Pediatric Anesthesia最新文献

{"title":"A Triple-Blinded, Randomized, Controlled Trial Comparing Hydromorphone vs. Fentanyl for Children Undergoing Tonsillectomy.","authors":"Gregory C Miller, Alan J Hifko, Julia K Lieu, Joseph T Nguyen, Judith E C Lieu, Michael C Montana","doi":"10.1002/pan.70240","DOIUrl":"10.1002/pan.70240","url":null,"abstract":"<p><strong>Background: </strong>Tonsillectomy is one of the most frequently performed pediatric surgeries; however, little evidence guides the choice of intraoperative opioids in a population at an elevated risk for perioperative respiratory complications. This study tested the hypothesis that fewer children who received hydromorphone during tonsillectomy would require postoperative \"rescue\" opioids compared to children who received fentanyl.</p><p><strong>Methods: </strong>We conducted a triple-blind, randomized, controlled trial to compare intravenous hydromorphone versus fentanyl in pediatric patients undergoing tonsillectomy. Children aged 2-15 years undergoing bilateral tonsillectomy or adenotonsillectomy were assigned (1:1) to receive hydromorphone (10 mcg/kg) or fentanyl (1 mcg/kg) intraoperatively. The primary endpoint was the number of patients who required rescue intravenous opioid analgesia following endotracheal extubation. Secondary endpoints included pain scores, pulse oximetry saturations, postoperative nausea, time in the recovery room, morphine milligram equivalents in the post-anesthesia care unit, and adverse events.</p><p><strong>Results: </strong>A total of 188 children underwent randomization, and 180 were analyzed (90 in each group). The median age was 5 years (interquartile range: 3-7 years). Rescue intravenous opioid was administered to 48 (53%) children who received intraoperative hydromorphone and 66 (73%) children who received intraoperative fentanyl (difference, 20.0 percentage points; 95% confidence interval, 6.2-33.8) (p = 0.005). Children who received hydromorphone also had lower mean pain scores for the first 15 min postoperatively and lower median morphine milligram equivalents. The incidence of adverse events was similar between the two groups.</p><p><strong>Conclusions: </strong>This study in children undergoing tonsillectomy found that intraoperative hydromorphone resulted in improved analgesia in the recovery room compared to fentanyl.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT04230681.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1254-1265"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272514","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":"Perspectives in Pediatric Ambulatory Anesthesia: Part 4-Evolving Solutions in Pediatric Ambulatory Anesthesia: From Registries to a Learning Health System Approach.","authors":"Vanessa A Olbrecht, Lynn D Martin","doi":"10.1002/pan.70256","DOIUrl":"10.1002/pan.70256","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric ambulatory anesthesia has rapidly evolved as the predominant model for surgical care in the United States, yet variability in practice standards and outcomes persists. This final installment of a four-part series addresses the gaps that remain between research and real-world practice, highlighting the limitations of traditional research models and existing registries in translating evidence into improved universal care and creation of benchmarks.</p><p><strong>Methods: </strong>Through a review of selected pediatric databases and registries, this paper examines their contributions, strengths, and challenges in generating actionable knowledge and standardizing care.</p><p><strong>Results: </strong>The discussion emphasizes the impact of unwarranted variation, the slow adoption of clinical guidelines, and the need for more robust, inclusive data sources that reflect the realities of community-based practice, where most children receive their care rather than the experience of large, academic centers.</p><p><strong>Discussion: </strong>To address these challenges, we propose the need to create a multicenter, collaborative Learning Health System (LHS) consortium, leveraging real-world electronic medical record data, continuous quality improvement, and implementation science focused on improving quality of care and outcomes in ambulatory Pediatric Anesthesia practice. This model prioritizes adaptive methodologies, inclusive participation across diverse practice settings, and iterative, data-driven improvements. One of the greatest challenges is the ability to capture data from a range of care settings, and not just tertiary and quaternary children's hospitals. We delve into a possible solution to overcome this limitation by extending its reach beyond safety. This proposed LHS consortium offers the possibility of a pragmatic and sustainable pathway to accelerate the development and dissemination of standards and best practices in Pediatric Anesthesia. By fostering collaboration, embracing positive deviance, and bridging the gap between research and practice, this approach ensures that every child benefits from the highest standards of safety, quality, and innovation-regardless of where their care is delivered.