Journal of pediatric and adolescent gynecology最新文献

{"title":"Clinician Perspectives on Adolescent Contraceptive Counseling Following Dobbs v. Jackson: Implications for Young People's Contraceptive Autonomy","authors":"Brooke W. Bullington BA ,&nbsp;Emily S. Mann PhD ,&nbsp;Madeline Thornton MD ,&nbsp;Joline Hartheimer MD ,&nbsp;Kavita Shah Arora MD, MBE, MS ,&nbsp;Bianca A. Allison MD MPH","doi":"10.1016/j.jpag.2024.10.007","DOIUrl":"10.1016/j.jpag.2024.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study is to understand whether clinicians who provide contraceptive counseling to adolescent patients perceive that the <em>Dobbs</em> decision has influenced their counseling.</div></div><div><h3>Study Design</h3><div>We conducted in-depth interviews with a convenience sample of 16 clinicians who provide contraceptive counseling to adolescents at the American Academy of Pediatrics annual conference in October 2022. We used thematic content analysis and an iterative process of constant comparison to identify themes inductively. This analysis focused on participants’ perception of if and how the <em>Dobbs</em> decision has or will influence their contraceptive counseling with adolescents.</div></div><div><h3>Results</h3><div>Most clinicians in our study reported that the <em>Dobbs</em> decision influenced their contraceptive counseling. This included promoting long-acting reversible methods more so than pre-<em>Dobbs</em>, and explicitly considering changing state-level abortion laws and restrictions. Many clinicians openly noted that their personal preferences influence their counseling, such as prioritizing pregnancy prevention and encouraging patients to use particular methods.</div></div><div><h3>Conclusion</h3><div>We found that most clinicians in our sample acknowledged that the <em>Dobbs</em> decision has influenced their contraceptive counseling practices with adolescents. Clinicians’ responses demonstrate that, in many instances, the <em>Dobbs</em> decision motivated them to focus on method effectiveness, leading to tiered and directive contraceptive counseling. We recommend practice changes to support comprehensive contraceptive care provision, provider trainings in unbiased counseling, and developmentally tailored decision aids are needed to ensure that adolescent patients’ autonomy is prioritized over a singular focus on pregnancy prevention.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 75-78"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Conservative Management of Second Trimester Spontaneous Abortion Complicated by Clostridial Sepsis","authors":"Jesseca R.A. Pirkle ,&nbsp;Antoun Al Khabbaz MD, FACOG","doi":"10.1016/j.jpag.2024.08.002","DOIUrl":"10.1016/j.jpag.2024.08.002","url":null,"abstract":"<div><div><em>Clostridium perfringens</em> is responsible for 5% of septic abortions. Emergent hysterectomy is often required for patient survival. This can be devastating to patients desiring future fertility. We report a 15-year-old female patient at 17 weeks and 6 days of gestation with a diagnosis of sepsis on admission. She was managed with broad-spectrum antibiotics followed by immediate evacuation of the retained placenta. Blood and placental cultures confirmed clostridial species. Successful conservative management allowed for a term pregnancy 2 years later, resulting in a healthy newborn. Few reports describe effective conservative management resulting in uterine sparing and good subsequent pregnancy outcomes.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 98-100"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Evaluation of “Period Kits” for Adolescents with Intellectual and Developmental Disabilities: An Embedded Mixed Methods Study","authors":"Sophia Boxerman BA ,&nbsp;Brittany Flores MD ,&nbsp;Xihan Yang PhD ,&nbsp;Elena M. Masters BA ,&nbsp;Eileen T. Crehan PhD ,&nbsp;Amanda V. French MD","doi":"10.1016/j.jpag.2024.09.004","DOIUrl":"10.1016/j.jpag.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Patients with intellectual and developmental disabilities (IDD) experience greater unmet medical service needs and decreased care satisfaction compared to those without these diagnoses. There are no evidence-based resources widely available to prepare children with IDD for menarche.</div></div><div><h3>Methods</h3><div>This IRB approved embedded mixed methods study investigated the efficacy of “period kits” for patients with IDD to ease anxiety and improve preparedness for menarche. Custom kits included a colorful pouch, an original social story, a resource list, and common period management items. Nine family pairs (child/adult) were enrolled. Surveys performed before and after kit exploration queried participants’ understanding of menarche, and feedback about the kit itself. Data were analyzed using thematic analysis.</div></div><div><h3>Results</h3><div>Surveys of the children showed limited knowledge about periods at baseline. Additional themes prior to provision of the “period kit” included limited knowledge, negative perceptions and emotional responses about menstruation and puberty and hesitancy approaching period conversations. After kit exposure, there was an improvement in period related knowledge and promotion of interhousehold discussion with continued room for conversation.