Pediatric Cardiology最新文献

{"title":"Transcatheter Closure of Perimembranous Ventricular Septal Defect Using KONAR-MF™: A Multicenter Experience.","authors":"Nageswara Rao Koneti, Sushil Azad, Shweta Bakhru, Bhargavi Dhulipudi, Radhakrishnan Sitaraman, Raman Krishna Kumar","doi":"10.1007/s00246-024-03505-w","DOIUrl":"10.1007/s00246-024-03505-w","url":null,"abstract":"<p><p>Transcatheter closure of perimembranous ventricular septal defect (PmVSD) is an established procedure. However, the occurrence of complete heart block limits its scope. The newer KONAR-MF™ occluder has specific design characteristics that may improve the safety of PmVSD closure. The objective of the study was to describe the efficacy and mid-term follow-up of transcatheter closure of PmVSD using KONAR-MF™. The study was conducted prospectively in 3 Indian centers (January 2018-December 2022). PmVSD closure was done by both antegrade and retrograde methods, and patients were followed up at 1, 3, 6, 12 months, and annually after that. 121 out of 123 patients were included with the following characteristics: median age 4.4 (0.18-40) years; weight 15 (2.1-88) kg; mean Qp/Qs ratio 1.87 ± 0.52 and pulmonary artery mean pressure: 22 ± 6.9 mmHg. The procedure was successful in all but 3; the device was removed due to significant residual shunt (n = 2) and new development of aortic regurgitation (AR) (≥ mild) in 1. The median defect size was 5.2 (2.5-12) mm. Device sizes from 6/4 to 14/12 were deployed (median fluoroscopy time 13.3 min; range 3.6-47.8). Shunt occlusion rates were 90%-Immediate, 95%-pre-discharge, and 97%-1 month, with no instances of complete heart block after the procedure and during follow-up. Six had new onset AR (mild: 2, trivial 4), and one had increased tricuspid regurgitation. All patients were well during follow-up (median: 20 months; range: 6-46). The new KONAR-MF™ occluder appears to be a promising and safe alternative for the closure of the PmVSD; further long-term follow is merited.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"853-861"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870803","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":"Genetic Testing Resources and Practice Patterns Among Pediatric Cardiomyopathy Programs.","authors":"Justin Godown, Emily H Kim, Melanie D Everitt, Wendy K Chung, Irene D Lytrivi, Sonya Kirmani, Paul F Kantor, Stephanie M Ware, Jean A Ballweg, Ashwin K Lal, Neha Bansal, Jeffrey Towbin, Steven E Lipshultz, Teresa M Lee","doi":"10.1007/s00246-024-03498-6","DOIUrl":"10.1007/s00246-024-03498-6","url":null,"abstract":"<p><p>The use of genetic testing has enhanced the diagnostic accuracy of heritable genetic cardiomyopathies. However, it remains unclear how genetic information is interpreted and incorporated into clinical practice for children with cardiomyopathy. The primary aim of this study was to understand how clinical practice differs regarding sequence variant classifications amongst pediatric cardiologists who treat children with cardiomyopathy. A secondary aim was to understand the availability of genetic testing and counseling resources across participating pediatric cardiomyopathy programs. An electronic survey was distributed to pediatric heart failure, cardiomyopathy, or heart transplantation physicians between August and September 2022. A total of 106 individual providers from 68 unique centers responded to the survey. Resources for genetic testing and genetic counseling vary among large pediatric cardiomyopathy programs. A minority of centers reported having a geneticist (N = 16, 23.5%) or a genetic counselor (N = 21, 31%) on faculty within the division of pediatric cardiology. A total of 9 centers reported having both (13%). Few centers (N = 13, 19%) have a formal process in place to re-engage patients who were previously discharged from cardiology follow-up if variant reclassification would alter clinical management. Clinical practice patterns were uniform in response to pathogenic or likely pathogenic variants but were more variable for variants of uncertain significance. Efforts to better incorporate genetic expertise and resources into the clinical practice of pediatric cardiomyopathy may help to standardize the interpretation of genetic information and better inform clinical decision-making surrounding heritable cardiomyopathies.