of NE<!--> <!-->≥ 0.2 mcg/kg/min for ‘‘Delayed’’ MCS were 71% and 81%. Sensitivity and specificity of DPP of ≥40 mm<!--> <!-->Hg for No MCS were 83% and 74%. The discriminatory value of systemic vascular resistance for ‘‘Delayed’’ MCS was poor.</div></div><div><h3>Conclusion</h3><div>Risk factors and 1-year survival differed significantly between ‘‘Immediate’’ and ‘‘Delayed’’ post-HT MCS. The latter is related to lower DPP and higher NE, which is consistent with vasoplegia as the dominant pathophysiology.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 161-170"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174650","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":"Early stroke following durable left ventricular assist device (LVAD) implantation: An analysis of the Society of Thoracic Surgeons Intermacs National Database","authors":"Ezequiel J. Molina ,&nbsp;Daniel Goldstein ,&nbsp;Ryan S. Cantor ,&nbsp;Manreet K. Kanwar ,&nbsp;Dan Meyer ,&nbsp;Ulrich Jorde ,&nbsp;Omar Saeed ,&nbsp;Katherine Wood ,&nbsp;Rama Raju Rudraraju ,&nbsp;Seth Lewis ,&nbsp;James K. Kirklin ,&nbsp;Francis D. Pagani ,&nbsp;Arman Kilic MD","doi":"10.1016/j.healun.2024.09.031","DOIUrl":"10.1016/j.healun.2024.09.031","url":null,"abstract":"<div><h3>Background</h3><div>Stroke remains a devastating complication of durable left ventricular assist device (LVAD) therapy. This study evaluated the incidence and risk factors for early stroke within 7 days following LVAD implantation investigating both traditional pre-implant and new intraoperative variables collected by The Society of Thoracic Surgeons (STS) Intermacs National Database.</div></div><div><h3>Methods</h3><div>STS Intermacs was queried for patients undergoing implantation of a fully magnetically levitated centrifugal LVAD between November 25, 2020 and June 30, 2023. STS Intermacs stroke definitions were used to identify patients who suffered a stroke within the first 7 postoperative days (POD). A multivariable logistic regression model was created to generate adjusted odd ratios (OR) for variables associated with early stroke.</div></div><div><h3>Results</h3><div>Among 6,950 patients in the study cohort, 5.9% (413/6950) developed a stroke after a median follow-up of 11 months, with 50% (205/413) of strokes occurring within 7 days after LVAD implantation. Of the strokes occurring during POD 0-7, 70% (144/205) occurred on POD 0-2. By multivariable analysis, the following factors were associated with early stroke: older age (70 vs 50; OR 1.4, <em>p</em> = 0.0129), white race (OR 1.5, <em>p</em> = 0.0078), pre-implant temporary mechanical circulatory support (MCS) bridge (temporary LVAD only: OR 1.6, extracorporeal membrane oxygenation [ECMO] only: OR 1.7, combination of both devices: OR 3.3; <em>p</em> = 0.0001) and presence of an unremoved left atrial clot (OR 8.0, <em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>A significant proportion of strokes occur within the first 7 days following LVAD implantation, particularly within the first 2 days. In addition to pre-implant variables, we identified modifiable intraoperative factors associated with stroke that provide an opportunity for further risk mitigation and improvement in quality of care.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 263-272"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400488","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":"Could emulated trials play a key role in cardiogenic shock trials?","authors":"Aurore Ughetto MD, MSc ,&nbsp;Nicolas Nagot MD, PhD ,&nbsp;Clément Delmas MD, PhD","doi":"10.1016/j.healun.2024.10.025","DOIUrl":"10.1016/j.healun.2024.10.025","url":null,"abstract":"<div><div>Temporary mechanical circulatory support (tMCS) using extracorporeal life support (ECLS), has been widely implemented in patients with cardiogenic shock (CS), although evidence regarding its efficacy and safety remains unclear. This lack of clarity has recently raised concerns about the role of tMCS in CS management. Conducting randomized controlled trials (RCTs) in the context of CS poses significant challenges