Pediatric Pulmonology最新文献

{"title":"Infant Lung Function in Cystic Fibrosis: A Real-World Study.","authors":"Michele Arigliani, Sidrah Chaudhry, Rossa Brugha, Ranjan Suri, Paul Aurora","doi":"10.1002/ppul.71117","DOIUrl":"https://doi.org/10.1002/ppul.71117","url":null,"abstract":"<p><strong>Background: </strong>Previous research showed that lung function abnormalities are common in infants with cystic fibrosis (IwCF) but real-world data are missing.</p><p><strong>Methods: </strong>This single-center retrospective study analyzed infant lung function results from IwCF born in 2012-2018. The tests were conducted at Great Ormond Street Hospital, London, as part of routine care at 3 months, 1 year, and 2 years of age. Z-scores for SF₆ Lung Clearance Index (zLCI), plethysmographic FRC (zFRC_pleth) and FEV_0.5 were derived. Microbiology and antibiotics prescription from 3 months before lung function assessments, up to the closest medical review following the lung function encounter, were analyzed, along with changes in management advised by the physician.</p><p><strong>Results: </strong>A total of 126 lung function encounters (n = 43 at 3 months, 46 at 1 year, 37 at 2 years) from 60 IwCF were included. LCI was abnormal (zLCI > 1.96) in 31% (12/39) of 3-month-olds (mean± zLCI 1.21 ± 1.08), 28% (12/43) of 1-year-olds and 19% (7/36) of 2-year-olds (mean± zLCI 1.13 ± 1.10). Among 74 cases with recent positive microbiology or abnormal chest findings at medical review, 100% (31/31) of those with abnormal lung function and 86% (37/43) of those with normal lung function (p = 0.04) had a recent antibiotic prescription or a change in clinical management. Conversely, in encounters with abnormal lung function but normal clinical findings, management changes occurred in only 12% (2/16) of cases.</p><p><strong>Conclusion: </strong>In this real-word cohort of IwCF, clinical management was mainly influenced by clinical findings and only marginally by abnormal lung function (elevated FRC or LCI).</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71117"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discharge Practice Variability in Pediatric Chronic Home Invasive Ventilation.","authors":"Guillermo Beltran-Ale, Ryne Simpson, Terri Magruder, Ajay S Kasi, Amit Agarwal, Jake A Kaslow","doi":"10.1002/ppul.71130","DOIUrl":"10.1002/ppul.71130","url":null,"abstract":"<p><strong>Introduction: </strong>The Pediatric Mechanical Ventilation Society is a collaboration of pediatric pulmonologists with a focus on pediatric chronic home invasive ventilation (PCHIV). Since the initial discharge on PCHIV is not always directed by pediatric pulmonologists, we sought to understand how this variability between centers impact adherence to American Thoracic Society (ATS) guidelines for PCHIV.</p><p><strong>Methods: </strong>A survey was distributed to pediatric pulmonologists across multiple platforms inquiring about discharging practices for PCHIV and adherence to six of the nine ATS recommendations for PCHIV. Two subgroups were created based on common practices - discharge by pediatric pulmonologists from a non-ICU unit (pulmonary group) and discharge by ICU team from an ICU unit (ICU group).</p><p><strong>Results: </strong>A total of 107 surveys were completed, 90 from the US. Among the US centers, the ATS recommendations with lowest adherence were offering ongoing education to caregivers and the utilization of standardized criteria for discharge. Despite better adherence, the requirement of two caregivers for discharge was often made an exception for. When comparing the pulmonary and ICU groups, the number of annual discharges (p < 0.001), caregiver length of training (p = 0.003), and the utilization of standardized discharge criteria (p = 0.04) were significantly different.</p><p><strong>Discussion: </strong>Our study demonstrates variable adherence to expert consensus recommendations outlined by the ATS. A significant proportion of PCHIV patients were discharged directly from the ICU and by ICU teams. Practice variability was evident between institutions and discharging teams; therefore, the identification of barriers to guideline implementation and multidisciplinary collaboration is paramount to optimizing care.