Pediatric Cardiology最新文献

{"title":"Proposal: Bold New Indications for Transcatheter Pulmonary Flow Restrictors.","authors":"Dietmar Schranz","doi":"10.1007/s00246-024-03759-4","DOIUrl":"https://doi.org/10.1007/s00246-024-03759-4","url":null,"abstract":"<p><p>This proposal presents a proof of concept for the use of pulmonary flow restrictors (PFRs) based on MVP™-devices, drawing from clinical experience, and explores their potential role in the management of newborns with hypoplastic left heart syndrome (HLHS), other complex left heart lesions, and infants with end-stage dilated cardiomyopathy (DCM). At this early stage of age, manually adjusted PFRs can be tailored to patient's size and hemodynamic needs. Although currently used off-label, PFRs have substantial potential to improve outcomes in these vulnerable patient populations. When integrated into a holistic treatment strategy, they represent a promising advancement in care. There is significant potential to reduce mortality and improve the quality of life for neonates with HLHS and variants, as well as to support age-dependent functional regeneration in DCM, all while avoiding the need for advanced surgical procedures, including general anesthesia. The main barrier to broader adoption is the limited availability of appropriately sized MVP devices. However, with ongoing patient-centered knowledge sharing and refinement of transcatheter techniques, there is reason for optimism that PFRs, tailored for individual patients, could provide significant benefits to thousands of infants with congenital heart disease and DCM worldwide.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932382","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":"Clarifying the Cardiovascular Morphology and Associated Abnormalities in Patients with Double Inlet Right Ventricle Using Multidetector CT Angiography.","authors":"Niraj Nirmal Pandey, Mansi Verma, Sheetal Sharma, Vineeta Ojha, Sanjeev Kumar, Sivasubramanian Ramakrishnan, Priya Jagia","doi":"10.1007/s00246-024-03766-5","DOIUrl":"https://doi.org/10.1007/s00246-024-03766-5","url":null,"abstract":"<p><p>We sought to evaluate the intracardiac morphology and associated cardiovascular anomalies in patients with double inlet right ventricle (DIRV) on multidetector CT angiography. A retrospective search of our departmental database was conducted from January 2014 to January 2023 to identify patients with a diagnosis of DIRV on CT angiography. The intracardiac anatomy and associated cardiovascular abnormalities were systematically evaluated. Patients with a common atrioventricular valve were excluded. DIRV was diagnosed in 41 patients (36 males, 5 females; mean age at imaging: 7.4 years [range: 4 months-30 years]). Mirror-imaged viscero-atrial arrangement was observed in 12/41 (29.3%) while right isomerism and left isomerism were seen in 6/41 (14.6%) and 2/41 (4.9%) patients respectively. Hypoplastic left ventricular cavity was seen in 39/41 (95.1%) patients. AV valve straddling was observed in 40/41 (97.6%) patients. Atrial septal defect was seen in 28/41 (68.3%) patients. All (100%) patients had presence of ventricular septal defect. Twisted atrioventricular connections were seen in 4/41 (9.8%) patients. The most common ventriculo-arterial morphology was presence of double outlet right ventricle (DORV) seen in 25/41 (61%) patients. Some degree of pulmonary outflow obstruction was seen in 24/41 (58.5%) patients. Systemic venous anomalies, pulmonary venous anomalies and coronary artery anomalies were observed in 13/41 (31.7%), 6/41 (14.6%) and 8/41 (19.5%) patients. DIRV is a type of single ventricle congenital heart disease associated with an array of cardiovascular abnormalities, most commonly DORV and pulmonary outflow tract obstruction. The knowledge of associated anomalies is imperative for preoperative planning. CT angiography allows for detailed anatomical evaluation of DIRV and associated cardiovascular anomalies which may positively impact surgical management in these patients.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932353","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":"Medical & Socioeconomic Risk Factors Associated with Lack of Neurodevelopmental Evaluation Following Neonatal Cardiac Surgery.","authors":"Luma Essaid, Kelly Haque, Amanda Shillingford, Lauren Zimmerman, Alisa Burnham, Lyla Hampton, Oluwatimilehin Okunowo, J William Gaynor, Nicholas S Abend, Maryam Y Naim, Monique M Gardner","doi":"10.1007/s00246-024-03761-w","DOIUrl":"https://doi.org/10.1007/s00246-024-03761-w","url":null,"abstract":"<p><p>Neonates with congenital heart disease (CHD) who undergo cardiopulmonary bypass (CPB) are at high-risk for unfavorable neurodevelopmental (ND) outcomes and are recommended for ND evaluation (NDE); however, poor rates have been reported. We aimed to identify risk factors associated with lack of NDE. This single-center retrospective observational study included neonates < 30 days old who underwent CPB and