Journal of neurosurgery. Pediatrics最新文献

{"title":"Editorial. Utilization of advanced practice providers within neurosurgical practice.","authors":"Mari L Groves","doi":"10.3171/2024.11.PEDS24515","DOIUrl":"https://doi.org/10.3171/2024.11.PEDS24515","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-3"},"PeriodicalIF":2.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630503","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":"Advanced practice providers in pediatric neurosurgery: a single-institution analysis of clinical and surgical productivity.","authors":"Sarah A Layon, Kristina Marsack, Matthew J Parham, Heather R Burns, Emily E McClernon, Larry H Hollier, Howard L Weiner","doi":"10.3171/2024.10.PEDS24345","DOIUrl":"https://doi.org/10.3171/2024.10.PEDS24345","url":null,"abstract":"<p><strong>Objective: </strong>Advanced practice providers (APPs) have experienced remarkable growth in surgical fields, collaborating closely with surgeons to optimize patient care. Although several specialties have evaluated the roles and safety of APPs in team-based care models, few studies have explored their impact on clinical and surgical productivity, especially in pediatric settings. This study aimed to evaluate the influence of enhanced APP utilization within the division of neurosurgery at a leading academic pediatric institution in the United States.</p><p><strong>Methods: </strong>Productivity metrics were obtained from the Surgery Department Executive Committee annual reports from October 2011 to September 2023. Descriptive analyses were conducted to identify divisional trends in provider numbers, surgical and clinic volumes, total operating room (OR) hours, gross charges, and work relative value units.</p><p><strong>Results: </strong>Since 2012, the division of neurosurgery has witnessed consistent growth in clinic encounters per APP and in overall clinic volume, peaking in 2023. The MD surgical conversion rate was lowest in 2016 (1 OR case for every 6.39 encounters) and peaked in 2019 (1 OR case for every 3.57 encounters). Financial metrics, adjusted for inflation, demonstrated notable increases in work relative value units and gross charges over the decade.</p><p><strong>Conclusions: </strong>Increased utilization and autonomy of APPs within the division of neurosurgery have facilitated greater procedural productivity and access to patient care. This study emphasizes the importance of integrating well-trained APPs into patient care models, allowing them to leverage their full expertise and training, particularly in pediatric surgical settings.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630490","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":"Comparison of outcomes after spinal column shortening for secondary tethered cord syndrome in pediatric versus adult patients: the University of Oklahoma experience.","authors":"Burak Ozaydin, Kishore Balasubramanian, Andrew Jea","doi":"10.3171/2024.12.PEDS24523","DOIUrl":"https://doi.org/10.3171/2024.12.PEDS24523","url":null,"abstract":"<p><strong>Objective: </strong>Spinal column shortening (SCS) is an emerging alternative to traditional untethering in cases of secondary tethered cord syndrome. It was originally described and applied in adult patients with spinal dysraphism. In the more recent past, SCS has been used in pediatric patients. A comparison between pediatric and adult patients undergoing SCS has not been performed previously.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 19 patients (11 children, 8 adults) who underwent SCS procedures from November 30, 2020, to July 21, 2024, at the University of Oklahoma. Outcomes were assessed based on changes in pain, overall symptom burden, subjective bowel/bladder symptoms, and objective testing of urodynamic function. The median follow-up period was 30 months (range 10-41 months).</p><p><strong>Results: </strong>Most vertebral column resections were performed at the T12 level (79%), with T10-L2 being the most common fusion level (68%). There were no significant preoperative differences in clinical features between children and adults. Both children and adults experienced significant reductions in pain (p = 0.002 and p = 0.018, respectively) and overall symptom burden (p < 0.001 and p = 0.003, respectively). Complete symptom resolution was achieved in 63% of children and 25% of adults. Improvements in objective urodynamic function were observed but were not statistically significant in either group (p = 0.082 for children, p = 0.351 for adults). However, only children reported significant improvement in bowel/bladder function (p < 0.01). The difference in surgical metrics or postoperative clinical features was not significant between children and adults.