Journal of Intensive Care Medicine最新文献

{"title":"Safety and Feasibility of Percutaneous Tracheostomy in Patients with Traditional Contraindications: A Systematic Review of 2232 Cases.","authors":"Amani Daoud, Shiri Geva, Yonatan Finkelstein, Dana Grosbard, Ohad Ronen","doi":"10.1177/08850666261483584","DOIUrl":"10.1177/08850666261483584","url":null,"abstract":"<p><p>PurposePercutaneous dilational tracheostomy (PDT) is a widely performed procedure. However, it is sometimes contraindicated based on manufacturer guidelines and existing literature. This study evaluates the safety and feasibility of performing PDT in patients with documented contraindications.MethodsA systematic review was conducted using PubMed and TDNet, following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines. Studies describing PDT performed in the presence of absolute or relative contraindications were included<b><i>.</i></b> The literature search included studies published between 1991 and 2024. Data on patient demographics, contraindications, complications, and clinical outcomes were extracted. Statistical analysis incorporated findings from both the included studies and our case series.ResultsA total of 76 studies, along with our case series, included 2232 patients with a mean age of 48.5 years. The most common contraindications were bleeding diathesis (n = 947, 42.4%), and morbid obesity (n = 360, 16.1%). Many patients presented with multiple contraindications. The primary indications for tracheostomy were anticipated prolonged intubation, airway obstruction, and trauma. Bronchoscopic guidance was used in 45.6% of cases, and ultrasound guidance in 24.6%. The most frequently reported complication was bleeding (5.96%), followed by stoma narrowing (0.67%) and infection (0.63%). The overall procedural failure rate was 0.36%, and procedural mortality was rare (0.13%).ConclusionThis review suggests that PDT may be safely performed in carefully selected patients with traditional contraindications when conducted by experienced teams with appropriate backup. These findings do not support the routine use of PDT in all patients with traditional contraindications, but rather highlight its feasibility in carefully selected cases managed by appropriately skilled teams. Future controlled studies are warranted to re-evaluate current contraindications guidelines.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1178-1193"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906455","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":"Early Corticosteroid use and Clinical Outcomes in Patients with Mixed and Cardiogenic Shock.","authors":"Maria Gabriela Gastanadui, Hannah R Murphy, Andi Shahu, Israel Safiriyu, Cory Heck, Maria Hysolli, Santiago Callegari, Sanjana Garimella, Tariq Ali, Jacob C Jentzer, Ann Gage, Mark Jacobs, Jason N Katz, P Elliott Miller","doi":"10.1177/08850666261437767","DOIUrl":"10.1177/08850666261437767","url":null,"abstract":"<p><p>BackgroundThe pathophysiology of CS is complex and is associated with increased inflammation and impaired vascular tone. Corticosteroids are recommended in septic shock and have been proposed as a potential treatment for other types of shock.ObjectivesWe sought to evaluate the clinical outcomes associated with early corticosteroid use in patients with cardiogenic shock (CS).MethodsUsing a nationally representative database including over 1000 hospitals, we identified adults ≥18 years of age admitted from 2015-2023 with a diagnosis of CS. Patients with adrenal insufficiency, chronic rheumatologic conditions, COVID-19 infection and acute COPD exacerbation were excluded. Using inverse probability treatment weighting (IPTW), we assessed for the association of receiving early corticosteroids (within the first 2 days of admission) versus no early corticosteroids and in-hospital mortality.ResultsOf the 167,721 identified patients with CS, the mean (SD) age was 65.5 (±15.2) years and 35.0% were women. A total of 13.2% received any corticosteroid within the first 2 days of admission. The most common corticosteroid was hydrocortisone (73.9%). Mortality for those receiving and not receiving early corticosteroids was 48.8% and 29.6% (<i>p</i> < 0.001), respectively. After IPTW, early corticosteroid use remained associated with a 3.1% (95% confidence interval [CI]: 2.4% to 3.8%, <i>p</i> < 0.001) higher mortality. Among patients with CS and concomitant sepsis, 27.6% received early corticosteroids, which was similarly associated with a higher mortality (weighted mean 5.8% [95% CI: 4.6% to 7.0%, p < 0.001]).ConclusionsApproximately 1 in 7 patients with CS received corticosteroids early during their admission, which was associated with higher in-hospital mortality.