Medical mycology最新文献

{"title":"The evolution of HIV-associated cryptococcal meningitis in Uganda from 2010 to 2022.","authors":"Stewart Walukaga, Ann Fieberg, Abdu Musubire, Lillian Tugume, Kenneth Ssebambulidde, Enock Kagimu, John Kasibante, Morris K Rutakingirwa, Edward Mpoza, Jane Gakuru, Andrew Akampurira, Samuel Jjunju, James Mwesigye, Conrad Muzoora, Edwin Nuwagira, Ananta S Bangdiwala, Darlisha A Williams, Joshua Rhein, David B Meya, David R Boulware, Kathy Huppler Hullsiek, Radha Rajasingham","doi":"10.1093/mmy/myae115","DOIUrl":"10.1093/mmy/myae115","url":null,"abstract":"<p><p>Given extensive improvements in access to antiretroviral therapy (ART) over the past 12 years, the HIV and cryptococcal meningitis landscapes have dramatically changed since 2010. We sought to evaluate changes in clinical presentation and clinical outcomes of people presenting with HIV-associated cryptococcal meningitis between 2010 and 2022 in Uganda. We analyzed three prospective cohorts of HIV-infected Ugandans with cryptococcal meningitis during 2010-2012, 2013-2017, and 2018-2022. We summarized baseline demographics, clinical characteristics at presentation, and 2-week and 16-week mortality. Overall, 2022 persons had confirmed cryptococcal meningitis between 2010 and 2022. In the most recent 2018-2022 cohort, 48% presented as ART-naïve, and the median CD4 cell count was 26 cells/µl. Participants in the 2018-2022 cohort had the lowest cerebrospinal fluid (CSF) opening pressure (median 22 cmH2O) and the highest percentage with sterile CSF quantitative cultures (21%) compared with earlier cohorts (P < .001 for both), signifying a less severely ill population presenting with cryptococcal meningitis. Two-week mortality was lowest among participants with cryptococcal meningitis enrolled in a clinical trial in the 2018-2022 cohort at 13% compared to 26% in both 2010-2012 and 2013-2017 (P < .001). While AIDS-related deaths have dramatically declined over the past 12 years, cryptococcosis persists, presenting challenges to HIV program implementation. Two-week mortality has improved in the most recent cohort, likely due to the establishment of cryptococcal screening programs, better supportive care including scheduled lumbar punctures, and the availability of flucytosine-an essential component of antifungal therapy.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951433","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":"Evaluation of the diagnostic performance of a semi-quantitative lateral flow assay for the detection of Cryptococcus antigen in serum and cerebrospinal fluid specimens.","authors":"Maria Camila Castañeda-Torres, Julián Arango, Alejandra Zuluaga, Álvaro Rúa-Giraldo, Diego H Caceres","doi":"10.1093/mmy/myae116","DOIUrl":"10.1093/mmy/myae116","url":null,"abstract":"<p><p>Cryptococcosis predominantly affects immunocompromised individuals, particularly those with advanced HIV disease, with meningitis being the most severe form and linked to high mortality. Diagnosis typically relies on rapid Cryptococcus antigen (CrAg) testing, and antigen titer quantification helps in early detection and assessing disease severity. However, conventional titer methods are often more expensive than qualitative antigen detection. This study assessed the diagnostic performance of a semi-quantitative lateral flow assay (CrAgSQ LFA, IMMY™) for CrAg detection in serum and cerebrospinal fluid (CSF) collected between 2014 and 2022. The CrAgSQ LFA was compared to the standard CrAg LFA (IMMY™) and Clarus Cryptococcal Ag enzyme immunoassay (EIA-CrAg, IMMY™). The CrAgSQ LFA demonstrated 100% sensitivity and specificity in both serum and CSF, with perfect agreement (kappa 1.00) with the CrAg LFA. When comparing the CrAgSQ LFA with the titer measurement results obtained using CrAg LFA, titers ranged as follows: in category 1+, from 1:2 to 1:20; in 2+, from 1:5 to 1:40; in 3+, from 1:20 to 1:2560; and in 4+, from 1:320 to 1:2560. Titer results for the CrAgSQ LFA aligned well with CrAg LFA, and operator agreement was strong, with weighted kappa values of 0.926 and 0.966. The CrAg-EIA showed a sensitivity of 84% and specificity of 100% using the manufacture cutoff (>0.265), which improved to 96% sensitivity with an optimized cutoff value (>0.145). Overall, the CrAgSQ LFA demonstrated high accuracy and reliability, suggesting it could be a valuable tool for diagnosing cryptococcosis in the Americas.