</div></div><div><h3>Conclusions</h3><div>Many kids with IDD have limited baseline knowledge about menstruation. Custom “period kits” may be helpful in stimulating conversation within families and promoting increased knowledge about menses to children and families. Limitations of this study are small size and qualitative nature, potentially limiting generalizability and external data validity.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 45-51"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preconception Counseling in the Setting of Unilateral Cervical Atresia in a Patient with Uterus Bicornuate Bicollis: A Case Report.","authors":"Hana Murphy, Kathleen O'Brien, Yolanda Smith, Monica Rosen","doi":"10.1016/j.jpag.2025.01.172","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.01.172","url":null,"abstract":"<p><strong>Background: </strong>Müllerian anomalies are rare congenital anomalies of the reproductive tract that may significantly impact fertility, obstetric management, and pregnancy outcomes. Thus, contraception and preconception counseling tailored to patients' reproductive goals is needed.</p><p><strong>Case: </strong>We describe a rare case of a sexually active patient with an atypical uterus bicornuate bicollis with unilateral cervical atresia and communication between bilateral cervices and discuss key aspects of pregnancy counseling.</p><p><strong>Summary and conclusion: </strong>Patients with this Müllerian anomaly should be counseled on possible pregnancy in either uterine horn, need for high-risk obstetric care and surgical management in abortion, and consideration of surgery or in vitro fertilization to optimize implantation in the desired uterine horn. Further research should examine specific fertility and obstetric outcomes in patients with this anomaly.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital uterine anomaly with concurrent longitudinal and transverse vaginal septa: Presentation of two Cases.","authors":"Aikaterini-Gavriela I Giannakaki, Dimitris Baroutis, Andreas Kalampalikis, Lina Michala","doi":"10.1016/j.jpag.2025.01.171","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.01.171","url":null,"abstract":"<p><strong>Introduction: </strong>Didelphic and septate uterus are congenital uterine anomalies caused by the failure of fusion of the Mullerian ducts or resorption of the median septum post-fusion respectively. These can occasionally be associated with a longitudinal vaginal septum. The combination with a transverse vaginal septum is rare, leads to menstrual obstruction, and presents with severe abdominal pain in early adolescence.</p><p><strong>Cases: </strong>We present the cases of two 12-year-old girls, presenting with a uterine anomaly and concomitant longitudinal vaginal septum and haematocolpos due to the presence of a transverse vaginal septum.</p><p><strong>Discussion/conclusion: </strong>Congenital uterine anomalies can coexist with a longitudinal septum and rarely with a transverse vaginal septum causing obstruction. Early diagnosis and surgical correction of transverse vaginal septum are decisive for the relief of symptoms and the prevention of future complications. Physicians should always consider the presence of complex congenital anomalies in cases of menstrual obstruction. The coexistence of uterine and vaginal anomalies in this study are not adequately described by the existing classification systems, underlining the need for a more inclusive classification system.</p><p><strong>Categories: </strong>Obstetrics & Gynecology, Pediatrics, Pediatric & Adolescent Gynecology.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An intervention to increase fertility preservation counseling prior to starting gender-affirming hormone therapy.","authors":"Allison Pierce, Marissa Holden, An Pham, Richard Lucidi, Erika P New","doi":"10.1016/j.jpag.2025.01.173","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.01.173","url":null,"abstract":"<p><strong>Purpose: </strong>To determine if an educational handout regarding fertility preservation options affected rates of fertility preservation counseling, REI referrals, and gamete cryopreservation in transgender and non-binary adolescents.</p><p><strong>Methods: </strong>This was a retrospective observational pre/post intervention study of patients seen at a single academic gender-affirming care clinic and were prescribed gender-affirming hormone therapy from January 2022 to January 2023 and April 2023 to April 2024.</p><p><strong>Exposure: </strong>Educational handout MAIN OUTCOME MEASURES: The primary outcome was the rate of fertility preservation counseling.