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1168-1177"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138020","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":"Response to Olgun et al.: Bronchoscopy During Pediatric Extracorporeal Membrane Oxygenation.","authors":"Melany Gaetani, Briseida Mema","doi":"10.1177/08850666261469113","DOIUrl":"10.1177/08850666261469113","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1199-1200"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430567","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":"Use of a Mixed Agent Prophylactic Laxative Regimen in the Medical Intensive Care Unit Leads to Reduced Length of Stay: A Single-Center Process Improvement Initiative.","authors":"Christopher J Costa, Rachael Hagen, Raymond Foley","doi":"10.1177/08850666261435501","DOIUrl":"10.1177/08850666261435501","url":null,"abstract":"<p><p>Impaired GI tract function is a common and often underappreciated symptom in the Medical Intensive Care Unit (MICU). The most visible manifestation of this dysfunction is reduced bowel movements. The occurrence of impaired GI function is associated, both independently and in association with delayed enteral feeding, with increased length of stay, morbidity and mortality. We report on a process implementation project conducted at a single academic center designed to: (I) increase visibility of bowel movement charting and (II) transition from a reactive to a proactive laxative administration regimen for prophylaxis against MICU associated constipation. Scheduled laxatives, polyethylene glycol and sennoside-docusate, were added to the MICU admission orderset and bowel movement charting was moved to a more readily accessible flowsheet in the electronic medical record. Six months of pre-intervention and post-intervention admissions to the MICU were reviewed to determine patient demographics, admitting diagnosis, Sequential Organ Failure Assessment (SOFA) score, laxative utilization, and time to first bowel movement. Following implementation of these changes, prophylactic laxative utilization significantly increased (<i>p</i> < .001) driven largely by the agents included in the orderset. This was associated with a decrease in MICU length of stay by an average of 21 h (<i>p</i> = .006) and median time to first bowel movement by 4 h (<i>p</i> = .026), but no changes in incidence of impaired transit (as defined by greater than 72 h without a bowel movement). This data represents an exciting first step in the use of mixed agent prophylactic laxative regimens.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1144-1150"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521186","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":"The Diagnosis and Management of Hepatorenal Syndrome: A Comprehensive Update for the Intensivist.","authors":"J Pedro Teixeira, Constantine J Karvellas, Juan Carlos Q Velez","doi":"10.1177/08850666251345408","DOIUrl":"10.1177/08850666251345408","url":null,"abstract":"<p><p>Intensivists are being increasingly tasked with caring for critically ill patients with cirrhosis (ie, acute-on-chronic liver failure), many of whom develop acute kidney injury (AKI). Among the most morbid and complex causes of AKI in patients with cirrhosis is hepatorenal syndrome (HRS-AKI). Though HRS-AKI accounts for a fraction of AKI cases in the setting of cirrhosis, recent data suggest that effective pharmacologic treatment of HRS-AKI requires rapid diagnosis to allow for prompt intervention. Consequently, a firm understanding of the diagnosis and treatment of HRS-AKI is vital for all intensivists. In this review, we summarize recent developments in the diagnosis and treatment of HRS-AKI. Chief among these is the recent realization that HRS-AKI is not a diagnosis of exclusion, but instead may coexist with other forms of AKI, such as acute tubular injury, or may develop in the context of pre-existing chronic kidney disease. Moreover, with multiple recent trials suggesting that administration of fixed doses of intravenous albumin to unselected patients with cirrhosis and AKI may cause harm via volume overload and pulmonary edema, no longer is a 48-h trial of intravenous albumin recommended for all patients with AKI and cirrhosis. Instead, the newest guidelines recommend thoughtful assessment of volume status in all patients with AKI and cirrhosis and determination of an HRS-AKI diagnosis within 24 h to allow for prompt initiation of effective therapy. Short of liver transplantation, treatment of HRS-AKI is with vasoconstrictive agents. Though commonly used, midodrine/octreotide should largely be abandoned due to lack of efficacy. While recent trials have confirmed the effectiveness of terlipressin, its use is associated with a risk of potentially fatal respiratory failure and therefore requires careful patient selection and monitoring. As such, treatment of HRS-AKI with norepinephrine in the intensive care unit will remain the primary treatment option for many patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1070-1090"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234357","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":"State-of-the-art Neurointervention for Extended Window and Large Ischemic Core.","authors":"Kiwon Lee, Danielle Mahon","doi":"10.1177/08850666251346147","DOIUrl":"10.1177/08850666251346147","url":null,"abstract":"<p><p>The implementation of endovascular therapy as a treatment for acute ischemic stroke has developed greatly in recent years. The primary trials demonstrated negative to mixed results, and it wasn't until the MR CLEAN trial that thrombectomy was established as a beneficial treatment. Since then, further studies have continued to provide additional data allowing for expansion of patient eligibility to receive such therapy. This manuscipt highlights the development and progression of the utilization of endovascular treatment in acute ischemic stroke.