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"798-803"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877025","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":"The Effects of Aspirin dose in Children with Congenital and Acquired Heart Disease. Results from the Paediatric Study of Aspirin Efficacy using Diagnostic and Monitoring Tools (PAED-M).","authors":"Irene E Regan, Dermot Cox, Sean T Kelleher, Colin J McMahon","doi":"10.1007/s00246-024-03509-6","DOIUrl":"10.1007/s00246-024-03509-6","url":null,"abstract":"<p><p>The optimal dose of aspirin required in children with congenital and acquired heart disease is not known. The primary aim of this prospective observational study was to evaluate the effects of aspirin dose on platelet inhibition. The secondary aim was to determine the prevalence and clinical predictors of aspirin non-responsiveness. Measurements were by Thromboelastography with Platelet Mapping (TEGPM) only in children less than 2 years (y) of age with particular emphasis on the parameter known as maximum amplitude with arachidonic acid (MAAA) and using both TEGPM, and light transmission aggregometry (LTA) in children greater than 2 y. We prospectively studied 101 patients with congenital and acquired cardiac disease who were receiving empirical doses of aspirin for a minimum of 4 weeks but no other antiplatelet agents. Patients were stratified according to dose concentration and age. There was a trend toward lower age in patients with no response or semi-response to aspirin. All patients were considered responsive to aspirin in the higher-dose quartile (Q4) with a median dose of 4.72 (4.18-6.05) mg/kg/day suggesting that patients in this age group may require 5 mg/kg/day as an empirical dose. In children > 2 y, there was no significant difference in inhibition found in patients dosed at higher doses in Q3 versus Q4 suggesting that patients in this cohort are responsive with 3 mg/kg/day dose. The current practices may lead to reduced platelet inhibition in some children due to under-dosing or overdosing in others. In conclusion, younger children require higher doses of aspirin. Laboratory assessment is warranted in this population to mitigate against under and overdosing.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"862-873"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958742","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":"Mental Health Care for Children with Heart Disease and Their Families: Practical Approaches and Considerations for the Pediatric and Pediatric Cardiology Clinician.","authors":"Amanda D McCormick, Kriti Puri, S Yukiko Asaki, Shahnawaz Amdani, Devyani Chowdhury, Julie S Glickstein, Seda Tierney, Patricia Ibeziako, Melissa K Cousino, Christina Ronai","doi":"10.1007/s00246-024-03518-5","DOIUrl":"10.1007/s00246-024-03518-5","url":null,"abstract":"<p><p>Mental health conditions are a common comorbidity among children living with heart disease. Children with congenital heart disease are more likely to have a mental health condition than their unaffected peers or peers with other chronic illnesses, and mental health risk persists across their lifetime. While poorer mental health in adults with congenital heart disease is associated with worse overall health outcomes, the association between mental health and cardiac outcomes for children with heart disease remains unknown. Despite this, it is suspected that mental health conditions go undiagnosed in children with heart disease and that many affected children and adolescents do not receive optimal mental health care. In this article, we review mental health in congenital heart disease across the lifespan, across domains of care, and across diagnoses. Further directions to support mental health care for children and adolescents with heart disease include practical screening and access to timely referral and mental health resources.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"757-768"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945350","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":"Machine Learning Quantification of Pulmonary Regurgitation Fraction from Echocardiography.","authors":"Jennifer Cohen, Son Q Duong, Naveen Arivazhagan, David M Barris, Surkhay Bebiya, Rosalie Castaldo, Marjorie Gayanilo, Kali Hopkins, Maya Kailas, Grace Kong, Xiye Ma, Molly Marshall, Erin A Paul, Melanie Tan, Jen Lie Yau, Girish N Nadkarni, David Ezon","doi":"10.1007/s00246-024-03511-y","DOIUrl":"10.1007/s00246-024-03511-y","url":null,"abstract":"<p><p>Assessment of pulmonary regurgitation (PR) guides treatment for patients with congenital heart disease. Quantitative assessment of PR fraction (PRF) by echocardiography is limited. Cardiac MRI (cMRI) is the reference-standard for PRF quantification. We created an algorithm to predict cMRI-quantified PRF from echocardiography using machine learning (ML). We retrospectively performed echocardiographic measurements paired to cMRI within 3 months in patients with ≥ mild PR from 2009 to 2022. Model inputs were vena contracta ratio, PR index, PR pressure half-time, main and branch pulmonary artery diastolic flow reversal (BPAFR), and transannular patch repair. A gradient boosted trees ML algorithm was trained using k-fold cross-validation to predict cMRI PRF by phase contrast imaging as a continuous number and at > mild (PRF ≥ 20%) and severe (PRF ≥ 40%) thresholds. Regression performance was evaluated with mean absolute error (MAE), and at clinical thresholds with area-under-the-receiver-operating-characteristic curve (AUROC). Prediction accuracy was compared to historical clinician accuracy. We externally validated prior reported studies for comparison. We included 243 subjects (median age 21 years, 58% repaired tetralogy of Fallot). The regression MAE = 7.0%. For prediction