PM&R最新文献

{"title":"Departments.","authors":"","doi":"10.1002/pmrj.13362","DOIUrl":"https://doi.org/10.1002/pmrj.13362","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":"17 2","pages":"E1-E9"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415038","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 of hip strength to walking and balance performance in unilateral lower limb prosthesis users differs by amputation level.","authors":"Andrew Sawers, Stefania Fatone","doi":"10.1002/pmrj.13245","DOIUrl":"10.1002/pmrj.13245","url":null,"abstract":"<p><strong>Background: </strong>Safe and efficient locomotion is a frequently stated goal of lower limb prosthesis users, for which hip strength may play a central yet poorly understood role. Additional research to identify associations between hip strength, balance, and mobility among transtibial and transfemoral prosthesis users is required.</p><p><strong>Objective: </strong>To test whether residual and/or intact limb isometric hip strength was associated with lower limb prosthesis users' walking speed, endurance, and balance.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Research laboratory.</p><p><strong>Participants: </strong>Convivence sample of 14 transtibial and 14 transfemoral prosthesis users.</p><p><strong>Methods: </strong>Multiple linear regression was used to evaluate the relationship between isometric measures of residual and intact limb hip strength and walking and balance performance.</p><p><strong>Main outcome measurements: </strong>Measures of isometric hip muscle strength, including peak torque, average torque, torque impulse, and torque steadiness (i.e. consistency with which an isometric torque can be sustained) were derived from maximum voluntary hip flexion, extension, abduction and adduction torque signals collected with a motor-driven dynamometer. Walking speed, endurance, and balance were assessed by administering the 10-meter walk test, 2-minute walk test, Four Square Step Test, and Narrowing Beam Walking Test, respectively.</p><p><strong>Results: </strong>Residual limb hip extensor max torque and abductor torque steadiness explained between 51% and 69% of the variance in transtibial prosthesis users' walking speed, endurance, and balance. In contrast, intact limb hip abductor torque impulse explained between 33% and 48% of the variance in transfemoral prosthesis users' walking speed, endurance, and balance.</p><p><strong>Conclusions: </strong>Our results suggest that unilateral transtibial and transfemoral prosthesis users' walking and balance performance may depend on different hip muscles, and different facets of hip strength. Amputation level-specific hip strength interventions may therefore be required to improve walking and balance performance in unilateral transtibial and transfemoral prosthesis users. The \"intact leg strategy\" adopted by transfemoral prosthesis users may be due to a variety of prosthesis and biomechanical factors that limit the efficiency with which transfemoral prosthesis users can exploit the strength of their residual limb hip muscles while walking.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"147-158"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141907499","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":"Mobilization with movement is effective for improving ankle range of motion and walking ability in individuals after stroke: A systematic review with meta-analysis.","authors":"Lucas R Nascimento, Augusto Boening, Isabella Ribeiro, Maria Eduarda Dos Santos, Marcelo Benevides, Cíntia H Santuzzi","doi":"10.1002/pmrj.13259","DOIUrl":"10.1002/pmrj.13259","url":null,"abstract":"<p><strong>Background: </strong>Mobilization with movement has been recommended to improve foot mobility in people with ankle impairments and could improve walking after stroke.</p><p><strong>Objective: </strong>To examine the effects of the addition of mobilization with movement to commonly used exercises in physiotherapy for improving ankle range of motion and walking in people who have had a stroke.</p><p><strong>Design: </strong>Systematic review of randomized controlled trials.</p><p><strong>Settings: </strong>Not applicable.</p><p><strong>Participants: </strong>Ambulatory adults at any time after stroke.</p><p><strong>Intervention: </strong>The experimental intervention was exercises plus ankle mobilization with movement, in comparison with exercises alone.</p><p><strong>Main outcome: </strong>Ankle range of motion.</p><p><strong>Measurements: </strong>Walking parameters (ie., walking speed, cadence, step length).</p><p><strong>Results: </strong>Six trials, involving 160 participants, were included. The mean PEDro score of the trials was 6 (range 4 to 7). Mobilization with movement in addition to exercises improved range of motion by 4° (95% CI 2 to 6), walking speed by 0.08 m/s (95% CI 0.05 to 0.11), cadence by 9 steps/min (95% CI 7 to 12), and step length by 5 cm (95% CI 3 to 7) more than exercises alone. The quality of evidence was low for range of motion and moderate for walking outcomes.</p><p><strong>Conclusion: </strong>This systematic review provided evidence that the addition of mobilization with movement to commonly used exercises in neurological rehabilitation increases ankle dorsiflexion, and benefits are carried over to improving walking speed, cadence, and step length in moderately disabled individuals with chronic stroke.