Respiratory care最新文献

{"title":"When Simple Solutions Spark Unnecessary Complexity.","authors":"Emiliano Gogniat, Emilio Steinberg, Gustavo A Plotnikow","doi":"10.1089/respcare.13183","DOIUrl":"https://doi.org/10.1089/respcare.13183","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180196","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":"Effect of Noninvasive Ventilation on the Upper Airway in Patients With Amyotrophic Lateral Sclerosis: The Role of Upper-Airway Endoscopy.","authors":"Mikel Sarasate, Ana Córdoba-Izquierdo, Eva Farrero, Rosa López-Lisbona, Marta Díez-Ferrer, Pere Trias-Sabrià, Marta Plana, Mónica Povedano, Salud Santos, Enric Prats","doi":"10.1089/respcare.12791","DOIUrl":"https://doi.org/10.1089/respcare.12791","url":null,"abstract":"<p><p><b>Background:</b> Upper-airway obstruction (UAO) in amyotrophic lateral sclerosis (ALS) may reduce the efficacy of noninvasive ventilation (NIV). NIV can cause or worsen this obstruction, further worsening the disease prognosis. This study aims to describe UAO in ALS patients using upper-airway endoscopy (UA-End) during spontaneous breathing (SB) and NIV and to evaluate the usefulness of UA-End in adjusting NIV parameters to correct any observed obstruction. <b>Methods:</b> This prospective study (2017-2019) involved subjects with ALS and indications for NIV. After optimizing ventilation following standardized procedures, an awake UA-End was performed, first during SB and then during NIV. Endoscopic assessments included identification of the site of UAO using the VOTE classification, assessment of vocal cords, and adjustments of NIV settings to correct any identified obstructions. Afterward, a post hoc analysis was conducted comparing gasometrical and nocturnal oximetry variables between the groups with and without NIV obstruction at 3 and 6 months. <b>Results:</b> In total, 25 subjects were enrolled. UAO was observed in 9 cases (37%) during SB, whereas 12 cases (50%) showed obstruction during NIV, 7 newly appearing. Hypopharyngeal constriction and backward movement of the epiglottis were the most frequent findings. Adjustments in NIV settings during endoscopy improved UAO in all but one case. Survival rates were similar after UA-End adjustments for subjects on NIV, both with and without UAO. <b>Conclusions:</b> This study is, to the best of our knowledge, the first to show the usefulness of UA-End in assessing and correcting UAO in subjects with ALS at NIV initiation. Furthermore, correction of such events through UA-End may have a positive impact on ventilation control and survival.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182111","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":"Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure.","authors":"Candelaria de Haro, Alba Xifra-Porxas, Montserrat Batlle, Leonardo Sarlabous, Verónica Santos-Pulpón, Victor Mora, Francesc Suñol, Gemma Gomà, Júlia Estela, Carles Subirà, Josefina López-Aguilar, Sol Fernández-Gonzalo, Marta Godoy-González, Rafael Fernández, Rudys Magrans, Irene Telias, Oriol Roca, Laurent Brochard, Lluís Blanch","doi":"10.1089/respcare.12673","DOIUrl":"https://doi.org/10.1089/respcare.12673","url":null,"abstract":"<p><p><b>Background:</b> We sought to analyze the prevalence of patient-ventilator asynchronies in subjects with hypoxemic respiratory failure because of COVID-19 ARDS and their association with clinical outcomes. <b>Methods:</b> This was a two-center observational cohort study using prospectively collected real-world data. We included adult subjects with COVID-19 ARDS who required mechanical ventilation for more than 48 hours. We analyzed the prevalence, characteristics, and clusters of the following patient-ventilator asynchronies detected using dedicated software on continuous respiratory recordings obtained from ventilators over the duration of mechanical ventilation (Better Care, Sabadell, Spain): double triggering, ineffective efforts (IE), and reverse triggering with and without breath-stacking (BS). The outcome measures evaluated were duration of invasive mechanical ventilation, ICU stay, and ICU mortality. <b>Results:</b> We analyzed 82 subjects with COVID-19 ARDS. Over the complete duration of mechanical ventilation, the most frequent asynchronies and related clusters were reverse triggering without BS (0.72% of breaths [interquartile range (IQR), 0.17-3.07]) and 4.6 clusters/d [IQR, 2.0-8.1] and double triggering (0.44% of breaths [IQR, 0.19-0.80]) and 4.6 clusters/d [IQR, 2.1-7.3]. The use of neuromuscular blockers was associated with a lower prevalence of double triggering and IE, but reverse triggering was not significantly reduced. Double triggering significantly increased with longer mechanical ventilation