survived to discharge between 2012 and 2018. Primary outcome (NDE) was ≥ 1 appointment at our center's dedicated cardiac, neonatal, or general ND clinics before the 3rd birthday. Predictor variables included demographic, medical, and social factors. Social disorganization index (SDI) was obtained with geocoding based on address at time of discharge. Logistic regression identified risk factors associated with lack of NDE. The cohort included 594 patients, predominantly male (59%) and white (59%). A majority (63%) had NDE. Lack of NDE was more common in patients with postnatal CHD diagnosis, CHD without arch obstruction, absence of postoperative seizures, living below 100% poverty level, lack of insurance, younger parental age, and overall higher SDI (p < 0.03). In multivariable analysis, lack of NDE was associated with single-ventricle CHD without arch obstruction (OR 2.17; 95% CI 1.08-4.55), two ventricle CHD without arch obstruction (OR 2.56; 95% CI 1.59-4.17), and higher SDI (OR 1.25; 95% CI 1.05-1.49); all p < 0.05. This study identifies medical and neighborhood-level socioeconomic factors that may help address care gaps in this high-risk population. Patients with socioeconomic disparities may benefit from increased care coordination upon discharge.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927660","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":"Identifying Factors that Influence Pediatric Echo Lab Image Quality: Development and Validation of a New Assessment Tool.","authors":"Garick D Hill, Eunice Hahn, Joseph R Block, Alicia H Chaves, Kristopher Cumbermack, Joan Lipinski, Shobha Natarajan, David A Parra, Joshua D Robinson, Brian D Soriano, Michael J Walsh, JangDong Seo, Peter Frommelt","doi":"10.1007/s00246-024-03763-8","DOIUrl":"https://doi.org/10.1007/s00246-024-03763-8","url":null,"abstract":"<p><p>No method of evaluating transthoracic echocardiograms (TTE) image quality (IQ) has been validated. Furthermore, structural echo lab elements impacting IQ are unknown. We sought to develop and validate a TTE IQ grading tool and determine patient and echo lab features associated with IQ. Ten pediatric echo labs each submitted 50 consecutive new patient TTEs without complex heart disease. For each study, 3 sonographers independently rated IQ and performed routine measurements. IQ scoring used the American College of Cardiology Quality Network (ACC QNet) tool plus a novel Likert scale component. IQ scores were validated against the ability to make measurements and, when all measurements were made, variation between sonographers. After validation, patient and lab factors, from a previously published survey, associated with improved TTE IQ were determined by linear regression. Total IQ score (R² = 0.64), ACC QNet (R² = 0.29) and the Likert component (R² = 0.52) correlated with the total number of measurements made (p < 0.001). For the 236 (52%) TTEs with all measurements, the Likert scale component (OR 0.9, 95% CI 0.82-0.99, p = 0.037) was associated with lower measurement variability. Factors significantly associated with worse IQ scores were higher patient weight, performance by a traveling sonographer, lower annual and inpatient TTE volume, less dedicated teaching/administrative sonographer time, and full-day sessions for reading physicians. A novel TTE IQ scoring tool was created and validated for pediatric TTE. Modifiable structural components of echo labs associated with TTE IQ were identified. This novel IQ tool should guide IQ beyond the ACC QNet score.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910146","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":"Fetal Characteristics and Perinatal Outcomes in Tetralogy of Fallot Without a Ductus Arteriosus.","authors":"Azadeh Issapour, Minnie N Dasgupta, Amy Zhang, Theresa A Tacy, Shiraz A Maskatia, R Thomas Collins, Michelle Kaplinski","doi":"10.1007/s00246-024-03745-w","DOIUrl":"https://doi.org/10.1007/s00246-024-03745-w","url":null,"abstract":"<p><p>Absence of the ductus arteriosus (DA) is common in tetralogy of Fallot (TOF), occurring in up to 30% of cases. Yet, the clinical course and fetal echocardiographic features are not well described, limiting prenatal counseling. This study examines the fetal echocardiographic characteristics and perinatal outcomes in children with TOF absent DA (TOF/ADA), comparing them to those with a DA (TOF/DA). Fetal echocardiograms were retrospectively reviewed in children with TOF evaluated at our center between 12/1/2014 and 11/1/2022. Those with complete atrioventricular septal defect, pulmonary atresia or absent pulmonary valve were excluded. Diagnosis of TOF and absence of the DA were postnatally confirmed. Fetal echocardiographic indices, clinical characteristics, and perinatal course were compared between groups. The primary outcome was intervention (surgical or catheter-based) in the first 30 days of life. Among 58 fetuses with TOF, 23 (40%) had ADA, and 35 (60%) had a DA. The groups were similar in