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1185-1195"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339512","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":"Perspectives in Pediatric Ambulatory Anesthesia: Part 2-One Center's 15 Year Experience Improving Quality and Safety Outcomes.","authors":"Jennifer L Chiem, Elizabeth E Hansen, Kayla Reece, Samuel M Vanderhoek, Sanjay R Parikh, Paul A Merguerian, Lynn D Martin","doi":"10.1002/pan.70252","DOIUrl":"10.1002/pan.70252","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric ambulatory surgery has become the dominant model of surgical care in the United States, driven primarily by economic forces. There is variability in regional practice patterns, quality improvement cycles, and outcomes. Opportunity exists to overcome knowledge gaps and provide sustainable pathways of quality improvement. Our unique capability of describing the evolution of our pediatric ambulatory quality improvement practice allows us to contribute a single center's perspective.</p><p><strong>Methods: </strong>We chose to complete a comprehensive retrospective review of our quality improvement process, outcome, and balancing metrics contained in our electronic health record (EHR) from our free-standing pediatric ambulatory surgery center (ASC) from July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system's EHR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation.</p><p><strong>Results: </strong>Improvement themes (opioid-free anesthesia and stewardship, enhanced recovery, environmental efforts, positive deviance, and learning healthcare system) are described. Improvements in all six domains of quality (effectiveness, efficiency/timeliness, patient experience, equity, and safety) are illustrated with reliable sustainability. Our system achieved approximately a 13-fold increase in quality improvement (QI) project completion rate with self-serve, real-world data access; enabling the team to take on improvement tasks previously deemed too big, lengthy, or risky to complete.</p><p><strong>Discussion: </strong>We provide preliminary evidence that these methods may be generalizable. Requirements include engaged leadership, a standard framework for improvement with experienced leadership or accessible support, and easy access to real-world electronic medical record data (i.e., learning healthcare system [LHS]). Lastly, leaders must create a culture supportive of teamwork, change, and continuous improvement. Systems facilitate adoption and hinder resistance to standards, always with implementation and sustainability in mind. Meaningful, large-scale improvements in healthcare outcomes require collaboration across LHSs.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1196-1206"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382659","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":"Neuromuscular Monitoring of Rocuronium 0.6 mg/kg in Children Aged 3-24 Months With Electromyography and Acceleromyography: An Observational Study.","authors":"Sarah Sofie Wadland, Karl Peter Damgård Madsen, Mikkel Helmuth Jensen, Magnus Fuhr Hovind, Morten Sonne, Morten Bøttger, Arash Afshari, Frederik Mondrup, Matias Vested","doi":"10.1002/pan.70220","DOIUrl":"10.1002/pan.70220","url":null,"abstract":"<p><strong>Background: </strong>Objective neuromuscular monitoring is essential to prevent residual neuromuscular block in patients receiving neuromuscular blocking agents. However, the small size of pediatric hands and the lack of appropriately sized neuromuscular equipment have made quantitative neuromuscular monitoring at the ulnar nerve (UN) difficult. In such cases, the tibial nerve (TN) can serve as an alternative site. This study aimed to compare train-of-four (TOF) monitoring using acceleromyography (AMG) and electromyography (EMG) at the TN and UN in children aged 3-24 months. We hypothesized that the time to reach a train-of-four ratio (TOFR) ≥ 0.9 would be shorter with AMG compared to EMG.</p><p><strong>Methods: </strong>In this observational study, a total of 107 pediatric patients scheduled to elective surgery under general anesthesia with rocuronium 0.6 mg/kg were included. Patients were allocated to either bilateral tibial nerve (TN) or bilateral ulnar nerve (UN) monitoring using AMG and EMG. The primary outcome was time to TOFR ≥ 0.9. Other outcomes were time to TOFC = 0 (onset); reappearance of post tetanic count (PTC) = 1, TOFC = 1, TOFC = 2, and symptoms of residual neuromuscular block.</p><p><strong>Results: </strong>Fifty patients were bilaterally monitored at TN and 50 patients were bilaterally monitored at UN. At TN time to TOFR ≥ 0.9 was 81 min (SD 29) with AMG and 112 min (SD 34) with EMG with a mean difference of 34 min (95% CI: 29-39; p < 0.0001). At UN time to TOFR ≥ 0.9 was 71 min (SD 29) with AMG and 82 min (SD 28) with EMG, with a mean difference of 11 min (95% CI: 6-15; p < 0.0001). Seventeen patients exhibited symptoms of residual neuromuscular block.