Nephrology Dialysis Transplantation最新文献

{"title":"The biology of water homeostasis.","authors":"Mariavittoria D'Acierno, Robert A Fenton, Ewout J Hoorn","doi":"10.1093/ndt/gfae235","DOIUrl":"10.1093/ndt/gfae235","url":null,"abstract":"<p><p>Water homeostasis is controlled by a brain-kidney axis that consists of central osmoreceptors, synthesis and secretion of arginine vasopressin (AVP) and AVP-responsive aquaporin-2 (AQP2) water channels in kidney collecting duct principal cells that facilitate water reabsorption. In addition to AVP, thirst represents a second line of defence to maintain water balance. Water balance disorders arise because of deficiency, resistance or inappropriate secretion of AVP or disturbances in thirst sensation (hypodipsia, polydipsia). People with water balance disorders are prone to develop hyponatraemia or hypernatraemia, which expose cells to osmotic stress and activate cell volume regulation mechanisms. This review covers several recent insights that have expanded our understanding of central osmoregulation, AQP2 regulation and cell volume regulation. This includes the role of with no lysine kinase 1 (WNK1) as a putative central osmolality sensor and, more generally, as an intracellular crowding sensor that coordinates the cell volume rescue response by activating sodium and potassium cotransporters. Furthermore, several new regulators of AQP2 have been identified, including AVP-dependent AQP2 regulation (yes-associated protein, nuclear factor of activated T-cells, microRNAs) and AVP-independent AQP2 regulation (epidermal growth factor receptor, fluconazole, prostaglandin E2). It is also becoming increasingly clear that long-term cell volume adaptation to chronic hypotonicity through release of organic osmolytes comes at the expense of compromised organ function. This potentially explains the complications of chronic hyponatraemia, including cognitive impairment, bone loss and vascular calcification. This review illustrates why these new insights derived from basic science are also relevant for developing new approaches to treat water balance disorders.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"632-640"},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of nutritional vitamin D in chronic kidney disease-mineral and bone disorder in children and adults with chronic kidney disease, on dialysis, and after kidney transplantation-a European consensus statement.","authors":"Hanne Skou Jørgensen, Marc Vervloet, Etienne Cavalier, Justine Bacchetta, Martin H de Borst, Jordi Bover, Mario Cozzolino, Ana Carina Ferreira, Ditte Hansen, Markus Herrmann, Renate de Jongh, Sandro Mazzaferro, Mandy Wan, Rukshana Shroff, Pieter Evenepoel","doi":"10.1093/ndt/gfae293","DOIUrl":"10.1093/ndt/gfae293","url":null,"abstract":"<p><p>Vitamin D deficiency is common in patients with chronic kidney disease (CKD) and associates with poor outcomes. Current clinical practice guidelines recommend supplementation with nutritional vitamin D as for the general population. However, recent large-scale clinical trials in the general population failed to demonstrate a benefit of vitamin D supplementation on skeletal or non-skeletal outcomes, fueling a debate on the rationale for screening for and correcting vitamin D deficiency, both in non-CKD and CKD populations. In a collaboration between the European Renal Osteodystrophy initiative of the European Renal Association (ERA) and the European Society for Paediatric Nephrology (ESPN), an expert panel performed an extensive literature review and formulated clinical practice points on vitamin D supplementation in children and adults with CKD and after kidney transplantation. These were reviewed by a Delphi panel of members from relevant working groups of the ERA and ESPN. Key clinical practice points include recommendations to monitor for, and correct, vitamin D deficiency in children and adults with CKD and after kidney transplantation, targeting 25-hydroxyvitamin D levels >75 nmol/l (>30 ng/ml). Although vitamin D supplementation appears well-tolerated and safe, it is recommended to avoid mega-doses (≥100 000 IU) and very high levels of 25 hydroxyvitamin D (>150-200 nmol/l, or 60-80 ng/ml) to reduce the risk of toxicity. Future clinical trials should investigate the benefit of vitamin D supplementation on patient-relevant outcomes in the setting of vitamin D deficiency across different stages of CKD.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"797-822"},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Older people predialysis care pathways and early morbidity-mortality upon start of dialysis.","authors":"Aghiles Hamroun, Estelle Aymes, Cécile Couchoud, Clémence Béchade, Olivier Moranne, Jean-Baptiste Beuscart, Victoria Gauthier, Luc Dauchet, Philippe Amouyel, Bénédicte Stengel, François Glowacki","doi":"10.1093/ndt/gfae236","DOIUrl":"10.1093/ndt/gfae236","url":null,"abstract":"<p><strong>Background: </strong>The ageing of the population with advanced chronic kidney disease (CKD) increases the complexity of care pathways. Our aim was to identify subgroups of older people according to predialysis care pathways and describe their association with early morbidity-mortality after transition to dialysis.