of > mild PR, AUROC = 0.96, but BPAFR alone outperformed the ML model (sensitivity 94%, specificity 97%). The ML model detection of severe PR had AUROC = 0.86, but in the subgroup with BPAFR, performance dropped (AUROC = 0.73). Accuracy between clinicians and the ML model was similar (70% vs. 69%). There was decrement in performance of prior reported algorithms on external validation in our dataset. A novel ML model for echocardiographic quantification of PRF outperforms prior studies and has comparable overall accuracy to clinicians. BPAFR is an excellent marker for > mild PRF, and has moderate capacity to detect severe PR, but more work is required to distinguish moderate from severe PR. Poor external validation of prior works highlights reproducibility challenges.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"884-894"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903447","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":"Brachiocephalic Vein Duplication: Case Report of a Double Left Brachiocephalic Vein in an Infant.","authors":"Alyssa Marcum, Nita Ray Chaudhuri, Salwa Gendi","doi":"10.1007/s00246-024-03552-3","DOIUrl":"10.1007/s00246-024-03552-3","url":null,"abstract":"<p><p>A patient was delivered at 26 weeks (about 6 months) gestation via an emergency caesarian section. A patent ductus arteriosus (PDA) and atrial septal defect (ASD) were discovered during an echocardiogram 13 days after birth. The patient had catheter-based closure of the PDA and ASD. During a routine echocardiogram to check device placements, it was discovered that there was dilation of the superior vena cava (SVC), and it was suspected that a thrombus was present. Computed tomography angiography (CTA) was completed to better define SVC anatomy and flow acceleration. The CTA demonstrated that there was a double innominate vein.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1000-1002"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437296","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":"Trends in Tetralogy of Fallot-Related Mortality in the United States Between 1999 and 2020.","authors":"Obaid Ur Rehman, Eeshal Fatima, Adeena Jamil, Zain Ali Nadeem, Aimen Nadeem, Ahmed Kamal Siddiqi, Richard A Krasuski","doi":"10.1007/s00246-025-03846-0","DOIUrl":"https://doi.org/10.1007/s00246-025-03846-0","url":null,"abstract":"<p><p>We sought to identify mortality trends related to Tetralogy of Fallot (ToF) in the U.S. population, with specific emphasis on age-related, racial, and geographic differences. Death certificate data was retrieved from the CDC WONDER database, where crude mortality rate (CMR) and age-adjusted mortality rates (AAMR) with 95% CIs per 1,000,000 population were identified, along with annual percentage changes (APCs) and average annual percentage change (AAPC) determined by Joinpoint regression. From 1999 to 2020, a total of 5523 deaths were reported in association with ToF, with nearly half of all deaths occurring during the first year of life. The AAMR steadily decreased from 1999 to 2020 (AAPC: - 1.26, 95% CI - 2.29 to -0.38, p-value = 0.012). Males had a slightly higher AAMR (0.91) than females (0.77). Non-Hispanic (NH) Blacks/African Americans had a higher AAMR (1.00) compared with NH Whites (0.83). Infants less than a year old exhibited the highest CMRs among all age groups. Although lower rates were seen among all age strata < 45 years of age, deaths in patients > 45 years significantly increased from 2013 to 2020 (APC 6.17, 95% CI 0.79 to 20.35, p-value = 0.047). Rural areas consistently exhibited greater AAMRs and lesser declines over time compared to urban areas, with most deaths occurring in medical facilities. Over the last 2 decades in the US, the mortality rates associated with ToF have steadily decreased. Focusing resources on these higher risk populations may prove beneficial.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753959","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":"Congenital Cardiac Catheterization Risk Assessment in Infants Under 2.5 kg.","authors":"Michael L O'Byrne, Nicholas S Boscamp, Kimberlee Gauvreau, Grace R Rahman, Oliver M Barry, Sarosh P Batlivala, Lisa Bergersen, Elsa C Bjornlund, Martin L Bocks, Thomas Doyle, Michael Farias, Bryan H Goldstein, Ralf J Holzer, Suren R Veeram Reddy, Arash Salavitabar, Shyam Sathanandam, Wendy Whiteside, Brian P Quinn","doi":"10.1007/s00246-025-03821-9","DOIUrl":"https://doi.org/10.1007/s00246-025-03821-9","url":null,"abstract":"<p><p>Premature and small-for-gestational-age neonates with congenital heart disease increasingly require congenital cardiac catheterization (CCC). These patients present unique procedural and patient-specific risks that standard risk models do not fully capture. This study aims to assess risk in infants < 2.5 kg undergoing CCC, further stratifying by procedural type to better understand predictors of clinically meaningful adverse events (CMAE). Patient and Procedural data were collected on diagnostic and interventional catheterization procedures for infants < 2.5 kg