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1091-1099"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992654","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":"The Safety of Hypertonic Saline Administration Through Midline Catheters.","authors":"Suhali Kundu, Seda Akben, Jeffrey Shipley, Sasa Ivanovic, Katrina Hawkins, Daniel King, Danielle Davison, David Yamane","doi":"10.1177/08850666261432139","DOIUrl":"10.1177/08850666261432139","url":null,"abstract":"<p><p>IntroductionHypertonic saline (HTS) has been utilized in the treatment of several critical conditions including severe hyponatremia and elevated intracranial pressure. Current practice requires that HTS be administered through a central venous catheter (CVC). Midline catheters (MC) are a type of peripheral venous catheter (PIVC) placed in a large peripheral vein distal to the axillary vein. There are a few comprehensive studies investigating the efficacy of utilizing MCs for the administration of long-term HTS. MethodsA retrospective single center study performed at a tertiary care academic hospital, of patients admitted to the ICU for the administration of HTS through a MC. Data collected from 2019-2023 through a chart review of electronic medical records and recorded in REDCap.ResultsA total of 138 patients who received HTS via a MC were included in the analysis. Subjects were predominantly male (69.57%) and black (59.42%). The median age of the patient was 57 years ± 14.4 years old. The admission diagnoses included intracranial hemorrhage accounting for 67.39%, followed by altered mental status at 18.12%, trauma at 12.32% and sepsis at 7.25%.The concentrations of the HTS infusions were 2% NaCl in 54 patients, 3% NaCl in 82 patients, and 23% NaCl in 2 patients. The average duration of a continuous HTS infusion was 14 h and 34 min ± 15 h and 17 min. The average dosage rate was 86.03 ± 74.43 mL/h. Only one patient experienced thrombophlebitis. Thrombosis developed within the midline catheters for 5 patients. No complications related to drug extravasation or deep vein thrombosis were observed.ConclusionResults showed minor adverse events suggesting that MC may be a safe alternative for the administration of long-term HTS infusions. Midline catheters should be considered when weighing risk and benefits of HTS administration in the management of elevated intracranial pressure and severe hyponatremia.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1100-1104"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499069","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":"SOFA-2 Versus SOFA-1 for Mortality Prediction in Infection-Triggered ICU Patients.","authors":"Hakkı Meriç Türkkan, Umut Özgür, Olcay Dilken, Ahmet Doğukan Bayrak, Okan Derin","doi":"10.1177/08850666261435547","DOIUrl":"10.1177/08850666261435547","url":null,"abstract":"<p><p>BackgroundAccurate assessment of organ dysfunction is essential for risk stratification in critically ill patients. The traditional Sequential Organ Failure Assessment score (SOFA-1) is widely used but reflects clinical practices from the 1990s. The updated SOFA-2 incorporates revised thresholds aligned with current organ-support strategies; however, its prognostic performance in infection-focused intensive care unit (ICU) populations remains uncertain. We compared SOFA-1 and SOFA-2 for predicting 28-day mortality in ICU patients undergoing blood culture acquisition ≥48 h after admission.MethodsWe conducted a retrospective cohort study of adult ICU patients who underwent blood culture sampling ≥48 h after ICU admission between June 2022 and August 2024. SOFA-1 and SOFA-2 scores were calculated at the time of index blood culture. Mortality prediction was assessed using receiver operating characteristic analysis with paired DeLong comparisons. Associations with 28-day mortality were examined using logistic regression and Cox proportional hazards models adjusted for age and comorbidity burden. Clinical utility was evaluated using decision curve analysis.ResultsAmong 403 patients, 28-day mortality was 54%. SOFA-2 scores were lower than SOFA-1 in 70% of patients, resulting in frequent downward reclassification across severity strata. Discriminative performance for 28-day mortality was similar for SOFA-1 and SOFA-2 (AUC 0.707 vs 0.700; ΔAUC = 0.007; <i>p</i> = .031). Calibration and net clinical benefit were comparable between scores. In adjusted time-to-event analyses, only the very severe category (>10) was independently associated with mortality in both scoring systems, with a numerically higher hazard ratio for SOFA-2.ConclusionsIn this infection-triggered ICU cohort, SOFA-2 did not demonstrate consistent prognostic superiority over SOFA-1 