</p><p><strong>Results: </strong>There were 208 eligible patients, with 143 in the pre-intervention group and 65 in the post-intervention group. There was a significant increase in fertility preservation counseling rates after implementing the educational handout (31.5% counseling rate pre-intervention vs 58.46% post-intervention, percentage change 26.9%, SE 7.3%, p <0.001). Of the patients counseled on fertility preservation, there was no significant difference in REI referral rates (percentage change -3.2%, SE 6.5%, p=0.6208) or in gamete cryopreservation.</p><p><strong>Discussion: </strong>Increased access to educational materials increases the rate of fertility preservation counseling in transgender and non-binary adolescents. More research is needed to determine how to improve resources and empower adolescents and their families to make informed decisions regarding reproductive health.</p><p><strong>Implications and contribution: </strong>Clinicians who provide gender-affirming medical care should be equipped with educational resources they can offer their patients. Increased education and counseling may assist patients in making an informed decision regarding their fertility, regardless of whether or not they choose to preserve their fertility.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Length of hospital stay in adolescents receiving high-dose oral contraceptive pills with and without conjugated equine estrogen for the treatment of acute abnormal uterine bleeding.","authors":"Misha Khalighi, Ramon Durazo-Arvizu, Julie Jaffray, Anita Nelson, Marvin Belzer, Claudia Borzutzky","doi":"10.1016/j.jpag.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.01.011","url":null,"abstract":"<p><strong>Study objective: </strong>Compare the length of hospital stay of adolescents admitted for severe anemia (hemoglobin ≤ 8 g/dL) due to acute abnormal uterine bleeding (AUB) treated with high-dose combined oral contraceptive pills (HD-OCPs) versus those treated with HD-OCPs and intravenous conjugated equine estrogen, also referred to as dual therapy.</p><p><strong>Design, setting, and participants: </strong>This is a single institution retrospective cohort study of adolescents hospitalized for the management of acute AUB and severe anemia between July 1^st, 2004, to January 1^st, 2020. Subjects were excluded if they were pregnant, had a malignancy, thrombocytopenia, treated with other hormonal therapies, or if bleeding stopped prior to admission.</p><p><strong>Main outcome measures: </strong>Primary outcome was length of hospital stay. Secondary outcomes were rates of complications and side effects secondary to the hormonal medication.</p><p><strong>Results: </strong>There were 113 subjects included in the study. Seventy-four (65%) received HD-OCPs only, and the remainder received dual therapy. Mean subject age was 13.8 years for both groups. Those who received HD-OCPs alone were hospitalized for an average of 38.4 hours versus 45.6 hours for those who received dual therapy (p=0.0007). The only reported side effect in either group was nausea and/or vomiting, which was higher in the group who received dual therapy than those treated with HD-OCPs alone (85% versus 51.4% respectively, p-value=0.001).</p><p><strong>Conclusion: </strong>Adolescents who received dual therapy had a longer hospital stay than those who received HD-OCPs alone. There were no complications related to the medication regimens in either group, but those receiving dual therapy had significantly higher rates of anti-emetic use.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving pubertal health education for adolescent girls through a gamified learning approach.","authors":"Sana Nazmi, Atefeh Omrani, Fereshteh Bahmanesh, Hossein-Ali Nikbakht, Manoosh Mehrabi, Romina Hamzehpour","doi":"10.1016/j.jpag.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.01.003","url":null,"abstract":"<p><strong>Background: </strong>Adolescence is a crucial phase in a person's life. The purpose of this study was to evaluate the efficacy of gamification in the education of teenage females on pubertal health.</p><p><strong>Methods: </strong>This clinical trial, conducted on 90 adolescent girls in XXX, XXX, during the 2023-2024 year, used a multistage cluster sampling method to assign participants randomly to intervention and control groups. The intervention group received weekly puberty health education over four weeks through a gamification platform. Data collection involved a socio-demographic questionnaire as well as puberty awareness and practice assessments, completed by both groups before the intervention, immediately, and one month after study.</p><p><strong>Findings: </strong>The average puberty awareness and practice scores of the students in the intervention group significantly increased significantly, immediately and four-week after the intervention compared to the control group (P<0.001). The standardized effect sizes for awareness and practice were 0.74 and 0.25, respectively. In the intervention group, puberty awareness siginificanlty increased by 5.28 (95% CI:4.51 to 6.06) and 5.06 points (95%CI:4.31to 5.82) when comparing the two time periods before and immediately after, and before and four weeks after the intervention, respectively. Similarly, the puberty practice score significanly increased by 6.82 (95% CI:4.24 to 9.40) and 8.73 points (95% CI:5.94 to 11.51) in the same time comparisons (P<0.001).