</p><p><strong>Conclusions: </strong>SCS procedures appear to be effective in reducing pain and overall symptom burden in both pediatric and adult patients with complex tethered cord syndrome. SCS seems to improve bowel/bladder symptoms in children specifically. Further research with larger cohorts and longer follow-up periods is warranted to confirm these findings and assess long-term outcomes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630497","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":"Letter to the Editor. The young Chiari patient, an oft-forced hand?","authors":"Aaron M Yengo-Kahn, Douglas L Brockmeyer, Robert J Bollo","doi":"10.3171/2024.12.PEDS24645","DOIUrl":"https://doi.org/10.3171/2024.12.PEDS24645","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-2"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575885","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 surgical approaches in nonsyndromic multiple-suture synostosis: a systematic review and meta-analysis.","authors":"Felipe Gutierrez Pineda, Brodus A Franklin, Anuraag Punukollu, Hsien-Chung Chen, Gustavo Giraldo Garcia, Anna Lydia Machado Silva, Mark Proctor, Esteban Quiceno","doi":"10.3171/2024.11.PEDS24364","DOIUrl":"https://doi.org/10.3171/2024.11.PEDS24364","url":null,"abstract":"<p><strong>Objective: </strong>Nonsyndromic multiple-suture synostosis (MSS) is one of the rarest types of craniosynostosis. While both endoscopic and open surgical approaches have demonstrated efficacy for MSS patients, a comprehensive comparison of perioperative outcomes between the two approaches has yet to be fully explored. The aim of this systematic review and meta-analysis was to assess the available evidence among the two surgical approaches to better inform the management of complex craniosynostosis.</p><p><strong>Methods: </strong>PubMed, Embase, and Scopus were searched for studies published from the first reports through February 2024 that reported surgical outcomes of either endoscopic or open surgery for nonsyndromic MSS. The main outcome was the reoperation rate, with secondary endpoints including transfusion rates, intraoperative complications, and overall complications, with a subgroup analysis conducted for patients with nonsyndromic bicoronal synostosis.</p><p><strong>Results: </strong>Sixteen studies involving 310 patients were analyzed. Patients undergoing open surgery were older than those treated with endoscopy (mean age 10.39 vs 3.21 months). The pooled analysis showed a reoperation rate of 11% (95% CI 4%-23%, I2 = 25%) for endoscopic surgery compared with 22% (95% CI 14%-31%, I2 = 0) for open surgery (p = 0.11). Transfusion rates were 26% (95% CI 13%-45%, I2 = 50%) for endoscopic surgery and 50% (95% CI 22%-78%, I2 = 71%) for open surgery (p = 0.18). Intraoperative complications were similar: 17% (95% CI 7%-34%, I2 = 0%) for endoscopic vs 15% (95% CI 4%-42%, I2 = 76%) for open surgery (p = 0.85). Overall complication rates were 15% (95% CI 7%-31%, I2 = 45%) for endoscopic surgery and 20% (95% CI 9%-38%, I2 = 65%) for open surgery (p = 0.59). In the subgroup analysis of bicoronal synostosis, the reoperation rate was 10% (95% CI 4%-21%, I2 = 0%) for endoscopic surgery versus 16% (95% CI 7%-32%, I2 = 0%) for open surgery (p = 0.39).</p><p><strong>Conclusions: </strong>While both surgical approaches are reasonable options for nonsyndromic MSS, this meta-analysis suggests that endoscopic surgery could be associated with lower morbidity when compared with open surgery. Future studies with longer follow-up periods will be needed to validate these findings and contribute to the understanding of complex craniosynostosis management.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575884","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":"Building consensus regarding the definition of abnormal craniocervical motion in pediatric patients with Chiari malformation: a modified Delphi study.","authors":"Nikita G Alexiades, Daniela I Anderson, Amy D'Ambrosio, Rajiv Iyer, David F Bauer, Christopher M Bonfield, Sandip Chatterjee, Richard G Ellenbogen, Paul Grabb, Gerald Grant, Todd C Hankinson, Andrew Jea, David D Limbrick, Cormac Maher, Jonathan E Martin, Dominic N P Thompson, Douglas L Brockmeyer, Richard C E Anderson","doi":"10.3171/2024.11.PEDS24478","DOIUrl":"https://doi.org/10.3171/2024.11.PEDS24478","url":null,"abstract":"<p><strong>Objective: </strong>Abnormal craniocervical motion (ACCM) in the setting of pediatric Chiari type 1 and 1.5 malformation (CM-1/1.5) is generally regarded to be uncommon. The focus of this modified Delphi study was to investigate and build consensus regarding the definition of ACCM in pediatric patients with CM-1/1.5 and the clinical and radiographic methods to identify it.</p><p><strong>Methods: </strong>An international group of 14 pediatric neurosurgeons with clinical and research expertise in the management of CM was asked to participate. The study focused only on ACCM in the setting of CM-1 and excluded other types of CM. An initial survey of current practices was administered, and based on these responses, a follow-up survey of potential consensus statements was distributed. Consensus was defined as ≥ 80% of participants reaching agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). A final hybrid virtual/in-person meeting was held for discussion and to generate final consensus statements.