</p><p><strong>Review registration: </strong>PROSPERO (CRD42023405130).</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"200-209"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352492","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":"Basal cell carcinoma on amputated limb following radiation therapy for heterotopic ossification.","authors":"Gabriela Pinero-Crespo, Meredith E Thomley, Aashish Bhatt, Jeffrey Heckman, Thomas Beachkofsky","doi":"10.1002/pmrj.13336","DOIUrl":"https://doi.org/10.1002/pmrj.13336","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075295","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":"InspireGBs - Inspiratory muscle training in people with Guillain-Barré syndrome: A feasibility study.","authors":"Miguel P Almeida, João Carlos Winck, Alda Marques","doi":"10.1002/pmrj.13251","DOIUrl":"10.1002/pmrj.13251","url":null,"abstract":"<p><strong>Background: </strong>Guillain-Barré syndrome (GBS) is a rare immune-mediated peripheral nerve disease often preceded by infections. Respiratory muscle weakness is a common complication in this population, leading to decreased vital capacity, weakened coughing ability, atelectasis, and pulmonary infections. Inspiratory muscle training (IMT) has been widely used to enhance inspiratory muscle strength and pulmonary function in various diseases; however, its application in GBS is unknown.</p><p><strong>Objective: </strong>To assess the safety, feasibility, and preliminary effectiveness of an IMT protocol-InspireGBs-in people with GBS.</p><p><strong>Methods: </strong>A pre/post feasibility study was conducted. Feasibility was determined by participant recruitment/retention, adherence, time spent in each session, and adverse events. Secondary outcome was inspiratory muscle strength. InspireGBs consisted of twice daily sessions 5 times/week, three sets of 10 breaths in each session, for 6 weeks. Initial resistance was set at 50% of participant's baseline maximal inspiratory pressure (MIP) and with a weekly increase of 10% calculated from the previous week's training intensity, if tolerated, otherwise the increase was 5%.</p><p><strong>Results: </strong>Eleven patients (63% male; 63 ± 9 years) were recruited from inpatient rehabilitation and 10 completed the study. Recruitment and retention rates were high (79% and 91%, respectively). Excellent adherence rate (96%) was obtained with no reported adverse effects or safety issues. Sessions lasted from 4 to 6 minutes. The MIP improved (pretraining: 39 [26.5-50] cm H₂O vs. posttraining: 61 [56.3-64.5] cm H₂O, p = .005 and pretraining: 38 [30.5-53.8] % of predicted vs. posttraining: 60 [54.28-71.58] % of predicted, p = .009) with the InspireGBs.</p><p><strong>Conclusion: </strong>InspireGBs is safe, feasible, and may be effective in improving inspiratory muscle strength in individuals with GBS. A randomized controlled trial is now needed to strengthen these findings.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"187-194"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976435","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":"Beliefs regarding the use of imaging among patients with low back pain: A cross-sectional study in the context of a middle-income country.","authors":"Leandro M Diniz, Ítalo R Lemes, Ana P C F Freire, Ana F Guimarães, Lucas A C Ferreira, Marcia R Franco, Arianne P Verhagen, Guy Simoneau, Rafael Z Pinto","doi":"10.1002/pmrj.13237","DOIUrl":"10.1002/pmrj.13237","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with low back pain may play an active role in the prescription of excessive spine imaging.</p><p><strong>Objective: </strong>To determine the proportion of patients with low back pain who have beliefs not aligned with current evidence regarding the use of imaging and to identify factors associated with these beliefs.</p><p><strong>Design: </strong>Secondary analysis of baseline data of a previously published randomized clinical trial.</p><p><strong>Setting: </strong>Outpatient physical therapy clinic in a middle-income country.</p><p><strong>Patients: </strong>Individuals with non-specific low back pain.</p><p><strong>Methods: </strong>Outcome variables were two statements assessing the extent of patient agreement on the need for imaging in the management of low back pain. The predictor variables were age, educational level, duration of symptoms, disability level, pain intensity in the last 24 hours, beliefs about inevitable consequences of low back pain (assessed using the Back Belief Questionnaire), and having received imaging previously. Multivariable logistic models were used for data analysis.</p><p><strong>Main outcome measure(s): </strong>Level of agreement with Statement 1: X-rays or scans are necessary to get the best medical care for low back pain and Statement 2: Everyone with low back pain should have spine imaging.</p><p><strong>Results: </strong>A total of 159 patients were included. Of these, 88.1% believed that imaging was necessary for the best medical care for low back pain and 62.9% believed that everyone with low back pain should obtain imaging. Lower scores on the Back Belief Questionnaire were associated with beliefs that imaging was necessary (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.81, 0.99) and low education level was associated with the belief that everyone with low back pain should obtain imaging (OR = 3.03, 95% CI: 1.38, 6.61), after controlling for potential confounders.