</p><p><strong>Conclusion: </strong>Time to TOFR ≥ 0.9 after rocuronium 0.6 mg/kg in children aged 3-24 months was significantly shorter with AMG compared to EMG at both the UN and TN. AMG may underestimate the duration of action.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06409260.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1231-1237"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974218","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":"Training by Chance or by Design? Pediatric Anesthesia at a Crossroads.","authors":"Pablo M Ingelmo, Andrea Moscatelli, Andrea Wolfler","doi":"10.1002/pan.70231","DOIUrl":"10.1002/pan.70231","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1177-1178"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006203","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":"Contextualizing Opioid Consumption After Ambulatory Orthopedic Surgery in Adolescents.","authors":"Carolyn C Berggren, Anupa Parajuli, Amir L Butt, John Zhong","doi":"10.1002/pan.70241","DOIUrl":"10.1002/pan.70241","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1325-1326"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239853","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":"Retrospective Evaluation of an Artificial Intelligence-Assisted Video Laryngoscope System for Tracheal Intubation in Infants and Neonates.","authors":"Kouki Fukuda, Hiroki Nakamura, Takahiko Asano, Tatsuhiko Masue","doi":"10.1002/pan.70260","DOIUrl":"10.1002/pan.70260","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1316-1318"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382667","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":"Routine Replacement of Fasting Deficits in Pediatric Ambulatory Anesthesia: A Propensity-Matched Retrospective Cohort Study.","authors":"Xiang Sharon Luo, Mathew Mason, Shannon Chan, Peter C Minneci, Kimberly Russo, Karie Steinmetz, Vanessa A Olbrecht","doi":"10.1002/pan.70261","DOIUrl":"10.1002/pan.70261","url":null,"abstract":"<p><strong>Background: </strong>Routine replacement of calculated fasting deficits is common during pediatric anesthesia, but it remains uncertain whether formula-based deficit replacement is necessary to maintain intraoperative stability or postoperative recovery.</p><p><strong>Aims: </strong>We aimed to evaluate whether reducing routine fasting-deficit replacement adversely affected intraoperative hemodynamic stability or early postoperative recovery in pediatric ambulatory procedures.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 9640 pediatric ambulatory procedures at a tertiary children's hospital (May 2024-March 2025), of whom 8508 were included after propensity score matching (4254 per group). A national intravenous fluid shortage prompted an institution-wide reduction in routine fasting-deficit replacement, creating a natural experiment independent of clinician preference. The primary outcome was intraoperative vasopressor administration; secondary outcomes included post-anesthesia care unit (PACU) rescue antiemetic use, PACU length of stay, and emergency department encounters within 24 h.</p><p><strong>Results: </strong>Mean intraoperative crystalloid administration decreased by 38.1% following the practice change. Reduced fluid administration was not associated with increased vasopressor use (adjusted OR 1.13, 95% CI 0.92-1.38). Secondary outcomes-PACU rescue antiemetic use (adjusted OR 0.44, 95% CI 0.13-1.43), PACU length of stay (mean difference -0.7 min), and emergency department encounters within 24 h (adjusted OR 0.53, 95% CI 0.21-1.32)-did not differ between groups, though event rates were low and the study was not powered to detect differences in these outcomes. The confidence interval for the primary outcome does not exclude a clinically meaningful increase in vasopressor use; statistical non-significance should not be interpreted as equivalence.</p><p><strong>Conclusions: </strong>In children undergoing ambulatory procedures, a substantial reduction in routine fasting-deficit replacement was not associated with increased vasopressor use, and no important differences were observed in early postoperative recovery. These findings did not identify a clear benefit of routine empiric fasting-deficit replacement in otherwise healthy children undergoing short ambulatory procedures.