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807274","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":"Evaluation of a commercial Histoplasma antigen detection enzyme immunoassay for the follow-up of histoplasmosis treatment in people living with HIV from Argentina.","authors":"Fernando A Messina, Emmanuel Marin, Diego H Caceres, Mercedes Romero, Mariela Manrique, Gabriela Maria Santiso","doi":"10.1093/mmy/myae121","DOIUrl":"10.1093/mmy/myae121","url":null,"abstract":"<p><p>Histoplasmosis poses a significant risk to HIV patients, particularly in regions with limited access to antiretroviral therapy. Antigen detection assays are crucial in these settings for timely diagnosis and treatment, which can reduce mortality. While commercial antigen detection kits have performed well in diagnosing histoplasmosis, their effectiveness in monitoring treatment remains unclear. This study aimed to evaluate the correlation between urine antigen levels and clinical response using the clarus Histoplasma Galactomannan (GM) enzyme immunoassays (EIA) kit. The study followed 27 HIV patients diagnosed with histoplasmosis over 24 weeks, measuring urinary Histoplasma antigen (Ag) levels and clinical outcomes. Patients received amphotericin B as induction therapy, followed by maintenance with itraconazole. Results showed a significant decrease in Ag levels over time, with clinical scores improving in correlation with the decline in Ag levels. Four patients exhibited atypical Ag patterns due to immune reconstitution inflammatory syndrome or issues with itraconazole bioavailability. Despite these challenges, all patients showed improvement by week 24. The findings suggest that the clarus Histoplasma GM EIA kit could be a valuable tool for monitoring and evaluating the response to antifungal therapy in histoplasmosis patients.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864471","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":"Identification of the cell-surface lectin domain-containing protein expressed in the adhesive colony morphology of Trichosporon asahii.","authors":"Tomoe Ichikawa, Yoshio Ishibashi","doi":"10.1093/mmy/myae119","DOIUrl":"10.1093/mmy/myae119","url":null,"abstract":"<p><p>Trichosporon asahii is a yeast pathogen that causes a deep-seated infection. In fungal infections, molecules involved in adhesion to host tissues or catheters are one of the pathogenic factors. A single strain of T. asahii produces various colony morphologies, including highly adhesive colony types, but the molecules involved in the adhesiveness have not been identified. This study compared proteins in cell-surface extracts from weakly and highly adherent colony types and identified a protein abundantly expressed in highly adherent cells, which was named T. asahii R-type lectin domain-containing protein (TAL). TAL was a predicted 48 kDa protein with a carbohydrate-binding region, but a band was detected at ∼250 kDa in sodium dodecyl sulfate-polyacrylamide gel electrophoresis, suggesting that it was highly glycosylated. When TAL was overexpressed in mammalian cells and deglycosylated, the protein size decreased, confirming that it was glycosylated. In weakly adherent colony-type cells, the bands detected by anti-TAL antiserum were barely noted. The absence of bands indicates that the protein expression was low and does not suggest that the degree of glycosylation was different. These results suggested that multiple colony types derived from a single strain have different pathogenic properties.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823837","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":"Mortality patterns in candidemia: Insights from a multispecies analysis using a global research network.","authors":"George R Thompson Iii, Daniel B Chastain, Carolina Ferraz, Soubhi Alhayek, Jorge L Salinas, Stefan Sillau, Edward A Stenehjem, Andrés F Henao-Martínez","doi":"10.1093/mmy/myae122","DOIUrl":"10.1093/mmy/myae122","url":null,"abstract":"<p><p>Understanding the impact of different Candida species on patient outcomes is crucial for effective management and treatment strategies. This study aims to comprehensively analyze the association between Candida species and mortality in documented candidemia. We queried TriNetX, a global research network database, to identify patients diagnosed with candidemia through polymerase chain reaction from 2020 to 2023. The primary outcome was mortality in candidemia patients, categorized by Candida species at 90 days and 1 year. The time to death was assessed using Kaplan-Meier plots. Cox proportional hazard (PH) models were also used for comparative analysis, unadjusted and adjusted for demographic and comorbidity covariates. We captured 1234 candidemia episodes during the study period. The 90-day and 1-year mortality rates for the various Candida species were as follows: C. tropicalis (33.9% and 35.6%), C. glabrata (28.3% and 34%), multispecies (27.7% and 36.4%), C. parapsilosis (25.8% and 31.8%), C. krusei (21.4% and 28.6%), C. albicans (21.1% and 23.9%), and C. auris (13.3% and 15.9%). The unadjusted Kaplan-Meier Survival analysis showed that multispecies candidemia, followed by C. tropicalis, had the lowest survival. The adjusted multivariable Cox PH model found that C.albicans, C. glabrata, C. parapsilosis, C. tropicalis, and multispecies candidemia had significantly higher mortality rates than C. auris. Age and a higher Charlson comorbidity index value emerged as independent predictors of increased mortality. Among patients with candidemia, we found an overall 1-year mortality of 28%. Multispecies candidemia, C. tropicalis, older age, and a higher comorbidity burden were associated with the highest mortality rates.