gestational age, with similar Apgar scores. Four neonates required interventions for cyanosis: 2 with TOF/ADA and 2 with TOF/DA. One TOF/ADA patient died within the first year of life, from non-cardiac causes. Those with TOF/ADA had smaller third trimester main pulmonary artery (MPA) z-scores (- 2.75 vs. - 2.18, p = 0.02) and smaller neonatal pulmonary valve, MPA, and branch pulmonary artery z-scores. A genetic diagnosis was more common with ADA, specifically 22q11.2 deletion (22%, p = 0.03). While there were differences observed across groups, including smaller fetal and neonatal right ventricular outflow tract size and more diagnoses of 22q11.2 in ADA, absence of the DA was not linked to poorer clinical outcomes. This study expands our understanding of fetal echocardiographic findings and clinical trajectory in TOF/ADA, offering crucial insights for consultation and postnatal planning.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910141","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":"Lower Child Opportunity Index is Associated with Lower Exercise Capacity Post-Fontan Palliation.","authors":"Brock A Karolcik, Li Wang, Maya I Ragavan, Arvind K Hoskoppal, Anita P Saraf, Gaurav Arora, Jacqueline Kreutzer, Melita L Viegas, Tarek Alsaied","doi":"10.1007/s00246-024-03752-x","DOIUrl":"https://doi.org/10.1007/s00246-024-03752-x","url":null,"abstract":"<p><p>The Child Opportunity Index (COI) is a validated measurement that uses a composite index of 29 indicators of social determinants of health linked to the US Census. Patients post-Fontan palliation for single ventricle physiology often have reduced exercise capacity compared to the general population. Our hypothesis is that COI levels are directly associated with exercise capacity and inversely with late outcomes. A retrospective, single-center study was performed, including 99 patients post-Fontan procedure who had cardiac magnetic resonance imaging at our institution from January 2010 to July 2023, of which 78 had undergone an exercise test. Univariate analysis was performed with Pearson correlational testing and multivariable linear regression was then used to evaluate independent predictors of % predicted VO₂. The mean age and sex were not different between the low and high COI groups (24.1 ± 8.5 y vs 22.5 ± 9.7 y; 34.5% vs 29.3% female). Patients with low COI had lower peak VO2 (25.7 vs 31.0 L/min/kg, p = 0.002) and % predicted peak VO2 (61.9 vs 71.4%, p = 0.003). At follow-up post-Fontan (mean of 17.9 ± 7.4 y) there was one mortality and two heart transplants. There were more interventions in the low COI group (1.5 vs 0.9 intervention occurrence/patient, p = 0.038). There was no difference in hospital admissions or significant comorbidities between COI groups. Lower COI was associated with worse exercise capacity in Fontan patients and may negatively impact the need for late interventions. This highlights the need for efforts to provide community resources to promote equity in cardiac outcomes.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Confirmed as correct. Thank you!</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909876","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":"Myocardial Contractile Reserve Impairment in Patients with Kawasaki Disease During Convalescent Phase: A Study Based on Two-Dimensional Speckle-Tracking Stress Echocardiography.","authors":"Haiyong Wang, Xiaoli Long, Zhiming Han, Xin Dong, Ruiling Yan","doi":"10.1007/s00246-024-03751-y","DOIUrl":"https://doi.org/10.1007/s00246-024-03751-y","url":null,"abstract":"<p><p>Persistent myocardial impairment proved by histopathologic studies universally existed in patients with Kawasaki disease (KD); however, the long-term effects on myocardial contractile reserve in KD patients, especially on patients without coronary artery lesions (CALs), is still unknown. The aim of this study was to investigate myocardial contractile reserve in KD patients during late convalescent stage by speckle-tracking adenosine triphosphate (AT) echocardiography. A total of 63 antecedent KD patients at least 4 years after the disease onset and 40 age- and gender-matched normal controls were prospectively enrolled. Based on coronary artery status, patients were further divided into CALs group and non-CALs (NCALs) group. Left ventricular ejection fraction (LVEF), speckle-tracking derived-global longitudinal strain (GLS), and global circumferential strain (GCS) were evaluated at rest and during AT peak stress. Myocardial contractile reserve parameters including ΔLVEF, ΔGLS, and ΔGCS were defined as the absolute value differences in LVEF, GLS, and GCS from rest to peak stress. Of the patients with KD, 44 had normal coronary artery and 19 had CALs. KD patients regardless of CALs had lower GLS and GCS than normal controls at resting condition. Significant decreases in ΔGLS and ΔGCS were observed in patients with CALs compared to normal controls under peak stress. While ΔGLS and ΔGCS increased in patients