due to ethical considerations and logistical complexities. In response to these challenges, emulated trials (ETs) are emerging as a promising alternative. By incorporating design features from idealized RCTs, they use robust and rigorous methods to assess the efficacy and safety of health interventions in real-life settings, using observational data. In our manuscript, we highlight the complementary nature of RCT and ETs by evaluating tMCS for CS patients. While RCTs follow a rigorous experimental design and provide reliable evidence, ETs can swiftly estimate the risk-benefit ratio without encountering logistical barriers thereby offering clinicians’ early reassurance about the potential benefits of routinely used interventions. Furthermore, ETs offer potential value in unethical situations (refractory cardiac arrest or \"crash and burn\" CS) where interventional therapies, such as tMCS, are used as a last resort.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 298-303"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590720","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":"Sympathetic reinnervation in cardiac transplant recipients: Prevalence, time course, and association with long-term survival","authors":"Oliver J.F. Weiner ,&nbsp;Moloy Das ,&nbsp;Richard H. Clayton ,&nbsp;Janet M. McComb ,&nbsp;Alan Murray ,&nbsp;Gareth Parry ,&nbsp;Stephen W. Lord","doi":"10.1016/j.healun.2024.10.009","DOIUrl":"10.1016/j.healun.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Partial cardiac sympathetic reinnervation after cardiac transplant has been extensively investigated and evidenced. However, there have been no large-scale, long-term studies evaluating the prevalence, time-course, and association with long-term survival of sympathetic reinnervation of the heart.</div></div><div><h3>Methods</h3><div>Cardiac transplant recipients (<em>n</em> = 232) were recruited from outpatient clinic at a single transplant center in the United Kingdom. Participants were each tested once for the presence of sympathetic reinnervation of the sinus node using the low-frequency component of power spectral analysis of heart rate variability, with a cutoff defined as 2 standard deviations above the mean for denervated participants (those tested &lt;56 days posttransplant). Time course was calculated based on the timing of testing posttransplant. Patients were then followed up over a period of up to 27 years after transplant for survival analysis.</div></div><div><h3>Results</h3><div>The overall prevalence of cardiac sympathetic reinnervation in the 225 patients tested &gt;56 days posttransplant was 64.9%. Sympathetic reinnervation primarily occurred in the first 18 months after transplant, with a plateau thereafter. The prevalence in participants tested &gt;18 months posttransplant was 69.6%. In Kaplan-Meier survival analysis, sympathetic reinnervation was associated with significantly improved survival (Log-rank <em>p</em> = 0.019), with a median survival time for reinnervated patients of 19.9 years compared with 14.4 years for the denervated group.</div></div><div><h3>Conclusions</h3><div>Sympathetic reinnervation of the sinus node occurs mostly within 18 months of transplant, is found in 70% of cardiac transplant recipients tested &gt;18 months posttransplant, and is associated with significantly improved long-term survival.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 204-212"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467412","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":"Lung transplant pathology: No longer through a glass darkly?","authors":"Allan R. Glanville MBBS, FRACP, MD","doi":"10.1016/j.healun.2024.10.017","DOIUrl":"10.1016/j.healun.2024.10.017","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 182-183"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568933","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":"Diagnostic alignment to optimize inter-rater reliability among lung transplant pathologists","authors":"Elizabeth N. Pavlisko MD ,&nbsp;Megan L. Neely PhD ,&nbsp;Kathryn A. Wikenheiser-Brokamp MD, PhD ,&nbsp;Gregory A. Fishbein MD ,&nbsp;Leslie Litzky MD ,&nbsp;Carol F. Farver MD ,&nbsp;Prodipto Pal MD, PhD ,&nbsp;Mai He MD ,&nbsp;Peter B. Illei MD ,&nbsp;Charuhas Deshpande MD ,&nbsp;Mark A. Robien MD ,&nbsp;Jerry Kirchner BS ,&nbsp;Courtney W. Frankel PT, MS ,&nbsp;Jason E. Lang MD, MPH ,&nbsp;John A. Belperio MD ,&nbsp;Scott M. Palmer MD, MPH ,&nbsp;Stuart C. Sweet MD, PhD ,&nbsp;On behalf of the Clinical Trials and Organ Transplantation (CTOT)-47 consortium","doi":"10.1016/j.healun.2024.10.007","DOIUrl":"10.1016/j.healun.