</p><p><strong>Conclusion: </strong>Nearly 90% of patients believe that spine imaging is necessary for the management of low back pain. Beliefs about the inevitable consequences of low back pain and low education level may be factors that need to be considered when developing new interventions.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"178-186"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856246","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 Multilevel Limb-loss and Preservation Rehabilitation Continuum model (MLPRC): An evidence-based implementation model integrating multiple perspectives to improve outcomes for people facing limb loss.","authors":"Prateek Grover, Elvin Geng, Rachel G Tabak","doi":"10.1002/pmrj.13300","DOIUrl":"https://doi.org/10.1002/pmrj.13300","url":null,"abstract":"<p><strong>Background: </strong>The patient journey from threatened to actual limb loss, subsequent rehabilitation, and limb preservation through the health system is complicated and prone to delays, attrition, and inequities. A shared multi(socioecological)-level conceptualization of this journey among the multiple stakeholders is the first step for systematically improving limb care through identification of bottlenecks and gaps, contributory factors, and responsive interventions and implementation strategies.</p><p><strong>Objective: </strong>To meet this knowledge gap by presenting a novel implementation model, the Multilevel Limb-loss and Preservation Rehabilitation Continuum (MLPRC), that can be used to develop multilevel applications.</p><p><strong>Methods: </strong>MLPRC was developed in three overlapping steps: (1) design of the patient journey through the health system (horizontal element), (2) addition of multilevel perspectives along the journey (vertical element), and (3) implementation facilitation by incorporating implementation model constructs (concentric cells element).</p><p><strong>Results: </strong>MLPRC is an implementation model for limb loss and preservation with three concentric cells: inner context cell (horizontal time-ordered patient journey at patient level, based on phases of amputation rehabilitation and patient journey concepts, and corresponding care delivery at provider/organization-level, based on the continuum of care and lower limb loss rehabilitation continuum concepts, on the journey timeline), less influenceable outer context cell (community, system and policy level perspectives), and outermost implementation cell, based on Proctor Model of Implementation Research, that utilizes inner and outer context cells (concept derived from Exploration, Preparation, Implementation, Sustainment framework) information to define responsive metrics, interventions and implementation strategies.</p><p><strong>Discussion: </strong>Examples of MLPRC use as a blueprint for multilevel applications include patient level (education and navigation instruments), provider level (integrated practice clinic, referral streams), organization level (limb care continuum programs), and community, system, and policy level (interdisciplinary organizational partnerships, data repositories).</p><p><strong>Conclusion: </strong>MLPRC is among the first implementation model to present both a unified picture of the field of limb loss and preservation and a blueprint for multilevel applications.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067600","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":"Functional independence trajectories over 5 years in older veterans with traumatic brain injury: A model systems study.","authors":"Mia E Dini, Rachel E Wallace, Daniel W Klyce, Carmen M Tyler, Michael Vriesman, Shannon B Juengst, Victoria Liou-Johnson, Kelli W Gary, Kristen Dams-O'Connor, Raj G Kumar, Umesh M Venkatesam, Kritzia Merced, Paul B Perrin","doi":"10.1002/pmrj.13312","DOIUrl":"https://doi.org/10.1002/pmrj.13312","url":null,"abstract":"<p><strong>Background: </strong>Research on older adults who sustain a traumatic brain injury (TBI) has predominantly been on civilian, nonveteran populations. Military populations experience higher rates of TBI and often experience the additive effects of TBI and other comorbid disorders, including posttraumatic stress disorder and/or substance use that may increase disability over time.</p><p><strong>Objective: </strong>To investigate predictors of functional independence trajectories over the 5 years after TBI in veterans 55 years or older at injury.</p><p><strong>Setting: </strong>Five Veterans Affairs (VA) polytrauma rehabilitation center (PRC) inpatient rehabilitation programs.</p><p><strong>Participants: </strong>Veterans who experienced their TBI at 55 years or older and had completed one or more Functional Independence Measure (FIM) Motor and Cognitive measure at 1, 2, or 5 years after TBI (n = 184) from the VA TBI Model Systems national database.</p><p><strong>Design: </strong>Retrospective analysis of observational data using hierarchical linear models.</p><p><strong>Main measures: </strong>FIM Motor and Cognitive scores at 1, 2, and 5 years after TBI.