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1274-1282"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430886","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":"Implementing the Safer Anaesthesia From Education Paediatrics Course in Japan: Contextual Adaptation and Early National Dissemination.","authors":"Yuki Fujimoto, Norifumi Kuratani","doi":"10.1002/pan.70262","DOIUrl":"10.1002/pan.70262","url":null,"abstract":"<p><strong>Background: </strong>In Japan, declining birth rates and concentration of pediatric cases in fewer high-volume children's hospitals have reduced anesthesiologists' opportunities, particularly during training, to gain experience in pediatric anesthesia. There is no standardized national curriculum, and training relies largely on workplace-based learning. The Safer Anaesthesia From Education (SAFE) Paediatrics Course is a structured program originally developed for low- and middle-income countries; whether it can be contextually adapted and disseminated in a high-income country facing different training challenges has not been established.</p><p><strong>Aims: </strong>To describe the translation, contextual adaptation, early implementation, and initial national dissemination of the SAFE Paediatrics Course in Japan, including preliminary educational outcomes from a single-center resident training program.</p><p><strong>Methods: </strong>We conducted a two-phase descriptive educational project. Phase 1 comprised course translation, contextual adaptation, pilot testing of a multiple-choice question (MCQ) examination, and pilot delivery. Phase 2 comprised single-center implementation and evaluation at Saitama Children's Medical Center among anesthesia residents (October 2021-March 2023). Participants completed pre- and post-course MCQ tests and confidence ratings; a post-course survey assessed satisfaction. National dissemination was described using aggregated course-level data.</p><p><strong>Results: </strong>Thirty residents participated in the single-center evaluation. MCQ scores increased from 37.87 to 41.67 out of 50 (mean increase 3.80; 95% CI: 2.64-4.96; p < 0.001), and self-rated confidence increased. Satisfaction was high (17/20 respondents rated the course 4 or 5). Between October 2021 and January 2026, 28 courses were delivered across four geographical areas and national meeting-affiliated sessions, accounting for 359 participant attendances; many used condensed one-day or half-day formats.</p><p><strong>Conclusions: </strong>The SAFE Paediatrics Course was translated, contextually adapted, and implemented in Japan, with early dissemination across multiple geographical areas and flexible delivery formats. Preliminary single-center outcomes support its suitability as a structured pediatric anesthesia educational program in this setting. Further multicenter and longitudinal evaluation is warranted.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1266-1273"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405397","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":"Comparison of Discharge Readiness in Pediatric Patients: Oral Versus Intranasal Preoperative Midazolam Administration.","authors":"Mohammad Naem, Jobayer Hossain, Janna Hamideh, Judit Szolnoki","doi":"10.1002/pan.70267","DOIUrl":"10.1002/pan.70267","url":null,"abstract":"<p><strong>Background: </strong>Midazolam is commonly administered orally or intranasally to reduce preoperative anxiety in children undergoing tympanostomy. Prior studies suggest differences in recovery exist between the two routes, but their impact on post-anesthesia care unit (PACU) length of stay remains unclear.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of pediatric patients aged 6 months to 10 years undergoing tympanostomy at Nemours Children's Hospital, Central Florida, between November 2023 and November 2024. Patients were grouped by midazolam route (intranasal 0.2 mg/kg IV formulation vs. oral 0.5 mg/kg syrup). The primary outcome was PACU length of stay, defined as time from PACU arrival to discharge based on standard hospital criteria. Predictors of administration route were evaluated using univariate logistic regression, and PACU length of stay was analyzed using age-adjusted ANCOVA with backward stepwise variable selection.</p><p><strong>Results: </strong>A total of 463 patients were included: 322 received oral midazolam and 141 received intranasal midazolam. In unadjusted analysis, intranasal midazolam was associated with a shorter PACU stay (mean 39.7 vs. 42.9 min, p = 0.02). However, patients receiving intranasal midazolam were significantly younger (31.5 vs. 37.8 months, p < 0.001). After adjustment for age, age emerged as the only independent predictor of PACU length of stay, and the association between administration route and PACU duration was attenuated and no longer significant (p = 0.15).</p><p><strong>Conclusions: </strong>Age, rather than route of midazolam administration, primarily explained differences in PACU discharge readiness among children undergoing tympanostomy. Previously reported differences in recovery time between oral and intranasal midazolam may reflect age-related confounding rather than a true effect of route. Future prospective, age-stratified studies are needed to clarify this relationship and refine pediatric sedation practices.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1319-1321"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448604","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}