</p><p><strong>Methods: </strong>This study included 22 128 incident dialysis patients aged ≥75 years during 2009-2017 from the French nationwide registry linked to the National Health Data System. Predialysis care pathways were identified by ascending hierarchical classification based on preselected healthcare use indicators in the previous year. Their association with a composite outcome of death or hospitalization ≥50% of the time off dialysis within the first year of dialysis was studied by multivariable logistic regression accounting for demographics, comorbidities, functional status, conditions of dialysis initiation, socioeconomic deprivation index and home-to-dialysis center travel time.</p><p><strong>Results: </strong>Five care pathway profiles were identified, characterized by limited healthcare use (Cluster 1, 28%), non-nephrology ambulatory care (Cluster 2, 17%), nephrology ambulatory care (Cluster 3, 37%) and a high level of non-nephrology or nephrology hospitalizations (Clusters 4 and 5, both 9%). Profile subgroups did not differ according to patient age and comorbidities, but Clusters 1, 2 and 4 displayed higher levels of social deprivation. Compared with Cluster 3, the odds ratios of primary composite outcome were significantly increased for Clusters 1, 4 and 5 [odds ratio (95% confidence interval) of 1.16 (1.08-1.25), 1.17 (1.05-1.32) and 1.12 (1.01-1.25), respectively]. Moreover, prolonged hospitalizations were also more common in all groups, compared with Cluster 3.</p><p><strong>Conclusion: </strong>Despite a similar comorbidity profile, older people with advanced CKD experience very heterogeneous predialysis care pathways, some of which associated with higher burden of hospitalization after the transition to dialysis.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"768-780"},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normalization dynamics of donor-derived cell-free DNA predicts future kidney transplantat rejection.","authors":"David Cucchiari, Elena Cuadrado-Payán, Eva Gonzalez-Roca, Ignacio Revuelta, Maria José Ramirez-Bajo, Pedro Ventura-Aguiar, Jordi Rovira, Elisenda Bañon-Maneus, Mireia Musquera, Lluís Peri, Silvia Casas, Eduard Palou, Joan Anton Puig-Butille, Fritz Diekmann","doi":"10.1093/ndt/gfae291","DOIUrl":"https://doi.org/10.1093/ndt/gfae291","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psoriaisis associates with increased risk for kidney transplant rejection.","authors":"Rashi Agrawal, Jennifer L Waller, Stephanie L Baer, Wendy B Bollag","doi":"10.1093/ndt/gfaf047","DOIUrl":"https://doi.org/10.1093/ndt/gfaf047","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Psoriasis is a common immune-mediated skin disorder with additional manifestations due to systemic inflammation. Patients with psoriasis have an increased risk of end-stage renal disease (ESRD) requiring either dialysis or renal transplant; however, the relationship between psoriasis and renal allograft failure has not been established.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the United States Renal Data System to analyze the association between psoriasis and graft failure (occurring more than 2 weeks after the transplant). We compared transplant failure rates in ESRD patients with a psoriasis diagnosis prior to the initial transplant versus transplanted ESRD patients without a psoriasis diagnosis. From 2004-2019, a total of 151 272 renal transplant patients aged 18-100 and meeting exclusion and inclusion criteria were identified; in this cohort, 1 105 ESRD patients had International Classification of Disease (ICD)-9 and -10 claim codes for psoriasis prior to their renal transplant.</p><p><strong>Results: </strong>Logistic regression modeling was used to examine possible confounders of psoriasis on graft failure. Kaplan-Meier estimates indicated that renal transplant patients with psoriasis had reduced graft survival over time than those without psoriasis. In addition, Cox Proportional Hazard analysis, controlling for demographics and clinical risk factors, showed a significantly increased hazard ratio for renal allograft failure for patients with a diagnosis of psoriasis.</p><p><strong>Conclusion: </strong>The systemic inflammation and immune-mediated pathophysiology underlying psoriasis could underlie the association between psoriasis and the increased risk of renal transplant failure.