</p><p><strong>Results: </strong>Following the final Delphi round, 22 statements reached consensus following discussion and modification of previous statements. Statements that reached consensus included the identification of patient populations that may benefit from screening, recommended imaging for screening along with useful radiographic parameters, and a consideration of trial cervical immobilization in symptomatic patients with supportive imaging. An additional modification to all statements emphasizing the focus on ACCM was agreed upon. All participants stated that they would be willing or somewhat willing to change their practices based on consensus guidelines.</p><p><strong>Conclusions: </strong>In this study, an international group of pediatric neurosurgeons reached consensus on 22 expert opinion-based statements regarding ACCM in pediatric patients with CM-1. Further study using a standardized approach to screening may facilitate a better understanding of the true incidence and impact of ACCM in CM-1.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575883","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":"Letter to the Editor. Gender disparity: batten down the hatches, fair winds and following seas!","authors":"Noor Ul Huda Maria, Noor Ul Ain Fatima, Qurrat Ul Ain Siddiq","doi":"10.3171/2024.12.PEDS24612","DOIUrl":"https://doi.org/10.3171/2024.12.PEDS24612","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-2"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527851","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":"Optimal management of hydrocephalus in children with posterior fossa tumors: an international retrospective multicenter study.","authors":"Kasper Amund Henriksen, Arani Kulamurugan, Maia Poon, Harishchandra Lalgudi Srinivasan, Adam J Fleming, Sheila K Singh, Gorm Von Oettingen, Jane Skjøth-Rasmussen, Conor Mallucci, René Mathiasen, Jon Foss-Skiftesvik","doi":"10.3171/2024.12.PEDS24424","DOIUrl":"https://doi.org/10.3171/2024.12.PEDS24424","url":null,"abstract":"<p><strong>Objective: </strong>Hydrocephalus in children with posterior fossa tumors (PFTs) is commonly treated with extraventricular drain (EVD) placement, endoscopic third ventriculostomy (ETV), or tumor resection alone. However, the optimal treatment approach remains undetermined. Therefore, the objective of this study was to investigate the relationship between management of preoperative hydrocephalus in children with PFTs and the need for early postoperative CSF diversion and permanent drainage.</p><p><strong>Methods: </strong>This international multicenter retrospective cohort study included all pediatric patients (aged < 18 years) who underwent primary resection of a posterior fossa tumor at Alder Hey Children's Hospital, United Kingdom, 2008-2018; Rigshospitalet University Hospital, Denmark, 2011-2020; Aarhus University Hospital, Denmark, 2011-2020; and McMaster University Medical Centre, Canada, 2003-2020. The primary outcome was early postoperative CSF diversion (ETV, EVD, or shunt of any kind within 30 days of tumor resection). The secondary outcome was the permanent drainage (ventriculoperitoneal shunt) rate within 30 days after resection. Univariate and multivariate logistic regression analyses were performed.</p><p><strong>Results: </strong>In total, 310 children with PFTs were included, of whom 234 (75.5%) had preoperative hydrocephalus. Preoperative hydrocephalus was successfully treated in more than 85%. Thirty-eight children (12.3%) required permanent drainage, with a higher incidence in those treated with preoperative EVD. However, no statistically significant association was found between choice of preoperative hydrocephalus management (EVD vs ETV vs tumor resection alone) and persistent hydrocephalus requiring either early postoperative CSF diversion surgery or permanent CSF drainage.</p><p><strong>Conclusions: </strong>This large international multicenter study did not demonstrate a significant association between choice of management of preoperative hydrocephalus (EVD, ETV, or tumor resection alone) and persisting hydrocephalus requiring surgical intervention after tumor resection.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527830","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 AANS/CNS Section on Pediatric Neurological Surgery domestic traveling fellowship: history and survey results of past recipients.","authors":"Eric M Thompson, Agnieszka Stadnik, Jason E Blatt, Edward S Ahn","doi":"10.3171/2024.11.PEDS24455","DOIUrl":"https://doi.org/10.3171/2024.11.PEDS24455","url":null,"abstract":"<p><strong>Objective: </strong>The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) Section on Pediatric Neurological Surgery domestic traveling fellowship was created to cover the travel and living expenses for a North American neurosurgery resident for 1 month at another institution to gain experience in pediatric neurosurgery. The objective of this work was to guide future direction by surveying past recipients about the fellowship and its impact on their training and career.