for 28-day mortality prediction. Despite systematic score redistribution, overall discrimination and clinical utility were similar, with any apparent advantage of SOFA-2 confined to the highest-risk subgroup. Further validation in infection-enriched ICU populations is warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1151-1160"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277624","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":"Comparative Analysis of the Predictive Utility of Gastric Mucosal PH and Lactate in Septic Shock.","authors":"Zhang Yining, Tang Sha, Zhai Jianhua","doi":"10.1177/08850666261434931","DOIUrl":"10.1177/08850666261434931","url":null,"abstract":"&lt;p&gt;&lt;p&gt;ObjectiveTo provide novel insights for the diagnosis and management of patients with septic shock, this study analyzed the clinical characteristics of these patients and compared the predictive and combined value of blood lactate levels and gastric intramucosal pH (PHi) for in-hospital mortality.MethodsComparisons between groups were performed using independent sample &lt;i&gt;t&lt;/i&gt;-tests. Logistic regression analyses were conducted using Firth's penalized likelihood method to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for gastric mucosal PH and lactate levels. A variance inflation factor (VIF) test was performed to rule out potential issues of multicollinearity. Receiver operating characteristic (ROC) curves were generated to assess predictive performance, and the area under the curve (AUC) was calculated.ResultsPatients with septic shock who were admitted to Tianjin Medical University General Hospital's Emergency Intensive Care Unit between November 2022 and March 2024 were recruited for a prospective case-control study. There were 72 patients in all. Within 24 h of admission, baseline data, blood lactate levels, PH values of the stomach mucosa, and Sequential Organ Failure Assessment (SOFA) scores were documented. Patients were divided into two groups based on their 28-day in-hospital mortality: the death group (&lt;i&gt;n&lt;/i&gt; = 18) and the survival group (&lt;i&gt;n&lt;/i&gt; = 54). Among the 72 patients, 54 (75.0%) survived and 18 (25.0%) died. Independent &lt;i&gt;t&lt;/i&gt;-test results showed a significant difference in gastric mucosal PH between the two outcome groups (&lt;i&gt;t&lt;/i&gt; = 4.558, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), with lower PH levels observed in the death group. Lactate levels also differed significantly between groups (&lt;i&gt;t&lt;/i&gt; = -3.782, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), being higher in the death group. In the univariate Firth logistic regression model, gastric mucosal PH (OR = 3.40, &lt;i&gt;p&lt;/i&gt; &lt; 0.0001) was significantly associated with poor prognosis, whereas lactate (OR = 1.69, &lt;i&gt;p&lt;/i&gt; &gt; 0.05) did not reach statistical significance, as its 95% CI included 1.With ORs of 3.94 and 2.29, respectively, both variables remained significant in the bivariate model that included both, indicating a possible mutual attenuation effect and improved predictive power in comparison to univariate models. Lactate lost statistical significance (OR = 0.80, &lt;i&gt;p&lt;/i&gt; = 0.782), whereas stomach mucosal PHi remained a independent predictor of death (OR = 10.03, &lt;i&gt;p&lt;/i&gt; &lt; 0.05) after controlling for covariates in the multivariate model. These results suggest that while lactate's predictive significance may be muddled, gastric mucosal PH offers reliable and independent prognostic information. The variance inflation factor (VIF) test showed that all included variables had VIF values less than 5 (specifically, 1.15 for lactate and 1.22 for the SOFA score), indicating no severe multicollinearity in the model. ROC curve analysis further confirmed these results. The AUC for gastric mucosa","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1161-1167"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623343","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":"Acute Febrile Encephalopathy with Rigidity.","authors":"Dearbhla M Kelly, Eoin M Kelleher","doi":"10.1177/08850666251345448","DOIUrl":"10.1177/08850666251345448","url":null,"abstract":"<p><p>Febrile encephalopathy with rigidity can be the presenting feature of several life-threatening neurological emergencies such as neuroleptic malignant syndrome (NMS) and serotonin syndrome. Although the pathogenesis of these conditions is poorly understood, we review advances in our understanding of underlying genetic and other biological mechanisms. We also discuss the complex and expanding differential diagnoses which include other drug-induced hyperpyrexia or rigidity syndromes (eg malignant hyperthermia, parkinsonism-hyperpyrexia syndrome, malignant catatonia) as well as autoimmune syndromes. Finally, we consider potential predictive and preventative approaches along with best practice management strategies.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1053-1069"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191931","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}