Pharmacoepidemiology and Drug Safety最新文献

{"title":"Correction to \"An Open-Source Implementation of Tree-Based Scan Statistics\".","authors":"","doi":"10.1002/pds.70167","DOIUrl":"https://doi.org/10.1002/pds.70167","url":null,"abstract":"","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 6","pages":"e70167"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216522","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":"Correction to \"Adapting the European Concerted Action on Congenital Anomalies and Twins (EUROCAT) Guide 1.5 for Use in Post-Authorisation Safety Studies Using US Data\".","authors":"","doi":"10.1002/pds.70170","DOIUrl":"https://doi.org/10.1002/pds.70170","url":null,"abstract":"","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 6","pages":"e70170"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226154","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":"Clarithromycin Versus Azithromycin for Community-Acquired Pneumonia and the Risk of Major Adverse Cardiovascular Events: A Multicentre Cohort Study Using Data From Canada and Denmark.","authors":"Theis Skovsgaard Itenov, Anthony D Bai, Tor Biering-Sørensen, Amol Verma, Fahad Razak, Ajay Bhasin, Henning Bundgaard, Pradeesh Sivapalan, Kasper Iversen, Christian Rasmussen, Jens Rasmussen, Lotte Klitfod, Kathrine Dircks, Jens-Ulrik S Jensen, Mike Fralick","doi":"10.1002/pds.70163","DOIUrl":"10.1002/pds.70163","url":null,"abstract":"<p><strong>Background: </strong>Studies suggest that clarithromycin is associated with an increased risk of major adverse cardiovascular events (MACE) among adults with coronary artery disease. However, data comparing clarithromycin to other macrolides, such as azithromycin, in a broader population are lacking.</p><p><strong>Methods: </strong>A multicenter study was conducted in 33 hospitals in Ontario, Canada, and Copenhagen, Denmark, using the Target Trial framework. Adults hospitalized with community-acquired pneumonia (CAP) who received either clarithromycin or azithromycin were included. The primary outcome was MACE, defined as the one-year risk of nonfatal myocardial infarction, nonfatal stroke, or all-cause mortality. Propensity score matching and Cox proportional hazards models were used for analysis.</p><p><strong>Results: </strong>In Ontario, we identified 23 081 patients with CAP, and 11 164 received oral macrolides. After propensity score matching, the primary outcome occurred in 7.8% of clarithromycin patients and 9.1% of azithromycin patients (HR 0.85, 95% CI 0.60-1.21). In Copenhagen, there were 11 280 patients with CAP and 3924 received oral macrolides. After propensity score matching, 19% of clarithromycin patients and 12% of azithromycin patients experienced the primary outcome for oral macrolides (HR 1.7, 95% CI 1.2-2.4, p = 0.002). Meta-analysis of the point estimate from each country provided an overall HR of 1.21 (95% CI 0.61-2.39). For intravenous macrolides in Copenhagen, the HR was 1.15 (95% CI 1.0-1.3, p = 0.007) for clarithromycin compared to azithromycin.</p><p><strong>Conclusion: </strong>This study did not consistently observe an increased risk of cardiovascular events with clarithromycin among adults hospitalized with CAP. However, the observational nature of the study may introduce selection bias and unmeasured confounding.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 6","pages":"e70163"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248987","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":"Corrigendum to \"A Brief Report on Proposed Areas of International Harmonization of Real-World Evidence Relevance, Reliability and Quality Standards Among Medical Product Regulators\".","authors":"","doi":"10.1002/pds.70169","DOIUrl":"https://doi.org/10.1002/pds.70169","url":null,"abstract":"","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 6","pages":"e70169"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216523","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":"Drug Interactions With Tamoxifen and Treatment Effectiveness in Premenopausal Breast Cancer Patients: A Bayesian Joint Modeling Approach.","authors":"Kirsten M Woolpert, Deirdre P Cronin-Fenton, Per Damkier, Anders Kjærsgaard, Stephen Hamilton-Dutoit, Bent Ejlertsen, Richard F MacLehose, Peer Christiansen, Rebecca A Silliman, Timothy L Lash, Thomas P Ahern, Lindsay J Collin","doi":"10.1002/pds.70157","DOIUrl":"10.1002/pds.70157","url":null,"abstract":"<p><strong>Purpose: </strong>Tamoxifen is guideline treatment for premenopausal women with estrogen receptor-positive (ER+) breast cancer. Therapeutic efficacy relies partly on tamoxifen biotransformation by CYP2D6, CYP2C19, and CYP3A4 enzymes. We conducted a cohort study to evaluate whether concomitant prescription of drugs that inhibit these enzymes impacted breast cancer recurrence.