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Poor agreement among lung transplant (LTx) pathologists has been reported in the assessment of rejection. In addition to acute rejection (AR) and lymphocytic bronchiolitis (LB), acute lung injury (ALI) and organizing pneumonia (OP) were recently identified as histopathologic risk factors for chronic lung allograft dysfunction (CLAD). Therefore, maximizing inter-rater reliability (IRR) for identifying these histopathologic risk factors is important to guide individual patient care and to support incorporating them in inclusion criteria for clinical trials in lung transplantation.</div></div><div><h3>Methods</h3><div>Nine pathologists across 8 North American LTx centers were surveyed for practices in the assessment of LTx transbronchial biopsies. We conducted 7 diagnostic alignment sessions with pathologists discussing histomorphologic features of CLAD high-risk histopathology. Then, each pathologist blindly scored 75 digitized slides. Fleiss’ kappa, accounting for agreement across numerous observers, was used to determine IRR across all raters for the presence of any high-risk finding and each individual entity.</div></div><div><h3>Results</h3><div>IRR (95% confidence intervals) and % agreement for any high-risk finding (AR, LB, ALI, and/or OP) and each individual finding is as follows: Any Finding, k = 0.578 (0.487, 0.668), 78.9%; AR, k = 0.582 (0.481, 0.651), 79.1%; LB, k = 0.683 (0.585, 0.764), 83.5%; ALI, k = 0.418 (0.312, 0.494), 70.9%; and OP, k = 0.621 (0.560, 0.714), 81.0%.</div></div><div><h3>Conclusions</h3><div>After prestudy diagnostic alignment sessions, a multicenter group of LTx pathologists seeking to identify histopathology high-risk for CLAD achieved good IRR.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 173-181"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443665","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":"Loss of right ventricular outflow function in pulmonary hypertension","authors":"Bruno R. Brito da Rocha ,&nbsp;Athiththan Yogeswaran MD ,&nbsp;Bálint K. Lakatos MD ,&nbsp;Alexandra Fábián MD ,&nbsp;Henning Gall MD, PhD ,&nbsp;Hossein A. Ghofrani MD ,&nbsp;Nils C. Kremer MD ,&nbsp;Simon Schäfer ,&nbsp;Werner Seeger MD ,&nbsp;Daniel Zedler ,&nbsp;Selin Yildiz ,&nbsp;Zvonimir A. Rako MD ,&nbsp;Attila Kovács MD, PhD ,&nbsp;Khodr Tello MD","doi":"10.1016/j.healun.2024.09.026","DOIUrl":"10.1016/j.healun.2024.09.026","url":null,"abstract":"<div><div>Right ventricular outflow tract (RVOT) function is not systematically quantified by three-dimensional (3D) echocardiography. We tested the hypothesis that loss of RVOT function in pulmonary hypertension (PH) is related to disease severity independently of other echocardiographic parameters. In this observational study, patients with PH, disease controls, and a matched healthy control group underwent 3D echocardiography and RVOT analysis using ReVISION software. The study included 43 patients (38 with PH, 5 disease controls) and 43 healthy controls. Median 3D RVOT-ejection fraction (EF) was 30.4% in the patients and 44.2% in the healthy controls (<em>p</em> &lt; 0.001). Patients with low 3D RVOT-EF (&lt;30.4%) were more frequently categorized in higher-risk groups and had a higher incidence of clinical worsening than those with high 3D RVOT-EF. Even in patients with RV-EF ≥35%, those with low 3D RVOT-EF had worse outcomes. Segmental RVOT analysis identifies high-risk patients even with normal overall RV function.