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active glomerular inflammation versus chronicity and fibrosis: The role of targeted therapies in IgA nephropathy.","authors":"Jai Radhakrishnan, Richard A Lafayette","doi":"10.1093/ndt/gfaf059","DOIUrl":"https://doi.org/10.1093/ndt/gfaf059","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel system to continuously estimate intradialytic blood pressure in real-time.","authors":"Daniela Viramontes-Hörner, Paul Stewart, Jill Stewart, Maarten W Taal, Nicholas M Selby","doi":"10.1093/ndt/gfaf058","DOIUrl":"https://doi.org/10.1093/ndt/gfaf058","url":null,"abstract":"<p><strong>Background: </strong>Intradialytic hypotension (IDH) is a common complication of haemodialysis that is associated with adverse patient outcomes. We have developed a new non-invasive approach to continuously estimate systolic blood pressure (SBP) in real time during haemodialysis using pressure wave sensors in the extracorporeal circuit. We sought to compare the performance of our continuous real-time SBP estimator against brachial cuff SBP measurements.</p><p><strong>Methods: </strong>Single-centre, observational study conducted in 21 participants receiving haemodialysis with a functioning arteriovenous fistula, studied throughout two 4-hour haemodialysis sessions. Time-averaged real-time SBP estimator values from the 5-second period immediately prior to each cuff measurement were compared with matched brachial cuff SBP values.</p><p><strong>Results: </strong>Mean age was 71 ± 11 years and median dialysis vintage was 20.0 months (IQR 12.5-63.5). Across 522 SBP comparison data points, mean brachial cuff SBP and real-time SBP estimate were 121.8 ± 27.1 mmHg and 123.7 ± 27.9 mmHg, respectively. Brachial cuff SBP and real-time SBP estimate were significantly associated (r = 0.825; p < 0.001). There was a low absolute mean difference between the brachial cuff SBP and the real-time SBP estimate of -1.9±16 mmHg, and no evidence of systematic bias between measurements. Across all comparison points, 95% of estimator values were within 30% of the matched brachial cuff value, and 66% within 10% of the cuff value.</p><p><strong>Conclusions: </strong>A BP estimator that runs in real time during haemodialysis using pressure wave sensors in the extracorporeal circuit and avoiding additional sensor-burden on patients has good performance in tracking intradialytic SBP when compared against brachial cuff measurements, supporting its further development and larger scale testing.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controlled access to lumasiran in primary hyperoxaluria type 1: evaluation of a new access route for orphan drugs in The Netherlands.","authors":"Lisa J Deesker, Casper F M Franssen, Eiske Dorresteijn, Nicole C A J van de Kar, S Azam Nurmohamed, David Severs, Sander F Garrelfs, Anke A M G Pisters-van Roy, Carla E M Hollak, Jaap W Groothoff","doi":"10.1093/ndt/gfaf060","DOIUrl":"https://doi.org/10.1093/ndt/gfaf060","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>In search for controlled access to expensive innovative orphan drugs, a national access route called \"Orphan Drug Access Protocol\" (ODAP) was developed and piloted with lumasiran, a new drug for patients with primary hyperoxaluria type 1 (PH1). Here, we present a two-year evaluation of this pilot study.</p><p><strong>Methods: </strong>Specialists from the Dutch PH1 Expert Centre and the national ODAP steering group developed a protocol for controlled and conditional treatment of children and adults with PH1 with lumasiran. Indication for treatment is based on specific clinical characteristics. Cessation or continuation of therapy is evaluated every six months for five years by a national indication committee consisting of PH1 specialists, based on biochemical and clinical response. Drug wastage is minimized by centralizing and pooling patients for administration.</p><p><strong>Results: </strong>Between September 2022 and September 2024, 21 PH1 patients were reviewed and 76% were deemed eligible for lumasiran treatment. Ten patients were already receiving lumasiran through clinical trials or early access programs at time of assessment. The follow-up time with lumasiran was 0.1-6.6 years, including trial years. All patients with >1 year lumasiran treatment responded significantly biochemically and clinically. Details on outcomes are presented. Denials for lumasiran therapy were nearly all based on full pyridoxine responsiveness. All denied patients, except one, had good clinical outcomes. This patient received lumasiran after initial denial based on clinical and biochemical course. Patient selection and minimizing wastage saved approximately 3,227.065 euros per year based on the official list price.</p><p><strong>Conclusions: </strong>This national ODAP protocol enabled access to lumasiran therapy for severely ill patients, prevented unnecessary treatment in others, and provided new insights into the real-world effectiveness of lumasiran in PH1 patients through systematic monitoring. It may serve as a template for future access routes to new expensive therapeutics in orphan diseases.