</p><p><strong>Methods: </strong>We enrolled 4493 premenopausal women with stage I-III ER+ breast cancer (2002-2011) treated with tamoxifen. We defined time-varying CYP-inhibiting drug exposures as the proportion of overlapping days during the tamoxifen treatment period. We estimated associations of concomitant medication use with recurrence using: (1) Bayesian joint modeling (hazard ratio [HR] and 95% credible intervals [95% CrI]), (2) traditional Cox regression (HR and 95% confidence intervals [95% CI]).</p><p><strong>Results: </strong>During tamoxifen therapy, 13% of the cohort used strong CYP2D6 inhibitors, 31% weak CYP2D6 inhibitors, 37% CYP2C19 inhibitors, and 12% CYP3A4/5 inhibitors. Bayesian joint models showed that women with ≥ 50% overlap between tamoxifen and CYP2D6 inhibitors had increased recurrence risk compared with 0% overlap (HR: 1.24, 95% CrI: 0.96, 1.58). No recurrence association was seen for CYP2C19 inhibitors (≥ 50% vs. 0%, HR = 1.0, 95% CrI: 0.69, 1.40), but traditional Cox models yielded positive associations for CYP2C19 overlap (≥ 50% vs. 0%, HR = 1.45, 95% CI: 1.07, 1.96). With Bayesian joint models, we observed no association between ≥ 50% versus 0% overlap with CYP3A4/5 inhibitors (HR: 0.84, 95% CrI: 0.32, 1.93).</p><p><strong>Conclusions: </strong>With Bayesian joint modeling, we saw a slight increase in recurrence among CYP2D6-inhibitor users, but no increase among CYP2C19- or CYP3A4-inhibitor users. Results from Cox regression models were less plausible.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70157"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005143","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":"Hospital Discharge Prescription of Drugs That May Raise Blood Pressure in Patients With Hypertension.","authors":"Sarasa Miyake, Atsushi Miyawaki, Hiroki Matsui, Yuya Kimura, Hideo Yasunaga","doi":"10.1002/pds.70150","DOIUrl":"10.1002/pds.70150","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine the frequency of discharge prescriptions of drugs that may raise blood pressure (BP) in hospitalized patients with hypertension and identify factors associated with these prescriptions.</p><p><strong>Methods: </strong>A retrospective cross-sectional analysis was conducted using a nationwide inpatient database in Japan, focusing on adults with hypertension discharged from acute care hospitals between April 2021 and March 2022. The primary outcome was the prescription of drugs that may raise BP at discharge. A multivariable linear probability model was employed to assess the relationship between patient and hospital characteristics and the likelihood of receiving these prescriptions.</p><p><strong>Results: </strong>Among 979 234 patients with hypertension (mean age: 75.3 years, standard deviation: 13.2), 230 792 (23.6%) received at least one drug that may elevate BP at discharge. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most frequently prescribed (46.6%), followed by glucocorticoids (35.3%), atypical antipsychotics (15.1%), antidepressants (7.9%), and Japanese herbal medicines (6.1%). Prescription prevalence was higher among female patients, younger adults, those admitted for medical conditions, non-emergency hospitalizations, patients with disabilities, and those with a Charlson Comorbidity Index of 1. Patients hospitalized for musculoskeletal or skin conditions, transferred to another hospital, or discharged from high-volume hospitals were also more likely to receive these prescriptions.</p><p><strong>Conclusions: </strong>Drugs that may raise BP are commonly prescribed at discharge for patients with hypertension. This highlights the need for targeted interventions to optimize medication management at discharge, aiming to improve BP control and patient outcomes.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70150"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013785","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":"Treatment Persistence and Variations in Prescribing Oral, Injectable, and Inhaled Corticosteroids: A Population-Based Drug Utilisation Study.","authors":"Eleni Domzaridou, Matthew J Carr, David M Williams, Anthony J Avery, Tjeerd van Staa, D Aled Rees, Darren M Ashcroft","doi":"10.1002/pds.70153","DOIUrl":"https://doi.org/10.1002/pds.70153","url":null,"abstract":"<p><strong>Purpose: </strong>To examine variation in oral, injectable, and inhaled corticosteroid (CS) prescribing in primary care, exploring treatment persistence and coverage.