time, whereas reverse trigger significantly decreased during this period. Double triggering and clusters of double triggering were independently associated with longer mechanical ventilation duration and better ICU survival, whereas clusters of reverse triggering with BS were associated with longer duration of mechanical ventilation and ICU stay. <b>Conclusions:</b> Reverse triggering was the most prevalent asynchrony in subjects with ARDS COVID-19, decreased over time, and was followed by double triggering. Survivors had a higher prevalence of double triggering and clusters of double triggering, mostly occurring during spontaneous modes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183124","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":"High Tidal Volume Variability Is Associated With Worse Outcomes in Patients With ARDS.","authors":"Jee Hwan Ahn, Sang-Bum Hong, Chae-Man Lim, Jin Won Huh","doi":"10.1089/respcare.12930","DOIUrl":"https://doi.org/10.1089/respcare.12930","url":null,"abstract":"<p><p><b>Background:</b> The impact of spontaneous breathing during mechanical ventilation on the outcome of ARDS has yet to be established. This study aimed to evaluate the effect of tidal volume variability on ventilator-free days in mechanically ventilated subjects with ARDS using high-resolution tidal volume data collected through patient monitors. <b>Methods:</b> This single-center, retrospective cohort study included adult subjects with ARDS who received mechanical ventilation in our medical ICU between April 2018 and July 2019. The study subjects' expiratory tidal volume data during the first 7 days of mechanical ventilation were collected every 2 s from the patient monitors. The subjects were divided equally into 3 groups according to the coefficient of variation (CV) of all collected normalized tidal volume values. <b>Results:</b> A total of 108 subjects with ARDS were categorized into the low, intermediate, and high CV groups (each number <i>=</i> 36). Baseline characteristics of the 3 groups were comparable except for a lower P_aO₂/F_IO₂ in the low CV group (130 ± 50 mm Hg vs 160 ± 57 mm Hg vs 158 ± 50 mm Hg, P = .03). On average, 222,776 tidal volume data points were collected per subject during the first 7 days of mechanical ventilation. The CVs of tidal volume were 17% ± 3%, 26% ± 2%, and 38% ± 8% in each group, respectively. The number of ventilator-free days was significantly lower in the high CV group than in the intermediate CV group (0 [interquartile range or IQR, 0-2.5] days vs 16 [IQR, 0-21.5] days, <i>P</i> = .004 after Bonferroni correction). After adjusting in the zero-inflated negative binomial model, high CV was significantly associated with fewer ventilator-free days compared with intermediate CV (odds ratio, 11.1, 95% CI [2.3-52.7], <i>P</i> = .002). <b>Conclusions:</b> Based on the high-resolution tidal volume data from the patient monitors, high tidal volume variability during the first 7 days of mechanical ventilation in subjects with ARDS was associated with fewer ventilator-free days.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161740","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":"Characteristics of Rapidly Manufactured Ventilators: A Scoping Review.","authors":"Katie Mikkelsen, Marco Zaccagnini, Ginny Brunton, Ali Hosseini, Maria C Tan, Mika L Nonoyama","doi":"10.1089/respcare.12549","DOIUrl":"https://doi.org/10.1089/respcare.12549","url":null,"abstract":"<p><p>Many health care systems worldwide were ill-prepared for the mass-casualty surge caused by the COVID-19 pandemic. Mechanical ventilator shortages prompted the production of rapidly manufactured ventilators (RMVs). However, without standards to develop them, the effectiveness and safety of RMVs remain uncertain. The purpose of this study was to map the breadth and depth of the literature on RMVs and provide suggestions for effective and safe designs. A scoping review, following the Joanna Briggs Institute guidelines, was completed. A search of 9 electronic databases and Google Scholar was completed in April 2022 and updated in 2024. Dual screening and data extraction were conducted using predefined criteria based on 6 previously published RMV guidance documents. Results were collated into descriptive summaries and tables and used to develop the suggested standards. There were 66 RMVs described within 66 articles. The majority (60, 91%) of articles were published post-COVID-19 (2020), with 24 (36%) from the United States. Four designs were identified: 18 (27%) electro-pneumatic (E-P), 27 (41%) automatic compression of manual resuscitator (MR), 6 (9%) automatic compression of MR with E-P components (E-P and MR), and 15 (23%) \"other.