</p><p><strong>Results: </strong>Motor and cognitive functioning decreased over time. Lower FIM Motor trajectories occurred in participants who had pre-TBI functional limitations in going out of the home and with longer posttraumatic amnesia (PTA). FIM Motor scores decreased over time, and the decrease was steeper for those with a moderate or severe injury. Lower FIM Cognitive trajectories occurred in participants who had problematic substance use at baseline and among those with longer PTA. FIM Cognitive scores decreased at a steeper rate for participants with greater injury severity.</p><p><strong>Conclusions: </strong>Similar to previously published studies in civilian populations, older veterans with TBI may be at risk for functional and cognitive decline. This study's findings increase the field's understanding of functional trajectories after TBI in older adults and may help identifty those who are at risk for lower functional outcomes.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047632","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":"Effects of mirror therapy on motor and functional recovery of the upper extremity in subacute stroke: Systematic review and meta-analysis.","authors":"Yuan-Lun Hsieh, Tzu-Ying Yang, Zi-You Peng, Ray-Yau Wang, Hui-Ting Shih, Yea-Ru Yang","doi":"10.1002/pmrj.13316","DOIUrl":"https://doi.org/10.1002/pmrj.13316","url":null,"abstract":"<p><strong>Objective: </strong>To review and synthesize existing evidence on the effect of mirror therapy (MT) on motor and functional recovery and the effect of unimanual and bimanual MT in individuals with subacute stroke.</p><p><strong>Methodology: </strong>PubMed, Physiotherapy Evidence Database, Cochrane, and Airiti Library were searched for relevant studies. Randomized and pilot randomized controlled trials comparing MT with sham MT or conventional therapy were included. Three researchers independently reviewed eligible studies for study design, participants' characteristics, intervention, and outcome measures and assessed study quality. The Physiotherapy Evidence Database scale was used to evaluate the methodological quality of included studies, and the Cochrane Risk of Bias Tool was used to assess the risk of bias.</p><p><strong>Synthesis: </strong>Fifteen studies with 546 participants were included. An overall effect of MT was found for motor impairment (effect size [95% confidence interval]: 0.473 [0.274-0.673], p < .001), motor function (0.266 [0.059-0.474], p = .012), and activities of daily living (ADL) (0.461 [0.25-0.671], p < .001), compared with controls. There was a significant difference in motor impairment (0.39 [0.134-0.647], p = .003), motor function (0.298 [0.003-0.593], p = .048), and ADL (0.461 [0.157-0.766], p = .003) in favor of bimanual MT compared with controls. No significant effect was found for unimanual MT.</p><p><strong>Conclusion: </strong>MT, specifically bimanual MT, is an effective intervention for improving motor recovery, motor function, and ADL in individuals with subacute stroke, whereas unimanual MT does not show significant benefits in these areas.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033854","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":"Optimizing orthobiologic therapies with exercise, diet, and supplements.","authors":"Jami Montagnino, Matthew W Kaufman, Maya Shetty, Christopher Centeno, Michael Fredericson","doi":"10.1002/pmrj.13320","DOIUrl":"https://doi.org/10.1002/pmrj.13320","url":null,"abstract":"<p><p>Orthobiologic injections including platelet-rich plasma (PRP) and cell-based injections are becoming increasingly popular. Evidence suggests that these therapies can be effective in certain situations. The efficacy of these injections may be more dependent on the quality of the injectate, which given their autologous nature, may be dependent on lifestyle choices like exercise, diet, and supplements. The literature describing PRP injections shows that the number and activity of platelets can improve their efficacy. A multitude of lifestyle modifications can affect those factors. Exercise intensity appears to increase platelet count and increases adhesion as well as release of growth factors. Low inflammatory diets increase platelet counts and activity overall. Stress, some supplements, high cholesterol, or processed sugar diets can increase inflammation and potentially decrease platelet counts as well as quality of PRP injectate. Similarly, cell-based therapies can be affected by mesenchymal stromal cell (MSC) number and quality. Cell-based therapy is based upon limiting cellular senescence and increasing replication and differentiation. Exercise may limit senescence and improve replication and differentiation of these cell-based therapies, especially in older adult populations. There are a multitude of supplements that may potentiate these types of injections and patients should discuss the potential benefits and concerns when starting a supplement regimen. Certain foods as well as changes in oxygenation may limit cellular senescence and lower calorie intake may affect MSC viability and function as well. Overall, the current state of literature describes biologic plausibility of how exercise, diet and supplements might affect orthobiologic injection efficacy. Further translational research needs to be completed to describe the effect size and improve recommendations for clinical implementation.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033858","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}