from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry between 2014 and 2022. Cases were stratified into historical (2014-2018) and modern (2019-2022) eras and further categorized into PDA closure and 'All Other Cases'. Multivariable logistic regression assessed associations between covariates and the risk of CMAE. Analysis included 1,345 cases. In the modern era, PDA closures (n = 898, 66.8%) had a lower CMAE rate at 3.6% versus 8.1% for 'All Other Cases' (P < 0.001). Among 'All Other Cases' (n = 447) 23% were diagnostic and 77% interventional, with CMAE rates of 7.7% and 6.4%, respectively. CMAE types varied, with PDA cases mainly experiencing respiratory events (22%) and 'All Other Cases' showing higher rates of access complications (27%) and arrhythmias (29%). Risk in infants < 2.5 kg undergoing CCC is heavily dependent on procedural type and specific patient factors, highlighting the need for tailored risk assessment tools. This study, the largest to date in this population, emphasizes the importance of individualized care plans to improve outcomes.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736121","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":"Pulmonary Artery Size as a Predictor of Early Post-operative Pediatric and Congenital Heart Transplant Outcomes.","authors":"William A Harris, Zain S Kazmi, John M Costello, Jason R Buckley, Minoo N Kavarana, Andrew J Savage, Varsha M Bandisode, Anthony M Hlavacek, Carolyn L Taylor","doi":"10.1007/s00246-025-03839-z","DOIUrl":"https://doi.org/10.1007/s00246-025-03839-z","url":null,"abstract":"<p><p>Pulmonary artery size has been studied as an outcome predictor for selected congenital heart surgeries but has not been investigated in pediatric and congenital heart transplantation. We sought to evaluate pre-operative pulmonary artery size as a predictor of post-transplant outcomes. This single center retrospective study included all patients transplanted from 2014 to 2023. Echocardiography, computed tomography angiography (CTA), and catheter angiography were used to measure pre-operative pulmonary artery size. Cross-sectional areas were calculated and indexed to calculate Nakata index and lower lobe index. Outcomes included post-transplant cardiovascular and end-organ function, length of stay, and mortality. Statistical analyses included Spearman rank correlations, chi-squared tests, and Mann-Whitney U tests. Included were 68 patients with 37 (54%) having a diagnosis of congenital heart disease. Echocardiogram (n = 68), CTA (n = 52), and catheter angiogram (n = 31) measurements were analyzed. Smaller lower lobe index was associated with longer duration of post-transplant treatment with nitric oxide (p = 0.02). In the congenital heart disease cohort, smaller Nakata index was associated with pulmonary artery reconstruction during transplant (p = 0.003). Indexed pulmonary artery size was otherwise not associated with important outcomes in the entire population or congenital heart disease cohort. While pre-operative pulmonary artery size was associated with prolonged nitric oxide use, it was generally not predictive of other early post-transplant outcomes. No imaging modality was found to have superior predictive value. Use of advanced imaging to guide surgical technique during transplant may negate the impact of smaller pulmonary artery size.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730886","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":"A Case of Indolent Kawasaki Disease with Delayed Coronary Artery Lesions: The Role of Proactive Imaging.","authors":"Koji Nishigaki, Kunihiko Takahashi, Shota Hamano, Masaki Ota, Ayuka Kato, Kyoko Noguchi, Taisuke Onoe, Shizuka Nishimoto, Makiko Kikkawa, Yasuyuki Tokunaga, Kosuke Chayama","doi":"10.1007/s00246-025-03836-2","DOIUrl":"https://doi.org/10.1007/s00246-025-03836-2","url":null,"abstract":"<p><p>Kawasaki Disease (KD) is an acute vasculitis primarily affecting children and can lead to coronary artery lesions (CALs) if not promptly diagnosed and treated. Indolent KD, characterized by spontaneous fever resolution without early intervention, poses diagnostic challenges as patients may not initially meet the complete diagnostic criteria, delaying treatment and increasing the risk of CAL development. We report a case of a 17-month-old boy with indolent KD who developed CAL on the 18th day of illness, necessitating IVIG therapy. Despite initial symptom resolution, echocardiographic monitoring revealed delayed coronary artery involvement, underscoring the importance of proactive imaging. This case highlights the need for frequent echocardiographic evaluation in indolent KD, particularly when clinical and laboratory findings are inconclusive. Serial imaging facilitates early detection of CALs, enabling timely IVIG therapy and potentially preventing disease progression. A structured follow-up strategy is crucial in managing indolent KD to reduce the risk of long-term cardiovascular complications.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720880","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}