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71130"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchiolitis in Early Infancy Is Associated With Irreversible Airway Obstruction in Young Adulthood.","authors":"Sanna Saarikallio, Riikka Riikonen, Antti Tikkakoski, Sonja Laitinen, Annukka Holster, Matti Korppi, Eero Lauhkonen","doi":"10.1002/ppul.71139","DOIUrl":"https://doi.org/10.1002/ppul.71139","url":null,"abstract":"<p><strong>Background: </strong>Childhood risk factors, such as bronchiolitis, have been associated with airway obstruction later in life. However, assessing childhood risk factors for airway obstruction in adulthood requires long follow-ups with carefully gathered data. Our long-term follow-up represents lung function in early adulthood after infant bronchiolitis with evaluation of asthma and tobacco smoke exposure as childhood risk factors.</p><p><strong>Methods: </strong>We prospectively followed 166 term children hospitalized for bronchiolitis under 6 months of age. Lung function was measured at the mean age of 18.3 years by spirometry on 72 former bronchiolitis patients and 28 controls. We compared z-scores of FEV1 (forced expiratory volume in first second), FVC (forced vital capacity), and FEV1/FVC before and after bronchodilation. Reversibility was tested as FEV1 change in the bronchodilation test. The roles of asthma and smoke exposure were controlled in the analysis.</p><p><strong>Results: </strong>FEV1/FVC was lower in cases versus controls at baseline (mean z-score -0.90, SD 1.40 vs 0.10 SD 1.17; p = 0.001) and after bronchodilatation (0.54, SD 1.06 vs. -0.05, SD 1.22; p = 0.028). FEV1 increase in the bronchodilation test was greater in cases versus controls (6.3%, SD 5.3 vs. 2.3%, SD 3.7; p = 0.001). After excluding subjects with current asthma, the differences remained significant in baseline and post-bronchodilator FEV1/FVC and in FEV1 change in bronchodilation test, and after adjusting for previous asthma and household smoking, the differences remained significant in baseline and post-bronchodilator FEV1/FVC.</p><p><strong>Conclusion: </strong>Lower FEV1/FVC after bronchodilation in cases suggests a risk of irreversible obstructive lung function in young adults after infant bronchiolitis.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71139"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Newborn Screening Experience of Caregivers of Children With Cystic Fibrosis in the United States: A Cross-Sectional Survey.","authors":"Marie E Heffernan, Leo Barrera, MicKayla Jones, Ashley Hayes, Marisol Roldan, Michele Wright, Meghan E McGarry, Lainie F Ross, Susanna A McColley","doi":"10.1002/ppul.71110","DOIUrl":"https://doi.org/10.1002/ppul.71110","url":null,"abstract":"<p><strong>Background: </strong>There have been significant improvements in the health of infants and children with cystic fibrosis (CF) since universal newborn screening (NBS) was implemented in the United States (US). However, a significant proportion of infants with CF are not evaluated in a timely manner, and delays disproportionately affect children from minoritized racial/ethnic groups. The aim of this study was to understand experiences of NBS in caregivers of young children with CF in the United States.</p><p><strong>Methods: </strong>We recruited caregivers of children (0-13 years) with CF through listservs and social media of CF organizations. The survey was administered online in 2023 and included questions about their recollections of their child's NBS and the process of getting a CF diagnosis.</p><p><strong>Results: </strong>Of 383 caregiver respondents, 43% reported being informed that their child's race or ethnicity was a predictor of the chances of their child having CF. Most reported that after they were notified of a positive NBS test, the initial evaluation for CF was scheduled ≥ 4 days later, 45% reported a delay of ≥ 8 days, and 5% reporting a delay of ≥ 15 days. Most (91%) felt the initial evaluation for CF was thorough, but 35% reported delays in getting information about their child's diagnosis.</p><p><strong>Conclusions: </strong>Caregivers report delays in evaluation after a positive NBS. A significant proportion reported delays in receiving information about their child's diagnosis or being told that race or ethnicity were related to risk of CF. These findings show the need for education and practice changes in both primary care and CF center settings.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71110"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic Fibrosis Learning Network Telehealth Innovation Lab During the COVID-19 Pandemic: Impact on Access to Care, Outcomes, and a New CF Care Model.","authors":"Dana Albon, Thida Ong, Bethany Horton, David Brighton, Shiyi Shen, Rhonda List, Nicholas Antos, Fadi Asfour, Ella Balasa, Danielle Beachler, Cori Daines, Deborah Froh, Catherine Kier, Samya Nasr, Meghana Sathe, Gregory Sawicki, Michael Schechter, George Solomon, Michael Powers","doi":"10.1002/ppul.71102","DOIUrl":"https://doi.org/10.1002/ppul.71102","url":null,"abstract":"<p><strong>Background: </strong>Cystic fibrosis (CF) is a chronic genetic disorder requiring regimented visits for maintenance of care. The COVID-19 pandemic accelerated the accessibility of telehealth (TH) and forced a trial of incorporating remote care into routine CF care. The CF Learning Network (CFLN) organized for data sharing into a telehealth innovation lab (TH-iLab) to improve access to the interdisciplinary care team and co-produced shared agenda-setting.