\" The E-P designs mimicked conventional ventilators and MR designs incorporated an MR with a motor and arm. Four RMV characteristic categories emerged from the data: operating features, performance features, other features outside routine use, and engineering features. There was significant variability in the RMV designs. Eleven suggestions regarding RMV design, performance, and testing were developed. This study provides preliminary information to inform the standardization of RMV designs to guide future manufacturing for effective and safe use. Although pandemic urgency has waned, RMV utility may extend to future mass-casualty scenarios (eg, natural disasters, wars) and in low- and middle-income countries, which often lack sufficient resources even under normal conditions.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161735","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":"Translating Recent ARDS Criteria and Practice Guidelines Into Effective Clinical Interventions.","authors":"Peter E Morris","doi":"10.1089/respcare.13168","DOIUrl":"https://doi.org/10.1089/respcare.13168","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151552","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":"Evaluation of the Accuracy of a Mechanical Insufflation-Exsufflation Device's Cough Peak Flow Measurement.","authors":"Neeraj M Shah, Sophie Madden-Scott, Chloe Apps, Ema Swingwood, Harriet Shannon, Eui-Sik Suh, Nicholas Hart, Georgios Kaltsakas, Leyla Osman, Patrick B Murphy","doi":"10.1089/respcare.12514","DOIUrl":"https://doi.org/10.1089/respcare.12514","url":null,"abstract":"<p><p><b>Background:</b> Mechanical insufflation-exsufflation (MI-E) is used to augment secretion clearance in neuromuscular patients with weakened cough strength. Cough peak flow (CPF) is a measure of cough function that is used to assess a patient's ability to clear secretions, with thresholds set that categorize cough as effective, ineffective or severely ineffective. MI-E is prescribed according to these thresholds, and CPF is used to assess titration of MI-E settings. The Clearway2 (Breas Medical, Stratford-upon-Avon, United Kingdom) displays a real-time CPF, measured by an internal pneumotachograph. This study sought to assess the agreement and repeatability of this displayed CPF, against the reference CPF measurement by a calibrated pneumotachograph. <b>Methods:</b> This study consisted of two phases (1) lung model (Group A) and (2) acutely unwell individuals with neuromuscular conditions (Group B) and clinically stable individuals with neuromuscular conditions (Group C). Simultaneous CPF measurements were recorded from the MI-E device (CPF_MI-E) and a calibrated pneumotachograph (CPF), which was inserted into the MI-E circuit. Bland-Altman analysis was used to assess agreement between methods of measurement, and repeatability was assessed using a repeated measures analysis of variance. <b>Results:</b> During phase 1, 805 simulated coughs were evaluated with the Clearway2. The mean bias toward CPF_MI-E was 33 L/min (95% limits of agreement 6-60 L/min). During phase 2, the mean bias increased to 66 L/min (95% limits of agreement 13-119 L/min). CPF_MI-E and CPF both had good repeatability in all groups. <b>Conclusions:</b> The Clearway2 MI-E device provided a real-time CPF measurement that was repeatable and systematically higher than CPF. It may therefore be a useful tool to measure change longitudinally, or in response to changes in MI-E settings, in an individual patient. Caution is advised if using the CPF_MI-E to assess cough efficacy against clinical thresholds.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120525","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":"Neonatal Resuscitation Program Versus Pediatric Advanced Life Support: An Examination of Rescue Breaths With Changing Pulmonary Mechanics Using a Simulator.","authors":"Mathavan Sivarajah, Shafeeque Kunhiabdullah, Sreenivas Karnati, Allison Peluso, Hany Aly, Robert Chatburn, Ibrahim Sammour","doi":"10.1089/respcare.11056","DOIUrl":"https://doi.org/10.1089/respcare.11056","url":null,"abstract":"<p><p><b>Background:</b> The Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) differ considerably, and the transition from one to the other has not been well studied. Pulmonary mechanics change markedly with growth, increasing compliance, decreasing airway resistance, and prolonging the time constant. Differences in lung mechanics may warrant different rescue breath strategies. <b>Design/Methods:</b> Using published predictive equations and Centers for Disease Control and Prevention growth nomograms, gender-agnostic pulmonary compliance (Cstat) and resistance (Rrs) were computed for infants at birth and at regular intervals starting at 2 weeks of age. An IngMar