</p><p><strong>Methods: </strong>We examined patient-level electronic health records from English general practices in the Clinical Practice Research Datalink Aurum database. We delineated a cohort of new users of oral, injectable, or inhaled CS with prescriptions issued between January 1, 2000, and June 30, 2021. Lorenz curves assessed potential prescribing skewness, and Kaplan-Meier (KM) plots estimated treatment persistence. The Proportion of Patients Covered (PPC) method estimated the proportion of patients still covered by treatment 1 year after initiation.</p><p><strong>Results: </strong>We observed 1 942 571 CS users across 1471 general practices, with 20% of oral and inhaled CS users accounting for almost 80% of total CS use. Older patients with comorbidities including respiratory diseases (13.5%), skin conditions (5.8%), or inflammatory bowel diseases (1.6%) were more likely to be prescribed higher doses. The KM plots showed that 20% of oral and 50% of inhaled CS users were persistent after one and 2 months, respectively. The PPC method indicated that 30% of oral and 60% of inhaled CS users were covered by treatment 6 months post-initiation. Some variation was observed when different grace periods were applied. Combined use of oral and inhaled CS was observed for 6.9% of patients.</p><p><strong>Conclusion: </strong>A fifth of patients receiving CS accounted for over 80% of oral and inhaled CS prescribing in primary care. Identifying these patients is crucial for targeting future interventions to promote patient safety and cost-effective CS use.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70153"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036998","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":"Proton Pump Inhibitor Use Exceeding the U.S. Food and Drug Administration Approved Treatment Duration for Patients With Peptic Ulcer Disease: A Retrospective Cohort Study.","authors":"Jordan A Villars, Timothy S Anderson, Jonathan G Yabes, Robert E Schoen, Ravy K Vajravelu","doi":"10.1002/pds.70152","DOIUrl":"https://doi.org/10.1002/pds.70152","url":null,"abstract":"<p><strong>Background: </strong>Proton-pump inhibitors (PPIs) are effective in treating peptic ulcer disease (PUD), but they are often prescribed beyond the approved duration. Because PPIs are associated with adverse effects, there is a need for effective stewardship.</p><p><strong>Objective: </strong>To identify the frequency of and healthcare factors associated with PPI prescriptions exceeding the approved eight-week treatment duration for PUD.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients diagnosed with acute PUD without other indications for PPI use using data from the Veterans Health Administration in the United States. Exposures were patient, provider, and facility factors that could influence PPI prescribing. The outcome was time to a filled PPI prescription exceeding the approved treatment duration for PUD. Associations were assessed using a multivariable time-to-recurrent-event model to calculate adjusted hazard ratios (aHR) and population-attributable fractions. Patients who developed indications for long-term PPI use were censored.</p><p><strong>Results: </strong>We identified 7708 patients with PUD who met eligibility criteria and received PUD treatment (median age 79 [IQR 71-85], 7% female). Thirty-five percent had PPI prescriptions exceeding the approved duration for a median of 346 days (IQR 165-643) of overuse. On the patient level, inpatient PUD diagnosis (aHR 1.32, 95% CI 1.25-1.39), use of nonsteroidal anti-inflammatory drugs (NSAIDs) (aHR 1.26, 95% CI 1.18-1.34), use of anticoagulants (aHR 1.25, 95% CI 1.13-1.38), and moderate frailty (1.15, 95% CI 1.06-1.26) had the strongest associations with filled PPI prescriptions exceeding the approved duration. On the health-system level, inpatient PUD diagnosis had the highest peak population attributable fraction at 0.26, followed by NSAIDs and anticoagulants at 0.18.</p><p><strong>Conclusions: </strong>Markers of patient complexity and medication use not meeting gastroprotection guidelines are associated with inappropriate PPI persistence among patients with PUD. These data may inform future targeted PPI deprescribing programs.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70152"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006873","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":"Validity of Diagnostic Codes and Laboratory Tests to Identify Cholangiocarcinoma and Its Subtypes.","authors":"Nicole D Ferrante, Rebecca A Hubbard, Kelley Weinfurtner, Anya I Mezina, Craig W Newcomb, Emma E Furth, Debika Bhattacharya, Basile Njei, Tamar H Taddei, Amit Singal, Maarouf A Hoteit, Lesley S Park, David Kaplan, Vincent Lo Re","doi":"10.1002/pds.70154","DOIUrl":"https://doi.org/10.1002/pds.70154","url":null,"abstract":"<p><strong>Background: </strong>The absence of validated methods to identify cholangiocarcinoma in real-world data has prevented the conduct of pharmacoepidemiologic studies to evaluate determinants of this malignancy and examine the effectiveness of cholangiocarcinoma treatments.