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854863","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":"A new quantitative reverse transcription PCR assay to improve the routine diagnosis of paracoccidioidomycosis.","authors":"Priscila Marques de Macedo, Aude Sturny-Leclère, Samia Hamane, Thierry Pautet, Anderson Messias Rodrigues, Dayvison Francis Saraiva Freitas, Antonio Carlos Francesconi do Valle, Rosely Maria Zancopé-Oliveira, Rodrigo Almeida-Paes, Alexandre Alanio","doi":"10.1093/mmy/myae125","DOIUrl":"10.1093/mmy/myae125","url":null,"abstract":"<p><p>Paracoccidioides are dimorphic fungal pathogens and the etiological agents of paracoccidioidomycosis (PCM). This severe systemic mycosis is restricted to Latin America, where it has been historically endemic. Currently, PCM presents the fewest diagnostic tools available when compared to other endemic mycoses. The main PCM diagnostic methods also have limitations. Molecular methods using different protocols have been proposed, but are restricted to a few regions. An analytical transversal study was conducted to evaluate a new molecular tool using specimens from patients diagnosed with PCM at a reference center for endemic mycoses in Rio de Janeiro, Brazil. After whole nucleic acid (WNA) extraction, RT-qPCR was performed in two independent simplex reactions, targeting the mitochondrial small subunit ribosomal RNA genes of Paracoccidioides brasiliensis and Paracoccidioides lutzii. Additionally, WNAs from all PCM-related Paracoccidioides species and from 114 other fungal strains, as well as from samples obtained from patients diagnosed with other endemic mycoses and tuberculosis, were also tested for specificity. The RT-qPCR targeting P. brasiliensis successfully amplified genetic material from all tested Paracoccidioides species but not P. lutzii, which is why a specific RT-qPCR was designed. The RT-qPCR efficiency was 1.95 (95%) with 100% analytical specificity for both targets. All included PCM clinical samples were positive (100% sensitivity) for P. brasiliensis, and all yielded negative for P. lutzii. Additionally, all samples collected from patients with other diseases were negative, reinforcing the assay's specificity. In conclusion, this study proposes a new accurate tool to cover gaps, contributing to the molecular diagnosis of this neglected disease.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951432","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":"Clinical characteristics and outcomes of colonization and infection by yeast species in solid organ transplant recipients: Molecular identification and antifungal susceptibility patterns of isolates.","authors":"Somayeh Yazdanpanah, Mojtaba Shafiekhani, Mohammad Ahmadi, Zahra Zare, Hamed Nikoupour, Sara Arabsheybani, Bita Geramizadeh, Mohammad-Hossein Anbardar, Parisa Chamanpara, Hamid Badali, Mohsen Moghadami, Keyvan Pakshir, Kamiar Zomorodian","doi":"10.1093/mmy/myae118","DOIUrl":"10.1093/mmy/myae118","url":null,"abstract":"<p><p>Fungal infections are serious complications after solid organ transplantation, with high mortality and morbidity. Given the importance of the local epidemiological data and also extensive prophylactic regimens in solid organ transplant (SOT) recipients, this study aimed to investigate the clinical characteristics and resistance patterns of yeast isolates in SOT recipients at a main referral transplant center in Iran. Of the 275 recipients enrolled, 22 (8%) had at least one positive yeast culture at a median of 5 days after transplantation. Bacterial infection and reoperation were significantly associated with colonization or infection caused by yeast species (P = .001). Moreover, mortality and length of ICU/hospital stay were significantly higher in patients with positive yeast cultures (P < .05). The most frequent species isolated was Candida albicans (50%), followed by C. glabrata (22.7%). Of species with definite breakpoints, the fluconazole-resistant rate was 23%. Caspofungin and amphotericin B showed potent activity against all isolates. Regarding the high risk of fungal infections, awareness of local epidemiological trends and resistance patterns can help improve outcomes in SOT recipients.