</p><p><strong>Methods: </strong>All persons with CF (PwCF) with a CF diagnosis in the CF Foundation Registry (CFFPR) from 1/2020-12/2021 were included and categorized into CFLN TH-iLab, CFLN TH-iLab non-participants, and non-CFLN programs.</p><p><strong>Hypothesis: </strong>standardized TH implementation in the CFLN TH-iLab is associated with increased access to the CF care model and results in similar lung function and nutrition health outcomes.</p><p><strong>Results: </strong>In 2020 and 2021, the average number of TH visits per person per year and the percentage of PwCF with one or more TH visits per year were higher in the CFLN TH-iLab than in the other groups. Lung function was highest in PwCF, followed by a program that was part of the CFLN TH-iLab in 2020 and 2021. Anthropometric measurements, spirometry, and attainment of microbiology cultures were similar among all three groups. Access to interdisciplinary care was highest in the CFLN non-TH-iLab group.</p><p><strong>Conclusion: </strong>Integrating TH into CF care in the CFLN TH-iLab provided access to care during the COVID-19 pandemic without compromising clinical outcomes. Further research on optimizing the telehealth experience for PwCF can help better understand TH's long-term impact on CF care.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71102"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Prediction Models for Less Invasive Surfactant Administration Failure in Preterm Infants: A Retrospective Cohort Study in a Low-and-Middle Income Country.","authors":"Somnath Pal, Moumita Ghosh","doi":"10.1002/ppul.71127","DOIUrl":"https://doi.org/10.1002/ppul.71127","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify risk factors associated with less invasive surfactant administration (LISA) failure in preterm infants with respiratory distress syndrome (RDS) in a low-and-middle income country (LMIC) and develop a prediction model to estimate the risk of LISA failure.</p><p><strong>Methods: </strong>This retrospective cohort study included 600 preterm infants who received LISA at a tertiary care neonatal unit in eastern India from January 2020 to December 2024.</p><p><strong>Results: </strong>LISA failure, defined as the need for intubation and mechanical ventilation within 72 h of the procedure, ranged from 30% to 40%. The most important risk factors for LISA failure identified by random forest analysis were higher oxygen saturation index (OSI), higher cord base deficit, lower birth weight, lower admission temperature, and incomplete course of antenatal corticosteroids (ANS). Various prediction models were developed and validated on the testing set, with random forest and support vector machine using radial kernel demonstrating the highest accuracy (92.42% and 90.91%, respectively). In terms of sensitivity, Lasso penalized logistic regression was the best performing model followed by the random forest (96.55% and 93.88% respectively). The incidence of bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) requiring treatment, mortality, median duration of respiratory support, and time to discharge were significantly higher in the LISA failure group compared to the successful LISA group.</p><p><strong>Conclusion: </strong>This study highlights the need for prediction models to estimate the risk of LISA failure in individual patients, which may inform decisions regarding alternative methods of surfactant administration in patients at high risk of LISA failure.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71127"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-Tidal Carbon Dioxide Monitoring in Neonates Receiving Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy.","authors":"Mate Detar, Barbara Szasz, Hajnalka Barta, Miklos Szabo, Agnes Jermendy, Eniko Szakmar","doi":"10.1002/ppul.71144","DOIUrl":"10.1002/ppul.71144","url":null,"abstract":"<p><strong>Introduction: </strong>Primary aim was to assess the agreement between end-tidal carbon dioxide (etCO₂) monitoring and arterial, capillary and venous PCO₂ values in mechanically ventilated patients receiving therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy (HIE). Secondary, to assess the percentage of time spent in predefined PCO₂ ranges based on continuous etCO₂ monitoring.