</p><p><strong>Methods: </strong>Historical data have been maintained by the AANS/CNS Executive Committee and past and current chairs of the Traveling Fellowship Subcommittee. A 10-question REDCap survey was emailed to all previous fellowship recipients.</p><p><strong>Results: </strong>There have been 58 recipients of the traveling fellowship since 1998. The most common host program was Boston Children's Hospital (n = 21), followed by The Hospital for Sick Children (n = 12). Excluding recent recipients after 2017 who may still be working toward certification, 20 of 38 (53%) recipients have been certified by the American Board of Pediatric Neurological Surgery (ABPNS). Twenty-four of 49 (49%) recipients completed the survey. Twenty (83.3%) respondents were either ABPNS certified or planning to seek certification, 17 (70.8%) respondents' practices consisted of > 50% patients aged ≤ 21 years, and 18 (75%) spent 4-8 weeks at the host program, which was longer than the 1 month funded by the stipend. Twenty-two (91.7%) respondents would recommend the traveling fellowship to a resident interested in pediatric neurosurgery, and 18 (75%) believed the traveling fellowship helped them decide to pursue a career in pediatric neurosurgery, while 17 (70.8%) found that the professional connections they made were the most useful aspect of the fellowship. Fifteen (62.5%) respondents believed that the stipend of $2500 was inadequate to cover the cost of traveling and housing.</p><p><strong>Conclusions: </strong>The majority of respondents are currently practicing pediatric neurosurgeons, would recommend the traveling fellowship to residents interested in neurosurgery, and believed that the experience helped them decide to pursue a career in pediatric neurosurgery. Opportunities for improvement include increasing the stipend to more appropriately fund rotations that have mostly been longer than 1 month.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527833","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":"Optimal timing of endoscopic sagittal suturectomy.","authors":"Patrick F O'Brien, Saige A Teti, Callum Dewar, Kristen Stabingas, Md Sohel Rana, Suresh N Magge, Daniel A Donoho, Hasan R Syed, Chima Oluigbo, John S Myseros, Gary F Rogers, Robert F Keating","doi":"10.3171/2024.11.PEDS24272","DOIUrl":"https://doi.org/10.3171/2024.11.PEDS24272","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic sagittal suturectomy (ESS) is commonly offered for sagittal craniosynostosis in infants, but the optimal timing of surgery remains controversial, with many clinicians only offering ESS surgery before 3 months of age. This study investigated whether patient age predicts craniometric correction and, more specifically, whether patients > 3 months of age at surgery manifest less correction. The effects of age on blood transfusion were also investigated.</p><p><strong>Methods: </strong>A single-center retrospective review identifying patients with sagittal craniosynostosis who underwent ESS between 2009 and 2023 at Children's National Medical Center was performed. The authors stratified patients by age groups to compare outcomes and transfusion rates. Additionally, receiver operating characteristic (ROC) area under the curve (AUC) analysis was performed to identify optimal age cutoffs.</p><p><strong>Results: </strong>In total, 107 patients were included. Stratifying age group by 0-2 months, 2-3 months, and > 3 months revealed that the > 3-month age group was less likely to achieve the target cephalic index (CI) at the final follow-up (48.8% vs 61.5% vs 25.0%, p = 0.031) and had less mean percentage CI change at the 6-month follow-up (17% ± 8% vs 18% ± 8% vs 12% ± 6%, p = 0.011), helmet discontinuation (18% ± 9% vs 18% ± 8% vs 12% ± 6%, p = 0.008), 1-year follow-up (15% ± 9% vs 17% ± 7% vs 10% ± 7%, p = 0.005), and final follow-up (14% ± 9% vs 15% ± 7% vs 8% ± 7%, p = 0.004). There were no differences in outcomes between groups when stratified as 0-2 months versus > 2 months of age. The only difference in outcomes between groups when stratified as 0-3 months versus > 3 months of age was the mean percentage change in CI at helmet removal (18% ± 8% vs 15% ± 7%, p = 0.044). Patients requiring transfusion were likely to be younger (median age 2 vs 3 months, p = 0.028). ROC curve analysis identified an age cut-point of 3.75 months as optimal for achieving the target CI correction at the final follow-up (AUC 0.58) and 2.75 months for transfusion avoidance (AUC 0.65).</p><p><strong>Conclusions: </strong>Patients > 3 months of age may benefit from ESS for sagittal craniosynostosis. Further investigation is warranted to identify the optimal age for surgery and to investigate other variables influencing outcomes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472578","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}