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 273-277"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406488","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":"The lung transplant endobronchial biopsy: A forgotten specimen comes of age","authors":"Kieran Halloran MD, MSc ,&nbsp;Robin Vos MD, PhD ,&nbsp;Greg Snell MD ,&nbsp;John R. Greenland MD, PhD","doi":"10.1016/j.healun.2024.10.019","DOIUrl":"10.1016/j.healun.2024.10.019","url":null,"abstract":"<div><div>Mucosal or endobronchial biopsies (EBB) are typically used in the diagnosis of directly visualized bronchial lesions, infection, and sarcoidosis, but their utility in the evaluation of lung transplant recipients is controversial. EBB represents an attractive alternative to transbronchial biopsy (TBB): EBB provides straightforward sampling of airway pathology with decreased complication rates due to minimal and visualizable bleeding and the elimination of pneumothorax risk. In lung transplant recipients, EBB may be obtained when TBB is too high-risk, including in the setting of acute lung allograft dysfunction (ALAD) requiring mechanical ventilation or in advanced chronic lung allograft dysfunction (CLAD). Most centers do not include EBB in post-transplant surveillance or for-cause bronchoscopy protocols, possibly due to a lack of a common histologic interpretation system. Previous work has demonstrated that lymphocytic inflammation in lung transplant EBB is associated with acute cellular rejection and future risk for CLAD, but these have not translated into subsequent studies on clinical utility or into clinical practice. Recent multicenter studies suggest that gene expression-based diagnostics leveraging EBB may outperform histologic grading and provide important prognostic utility in predicting graft loss. Herein, we will review what is known about the lung transplant mucosa including recent diagnostic advances and propose how EBB analyses could be incorporated into research studies and clinical workflows. We propose that mucosal sampling could provide safe, consistent, and informative data to improve patient outcomes after lung transplant.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 293-297"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545774","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":"Nr4a1: A multilevel target to overcome PGD in lung transplantation","authors":"Cedric Vanluyten MD ,&nbsp;Robin Vos MD, PhD ,&nbsp;Laurens J. Ceulemans MD, PhD","doi":"10.1016/j.healun.2024.11.008","DOIUrl":"10.1016/j.healun.2024.11.008","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 261-262"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693051","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":"A perspective on the added value of red blood cells during cardiac hypothermic oxygenated perfusion","authors":"Mats T. Vervoorn MD ,&nbsp;Elisa M. Ballan MSc ,&nbsp;Selma E. Kaffka genaamd Dengler MD ,&nbsp;Veronique M.F. Meijborg PhD ,&nbsp;Saskia C.A. de Jager PhD ,&nbsp;Richard Van Wijk PhD ,&nbsp;Niels P. van der Kaaij MD, PhD","doi":"10.1016/j.healun.2024.09.025","DOIUrl":"10.1016/j.healun.2024.09.025","url":null,"abstract":"<div><div>Hypothermic oxygenated perfusion (HOPE) is an emerging technique for donor heart preservation that is currently being studied in multiple clinical trials with promising results. When compared to HOPE for other organs, cardiac protocols involve red blood cell (RBC) supplementation, despite absence of comparative evidence for its benefits. In this perspective paper, we discuss the pros and cons of the addition of RBCs during cardiac HOPE. Although the current clinical results with RBC supplementation during HOPE seem promising, potential downsides of RBC supplementation cannot be ruled out. The impact of supplemented RBCs during cardiac HOPE requires further investigation to improve HOPE protocols, to optimize heart preservation using this promising technology.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 2","pages":"Pages 285-288"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381041","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}