without CALs following stress, improvements were significantly weaker than those in normal controls. However, no significant differences in LVEF at rest and ΔLVEF under peak stress between KD patients irrespective of CALs and normal controls were found. In addition, when comparing with patients with NCALs, patients with CALs had lower GLS and GCS at rest and lower ΔGLS and ΔGCS in response to stress. Subclinical abnormality of myocardial contractile reserve existed in KD patients during late convalescent phase. Even patients without CALs need an additional surveillance on myocardial contractile reserve in the long-term follow-up. These novel findings by speckle-tracking stress echocardiographic analysis may provide more valuable clinical implications for better understanding and long-term management of such patients.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896587","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":"The Relationship Between Ambulatory Blood Pressure and Atherogenic Index with LV Geometry Pattern in Obese Children: Results from a Cross-Sectional Study in Serbia.","authors":"Bjelakovic Bojko, Stefanutti Claudia, Vukovic Vladimir, Klisic Aleksandra, Stojkovic Stefan, Jovic Marko, Bjelakovic Ilija, Banach Maciej","doi":"10.1007/s00246-024-03749-6","DOIUrl":"https://doi.org/10.1007/s00246-024-03749-6","url":null,"abstract":"<p><p>Arterial hypertension and increased atherogenic index of plasma (AIP) are strong predictors of cardiovascular risk associated in individuals with obesity both in adults and children. Thus, we aimed to explore the relationship between AIP and systolic ambulatory blood pressure index (sABPI) with left ventricular geometry pattern in obese children. In this cross-sectional study, a total of 129 obese children (BMI greater or equal to the 95th percentile for age and sex) were examined. Fasting blood samples were taken to measure plasma glucose level, lipid profile, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), serum uric acid (SUA), and insulin level. Two-dimensional (2-D) transthoracic echocardiography was performed to determine left ventricular geometry pattern. Ambulatory blood pressure recording was obtained for 24 h in all obese children. Linear regression analyses were conducted to explore relationships between AIP (calculated as logarithmic transformation of the ratio of TG to HDL-C) and sABPI with left ventricular myocardial mass index (LVMI) and relative wall thickness (RWT). We also used sex as a potential effect modifier, and calculated stratum-specific estimates of the effect. We demonstrated independent and positive association of age and AIP with RWT (Age: effect size = 0.83 (CI 0.22 - 1.45) p = 0.008; AI effect size 8.9 (CI 3.6 - 14.3); p = 0.01). In a subgroup analysis with sex as an effect modifier, independent positive association of borderline significance at p = 0.011 was found between AIP and RWT only in boys AIP: effect size 9.5 (CI 2.3 - 16.7) p = 0.01. LVMI was significantly associated with sex and BMI (sex: effect size = 6.8 CI (2.6 - 11) p = 0.002; BMI z score: effect size = 6.8 CI (3.2-10.4) p < 0.001). Independent positive association was also found between BMI and LVMI for girls, effect size = 11.9 (CI 4.1-19.8) (p = 0.005). AIP and age are independently associated with the presence of concentric left ventricular geometry with girls seeming more protected from atherogenic hypertrophic stimulus than boys. BMI and sex are independently associated with eccentric left ventricular remodeling, with BMI being a greater risk factor for girls.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896606","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":"Letter to the Editor: Chylothorax After Heart Surgery in Children.","authors":"Shehdev Meghwar, Ajeet Singh","doi":"10.1007/s00246-024-03753-w","DOIUrl":"https://doi.org/10.1007/s00246-024-03753-w","url":null,"abstract":"","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896583","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":"Response to \"Screening for LifeThreatening Arrhythmia in Asymptomatic Patients After Paediatric Cardiac Surgery: A Single Centre Retrospective Analysis of 790 Prehospitaldischarge 24 h Holter Electrocardiogram Recordings\".","authors":"Sohaihra Khan","doi":"10.1007/s00246-024-03757-6","DOIUrl":"https://doi.org/10.1007/s00246-024-03757-6","url":null,"abstract":"<p><p>To the editor! We read the study published in your journal with great enthusiasm and appreciate the authors' efforts to perform the research [1]. It sheds light on the discussed cause and aids comprehension of the topic at hand. For sure, it provides the groundwork for future research; nevertheless, we have a few doubts that have caused us to write this letter, and we are confident that if these doubts were addressed, the overall output of the study would have increased manifolds.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896602","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}