</p><p><strong>Objective: </strong>To determine the accuracy of International Classification of Diseases for Oncology, Third Edition (ICD-O-3)-based algorithms to identify cholangiocarcinoma and its subtype (intrahepatic or extrahepatic) within US Veterans Health Administration (VA) data.</p><p><strong>Methods: </strong>We identified patients with cholangiocarcinoma ICD-O-3 diagnosis codes from January 2000-December 2019 in VA data. We developed eight algorithms utilizing ICD-O-3 histology codes for cholangiocarcinoma and further used ICD-O-3 topography codes for location (liver, intrahepatic bile duct, extrahepatic bile duct) plus maximum total bilirubin (≥ 3 mg/dL vs. < 3 mg/dL) within ± 45 days of diagnosis to identify cholangiocarcinoma subtype. Up to 80 patients were randomly selected for each algorithm, and their records were reviewed by two hepatologists. The positive predictive values (PPV) and 95% confidence interval (CI) for each algorithm were estimated.</p><p><strong>Results: </strong>Among 2934 unique patients who met inclusion criteria, 574 were randomly selected for validation. All eight algorithms had high PPV for definite or probable cholangiocarcinoma, ranging from 83.8% (95% CI, 73.8%-91.1%) to 100.0% (95% CI, 95.5%-100.0%). Among three algorithms to identify intrahepatic cholangiocarcinoma, two had PPV ≥ 80% (range: 88.8% [95% CI, 79.7%-94.7%]-91.3% [95% CI, 82.8%-96.4%]). Among five algorithms to identify extrahepatic cholangiocarcinoma, four had PPV ≥ 80% (range: 80.0% [95% CI, 69.6%-88.1%]-94.0% [83.5%-98.7%]).</p><p><strong>Conclusion: </strong>These algorithms can be used in future pharmacoepidemiologic studies to evaluate medications associated with intrahepatic or extrahepatic cholangiocarcinoma.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70154"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025325","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":"Changes in Hormonal Contraceptive Dispensing Trends Among Commercially Insured Kentucky Females During the COVID-19 Pandemic.","authors":"Dustin K Miracle, Lindsey R Hammerslag, Svetla Slavova, Feitong Lei, Jeffery Talbert, Daniela C Moga, Patricia R Freeman","doi":"10.1002/pds.70159","DOIUrl":"https://doi.org/10.1002/pds.70159","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of the COVID-19 national emergency declaration on contraceptive dispensing trends among commercially insured Kentucky females.</p><p><strong>Methods: </strong>Data ranging from 1/7/2019 through 12/27/2020 for female enrollees aged 19-44 with a primary residence in Kentucky were extracted from the Merative Marketscan Commercial Claims and Encounters Database. A segmented regression analysis was used for statistical modeling of an interrupted time series design to describe changes in weekly contraceptive (oral, transdermal, and vaginal) dispensing rates and days' supply following the COVID-19 national emergency.</p><p><strong>Results: </strong>A total of 90 541 enrollees met study inclusion criteria. The estimated weekly contraceptive dispensing rate per 100 reproductive-aged female enrollees was 3.22 (95% confidence interval [CI] 3.16-3.28) at the beginning of the pre-pandemic period. Following the national emergency, an immediate estimated rate increase of 0.11 (95% CI 0.01-0.21; p = 0.030) was seen with no change in trend. At the beginning of the pre-pandemic period, the estimated weekly percentage of days' supply > 28 days was 29.2% (95% CI 28.8-29.6) with an increasing trend of 1.1% every 10 weeks (slope 0.11 [95% CI 0.09-0.12; p < 0.001]). Following the national emergency, an immediate decrease of 1.5% (95% CI -2.2 to -0.8; p < 0.001) was observed, followed by sustainment of the pre-pandemic trend. No differential impacts were seen with regard to age group (19-26 vs. 27-44) or rural-urban classification.</p><p><strong>Conclusions: </strong>Following the COVID-19 national emergency declaration, trends in both contraceptive dispensing and days' supply among commercially insured Kentucky females were relatively stable, suggesting multiple behavioral and policy-related factors potentially overshadowing changes in access.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70159"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079303","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}