</p><p><strong>Methods: </strong>In this prospective observational single center trial, infants with moderate-to-severe HIE receiving conventional ventilation with sidestream capnography were enrolled. Blood gas measurements were performed based on clinical indication. The mean of 12,000 etCO₂ values obtained over 10 min before each corresponding blood gas was used for analysis. The agreement between mean etCO₂ and temperature corrected and uncorrected PCO₂ at 37^◦C were analyzed using Bland-Altman (BA) plots.</p><p><strong>Results: </strong>A total of 262 paired PCO₂ and etCO₂ values were analyzed from 35 patients. The bias between temperature corrected arterial PCO₂ and etCO₂ (n = 116) was 1.87 mmHg (SD 5.54) with -8.99 and 12.73 limits of agreement; whereas the bias between capillary PCO₂ and etCO₂ (n = 132) was 7.22 mmHg (SD 6.08). EtCO₂ underestimated PCO₂ of any source at 37°C. Excluding patients with lung diseases from BA analysis did not show improvement in the agreement. Infants spent median 23.9% [IQR 8.5; 36.7] of monitoring time in etCO₂ range < 35 mmHg and median 75.0% [IQR 61.1; 87.7] in etCO₂ range of 35-55 mmHg.</p><p><strong>Conclusions: </strong>EtCO₂ monitoring may be a valuable addition to neurocritical care of infants with HIE as it showed a strong level of agreement with temperature corrected arterial PCO₂.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71144"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasal Nitric Oxide Measurements During Tidal Breathing: A Device Comparison Study in Ciliary Disease.","authors":"Nils Oskar Jõgi, Karin Ersson, Kjell Alving, Christina Krantz, Andrei Malinovschi","doi":"10.1002/ppul.71092","DOIUrl":"10.1002/ppul.71092","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71092"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous Carbon Dioxide Monitoring During Weaning From Mechanical Ventilation in Children: The WeanCO₂ Study.","authors":"Meryl Vedrenne-Cloquet, Charlotte Collignon, Noémie De Cacqueray, Mathilde Grapin, Mehdi Oualha, Sylvain Renolleau, Lucie Griffon, Sonia Khirani, Brigitte Fauroux","doi":"10.1002/ppul.71115","DOIUrl":"https://doi.org/10.1002/ppul.71115","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous breathing trial (SBT) is recommended during weaning from mechanical ventilation (MV), but objective and easy tools lack to identify pediatric weaning failure. We aimed to assess whether changes in estimated arterial CO₂ (PaCO₂) derived from transcutaneous measurements (P_TCCO₂) were associated with pediatric weaning failure.</p><p><strong>Methods: </strong>Children (age 72 h -18 years) with MV > 12 h were continuously monitored using a transcutaneous sensor to estimate PaCO₂ from skin CO₂ tension (P_TCCO₂). Values were recorded during SBT (30 min on positive end-expiratory pressure (PEEP) +5 cmH₂O, with pressure support of +5 cmH₂O for endotracheal tubes with internal diameter ≤ 3.5 mm), then up to 6 h after extubation. Mean P_TCCO₂ and P_TCCO₂ changes during SBT, and after extubation, were retrospectively collected to evaluate their association with SBT failure and extubation failure (reintubation within 48 h).</p><p><strong>Results: </strong>Eighty children (median [IQR] age 1.1 [0.3; 8.7] years) were included, with 89 SBT (14 failures, 75 successes). Sixty-four patients were extubated following their first SBT, with 10 (16%) extubation failures. P_TCCO₂ changes were not associated with SBT and extubation failures. Patients who failed extubation had a higher mean P_TCCO₂ value after extubation as compared to those who were successfully extubated (mean P_TCCO₂ of 51.8 [46.2; 55.4] vs. 42.3 [37.5; 47.2] mmHg, p = 0.02). The difference between the maximal P_TCCO₂ value within the 2 h following extubation and the value at extubation were higher in patients who failed extubation (ΔP_TCCO₂ of 20 [9.1; 26] vs. 6.8 [2.9; 9.7] mmHg, p < 10^-2).</p><p><strong>Conclusion: </strong>Early post-extubation increase in estimated PaCO₂ was associated with extubation failure, whereas P_TCCO₂ changes during SBT were not.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71115"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We Treat Children Not Guidelines.","authors":"Aaron J Stein, W Gerald Teague","doi":"10.1002/ppul.71123","DOIUrl":"https://doi.org/10.1002/ppul.71123","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71123"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}