</p><p><strong>Conclusion: </strong>This study demonstrated the effectiveness of using gamification in puberty health education on increasing puberty awareness and practice among adolescent girls. This innovative educational approach can enhance puberty health education programs, leading to better health outcomes for adolescent girls.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Imperforate Hymen at a Single Referral Center.","authors":"Sarah R Casey, Mary E Fang, Kassandra Goytia, Gianina Monestime, Jennifer E Dietrich","doi":"10.1016/j.jpag.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.01.004","url":null,"abstract":"<p><strong>Study objective: </strong>Imperforate hymen (IH) is a rare congenital anomaly that results in vaginal outlet obstruction. IH can cause significant morbidity if not managed appropriately, which depends on accurate identification of the condition. However, data on the accuracy of IH diagnosis is limited. This study aimed to investigate the accuracy of IH diagnosis at a single referral center.</p><p><strong>Methods: </strong>Institutional Review Board approval was obtained for this retrospective chart review. ICD-10 codes identified patients with \"hymenal abnormalities\" between 2018 and 2023 at a single children's hospital. The primary outcome was rate of misdiagnosis of IH through comparison of diagnosis codes and chart review. Descriptive statistics and Chi-square or Fischer's exact test were utilized as appropriate.</p><p><strong>Results: </strong>165 patients met inclusion criteria. 57 were initially diagnosed with IH and of those patients, 28 (49.1%) were misdiagnosed. Additionally, 5 patients initially diagnosed with a different condition were later found to have IH. There was no significant difference in misdiagnosis rate between premenarchal and menarchal patients (p=0.77). There was a significantly higher rate of misdiagnosis amongst generalist Ob/Gyn providers compared to pediatric gynecologists (p=0.04).</p><p><strong>Conclusion: </strong>Many patients with IH may initially be seen by primary care providers. Due to the rarity of the condition and a lack of provider exposure to IH, misdiagnosis is common. IH is important to distinguish from other anomalies of the reproductive tract, as the management differs. Misdiagnosis of IH may lead to incorrect surgical approach and subsequent complications. Training and education surrounding IH, along with referral to pediatric gynecology, may help reduce misdiagnosis.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menstrual Health Symptoms and Literacy among Young Women in Aotearoa New Zealand: A Nationwide Cross-Sectional Survey.","authors":"Theresa Mittermeier, Alexandra Hawkey, Deborah Bush, Joy Marriott, Jordan Tewhaiti-Smith, Wendy Burgess, Allie Eathorne, Mike Armour","doi":"10.1016/j.jpag.2024.12.019","DOIUrl":"10.1016/j.jpag.2024.12.019","url":null,"abstract":"<p><strong>Study objective: </strong>To explore menstrual cycle symptoms, information sources, and menstrual health literacy in young women (age 13-25) and those who menstruate in Aotearoa New Zealand DESIGN AND SETTING: A cross-sectional online survey in Aotearoa New Zealand was used.</p><p><strong>Participants: </strong>The participants were 1334 respondents (age 13-25 years, mean age 19.8) who had had at least 3 periods and were currently living in New Zealand.</p><p><strong>Interventions: </strong>An online survey was hosted by Qualtrics between October 2021 and January 2022.</p><p><strong>Main outcome measures: </strong>Information was obtained on menstrual cycle characteristics and symptoms and menstrual health literacy.</p><p><strong>Results and conclusions: </strong>Respondents reported high rates of regular dysmenorrhea (89%), fatigue/tiredness (78.1%), and mood changes (72.5%) associated with menstruation. A higher proportion of rangatahi (younger generation) Māori reported irregular cycles (53.5%) compared with non-Māori respondents (41.7%). Normalization of symptoms, especially pain (80.2%), was high. Most respondents recognized the need to see a doctor for period pain that impacted their daily lives (84.7%). However, noncyclical pelvic pain (45.7%), heavy bleeding (39%), and intermenstrual bleeding (29%) were less likely to be recognized as symptoms that require a doctor's visit. The main sources of menstrual health knowledge before menarche were a family member (74.2%) and health and physical education classes at school (63.7%). Many young people reported receiving little or no information about periods before menarche (37.9%), with very few respondents receiving information on how to manage menstrual symptoms (15.1%). Menstrual symptoms are common, and the provision of culturally safe information and opportunities to learn is important for young people, whānau, schools, and health care practitioners.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}