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813849","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":"Malassezia yeast population dynamics on the skin of patients living with HIV.","authors":"Abdourahim Abdillah, Isabelle Ravaux, Saadia Mokhtari, Stéphane Ranque","doi":"10.1093/mmy/myae120","DOIUrl":"10.1093/mmy/myae120","url":null,"abstract":"<p><p>Malassezia species are lipid-dependent yeasts of the normal skin mycobiota in humans and some animals. Yet, both the dynamic of Malassezia skin colonization and the associated fungal and bacterial skin microbiome remain unknown in HIV+ patients. This study aimed to compare Malassezia yeast community structure and associated microbiome on the healthy skin of HIV+ patients and healthy controls. A total of 23 HIV+ patients and 10 healthy controls were included and followed-up for a maximum of 5 visits over 10-17 months. At each visit, chest, face, nasolabial fold, and scalp skin samples were subjected to both culture and MALDI-TOF MS identification, and ITS/16S metabarcoding. The participants were categorized according to their Malassezia colony forming unit (CFU) abundance. Malassezia were cultured from each participant at each visit. HIV+ patients were highly colonized on all visits with CFU > 100. Malassezia sympodialis and M. globosa were the most dominant species. Malassezia furfur and M. dermatis were more prevalent in HIV+ than in healthy participants. Malassezia sympodialis prevalence was stable at each sampling sites over time. Malassezia furfur prevalence was stable and more abundant over time on HIV+ patients' chest. The metabarcoding analysis suggested a higher fungal and bacterial diversity and an increased abundance of Cladosporium halotolerans and Streptococcus in HIV+ patients than in controls. Overall, HIV+ patients display a high skin colonization by Malassezia yeasts and a dysbiosis of both fungal and bacterial communities.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823838","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":"Cryptococcus neoformans/gattii and Histoplasma capsulatum var. capsulatum infections on tissue sections: Diagnostic pitfalls and relevance of an integrated histomolecular diagnosis.","authors":"Alexis Trecourt, Meja Rabodonirina, Marie Donzel, Emmanuelle Chapey-Picq, Abderrazzak Bentaher, Damien Dupont, Charline Miossec, Florence Persat, Martine Wallon, Jean-Philippe Lemoine, Pauline Tirard-Collet, Aline Baltrès, Alexandre Alanio, Mojgan Devouassoux-Shisheboran, Jean Menotti","doi":"10.1093/mmy/myae126","DOIUrl":"10.1093/mmy/myae126","url":null,"abstract":"<p><p>Cryptococcus neoformans/gattii and Histoplasma capsulatum var. capsulatum may present atypical histopathological features inducing diagnostic errors. We aimed to estimate the frequency of these atypical features in formalin-fixed tissue (FT) samples and to assess the relevance of an integrated histomolecular diagnosis using specific H. capsulatum PCR and panfungal PCR followed by Sanger sequencing and/or targeted massive parallel sequencing (MPS). A total of 27 FT from 23 patients with a histopathological diagnosis of cryptococcosis (n = 16 FT from 13 patients) or histoplasmosis (n = 11 FT from 10 patients) were retrospectively included. All FT were consultation cases. Mycological identifications on equivalent fresh tissue were available for 11/23 (47.8%) patients. The expert pathologist review modified the diagnosis suggested by the initial pathologist in 7/27 (25.9%) FT. Fungal morphology and tissue inflammation were compared between both mycoses. The most discriminant atypical criterion was the presence of dented-looking yeasts, observed in 68.75% (11/16) of C. neoformans/gattii and none (0/11) of H. capsulatum var. capsulatum (P = .002). For the 12/23 (52.2%) patients without mycological identification on fresh tissue, an integrated histomolecular diagnosis on FT using specific PCR or panfungal PCR followed by Sanger sequencing and/or MPS led to fungal identification in 9/12 (75%) cases; for cryptococcosis, the targeted MPS sensitivity was higher than that of Sanger sequencing (P = .041). Thus, because atypical histopathological features may be tricky, integrated histomolecular diagnosis is essential for optimal patient care.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896126","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":"Clinical utility of pharmacogenomic testing for patients with coccidioidal meningitis.","authors":"Rawan Elkurdi, Marie F Grill, Adrijana Kekic, Janis E Blair","doi":"10.1093/mmy/myae113","DOIUrl":"10.1093/mmy/myae113","url":null,"abstract":"<p><p>Coccidioidomycosis can cause severe meningitis, requiring lifelong treatment. In this study, we sought to better understand the potential effect of pharmacogenomic testing on treatment outcomes of patients with coccidioidal meningitis. Of 13 patients with coccidioidal meningitis who underwent pharmacogenomic testing, 11 had genetic variants of CYP2C19 and CYP3A5 that affect antifungal efficacy. These results led to real-time treatment changes and future antifungal planning. Routine pharmacogenomic testing helps to avoid antifungal treatments that are futile or lead to adverse effects.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682088","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}