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific cardiac dysfunction in mice with chronic kidney disease.","authors":"Yitong Zhao, Karen Yang, Christy M Nguyen, Hongmei Wu, Han Liu, Leandro M Velez, Jin Kyung Kim, Marcus Seldin, Wei Ling Lau","doi":"10.1093/ndt/gfaf056","DOIUrl":"https://doi.org/10.1093/ndt/gfaf056","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is the leading cause of death among patients with chronic kidney disease (CKD). Rodent models are widely used to study uremic CVD pathophysiology. We compared cardiac function parameters in male and female animals from 2 established mouse CKD models and examined associations between gut-derived uremic toxins and echocardiogram findings.</p><p><strong>Methods: </strong>Male and female adult C57Bl/6J mice were randomly assigned to control, adenine-induced CKD and 5/6 nephrectomy CKD groups. Echocardiography was performed on all mice at age 17 weeks (5 weeks after CKD induction). Serum creatinine, cystatin C and gut-derived uremic toxins were analyzed at study termination, and RNA sequencing of left ventricle tissue was performed and analyzed.</p><p><strong>Results: </strong>Markers of kidney dysfunction were elevated in both CKD models. The gut-derived uremic toxin indoxyl sulfate was increased in both CKD models, while trimethylamine N-oxide was increased in adenine CKD mice and p-cresyl sulfate in nephrectomy animals. Left ventricular volume was increased in nephrectomy animals. Cardiac output was decreased in male CKD animals from both models compared to controls, and ejection fraction was decreased in male 5/6 nephrectomy mice. Female controls had lower stroke volume and cardiac output than male counterparts, and female CKD animals had preserved cardiac output and ejection fraction when compared to female controls. The gut-derived uremic toxins trimethylamine N-oxide and indoxyl sulfate correlated with decreased cardiac output in male animals. Transcriptomics of cardiac tissue revealed sex-based variations in matrix metalloproteinase and mitochondrial pathways associated with cardiac dysfunction.</p><p><strong>Conclusions: </strong>Our work highlights sex differences in cardiac function and serum chemistries in two established preclinical CKD models. Gut-derived uremic toxins may impact cardiorenal pathophysiology and low cardiac output in male CKD animals.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ABCDE to identify and prevent chronic kidney disease: a call to action.","authors":"Charles J Ferro, Christoph Wanner, Valerie Luyckx, Kate Stevens, Sofia Cerqueira, Rasha Darwish, Beatriz Fernandez Fernandez, David Fiel, Rumen Filev, Manfred Grieger, Antonia Lopez, Merike Luman, Jolanta Malyszko, Milena Krasimirova Nikolova-Vlahova, Fiita Romero, Chrysanthi Skalioti, Carla Alexandra Ribeiro Dos Santos Araújo, Ieva Ziedina, Daniel Gallego, Alberto Ortiz, Roser Torra, Raymond Vanholder","doi":"10.1093/ndt/gfaf057","DOIUrl":"https://doi.org/10.1093/ndt/gfaf057","url":null,"abstract":"<p><p>Kidney disease is a global health priority affecting over 850 million people worldwide. This number is projected to increase over the coming decades given the increasing prevalence of diabetes, hypertension and obesity, and the aging population. Chronic kidney disease can reduce both life-expectancy and quality of life and is intricately linked with cardiac and metabolic health - the cardio-kidney-metabolic multimorbidity syndrome. With early recognition of risk, chronic kidney disease can be prevented and with timely case-finding, early diagnosis and early intervention, its progression can be halted or slowed. The European Renal Association has established the Strong Kidneys Taskforce with the main purpose of creating awareness about the importance of kidney health for individual and population health. In collaboration with the European Kidney Health Alliance and the European Kidney Patients Federation, the ABCDE campaign will empower communities and individuals to remind their healthcare providers to assess their risk of kidney disease. ABCDE asks 5 simple questions about health status that only the healthcare system can provide: A) Do I have Albumin in my urine? B) What is my Blood pressure? C) What is my Cholesterol? D) Do I have Diabetes? E) What is my current kidney function (Estimated glomerular filtration rate)? This advocacy text aims to inform individuals, communities and front-line health care workers that capturing the risk of kidney, cardiac and metabolic health is simple, makes sense, is logical, and will save lives. Although making meaningful change will take time and involve major personal and societal changes the first step really is as easy as ABCDE!</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}