ASL 5000 high-fidelity breathing simulator was used to model these infants. A Maquet Servo-i ventilator provided positive pressure peak inspiratory pressure set at 20 and PEEP set at 5 cm H₂O. Inspiratory time was set to 0.5 s for NRP and 1 s for PALS. For NRP, the rate was set to 40, 50, and 60 breaths/min. For PALS it was set to 12, 20, and 30 breaths/min. Inspired tidal volume (V_Ti), PEEP measured at the airway (PEEP_aw) and total PEEP (PEEP_tot) values were extracted. Minute ventilation (V̇_E) was calculated and corrected to the model's weight. Data were analyzed by linear regression. <b>Results:</b> At a set ventilator pressure differential, NRP rescue breaths were associated with a greater decline in corrected V_Ti and V̇_E for age. PALS consistently delivered larger corrected V_Ti regardless of rate than NRP. Increasing the rate from 20 to 30 in PALS led to an expected increase in corrected V̇_E that approached those seen in NRP. Providing breaths at 50 and 60 breaths/min in NRP was associated with significant inadvertent development of PEEP_tot. Providing PALS at 30 and NRP at 40 breaths/min provided comparable PEEP_tot. <b>Conclusions:</b> PALS at 30 breaths/min provides similar corrected V̇_E and PEEP_tot to NRP at 40 breaths/min. Higher rates that can be employed in NRP can lead to a concerning buildup of PEEP_tot in older patients.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120592","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":"Transcutaneous P_CO₂ Measurements With Long-Term Noninvasive Ventilation.","authors":"Marte Skogstad Allgot, Joseph Malone, Anne Louise Kleiven, Ole Henning Skjønsberg, Sigurd Aarrestad","doi":"10.1089/respcare.12855","DOIUrl":"https://doi.org/10.1089/respcare.12855","url":null,"abstract":"<p><p><b>Background:</b> Current guidelines recommend that monitoring of long-term noninvasive ventilation (Long-term NIV) should include measurement of nocturnal transcutaneous P_CO₂ (P_tcCO₂). This has previously required an elective hospital admission. However, owing to a growing patient population and advancements in monitoring technology, there is a general trend toward moving specialized health care from the hospital to the home. The aim of this study was to compare the success rate and causes of failure of P_tcCO₂ monitoring at home versus at the hospital and to discuss the criteria used for the evaluation of nocturnal P_tcCO₂ monitoring. <b>Methods:</b> In this real-world observational study, subjects scheduled for long-term NIV follow-up at Oslo University Hospital in the time period January 2020 to December 2022 were prospectively identified. A total of 128 subjects were included, and monitoring occurred either at home or at the hospital. Two physicians, blinded to the location of the monitoring, retrospectively classified the P_tcCO₂ as successful or unsuccessful and identified the causes of failure for the latter. The evaluation was performed using a predefined set of criteria, and results were divided into successful and unsuccessful recordings based on nontechnical (human) errors, time requirements, and technical errors such as fixed bias, instrumental drift, and artifacts. <b>Results:</b> A total of 465 recordings of 128 subjects were performed. A 90% success rate was achieved for both groups. The predominant cause of failure in the home group was nontechnical (50% of total failures), whereas the predominant failure in the hospital group was caused by the recordings not meeting the minimum time requirement (38% of total failures). <b>Conclusions:</b> There was a 90% success rate for P_tcCO₂ measurements both at home and at the hospital. Our findings suggest that P_tcCO₂ measurements can successfully be implemented in the regular follow-up of long-term NIV treatment in a home setting.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120598","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":"Flow Index as a Noninvasive Method to Evaluate Inspiratory Effort in Patients on Pressure Support Ventilation.","authors":"Federica Fusina, Filippo Albani, Heder J de Vries, Luigi Pisani, Giuseppe Natalini, Pieter R Tuinman, Leo Heunks","doi":"10.1089/respcare.12671","DOIUrl":"https://doi.org/10.1089/respcare.12671","url":null,"abstract":"<p><p><b>Background:</b> The Flow Index was recently developed as a bedside method based on flow waveforms to assess patient inspiratory effort during invasive mechanical ventilation. The aim of this study is to externally validate the Flow Index by assessing its ability to identify low and high inspiratory effort breaths. <b>Methods:</b> Secondary analysis of a randomized controlled trial. The association between Flow Index and patient inspiratory effort (pressure generated by the respiratory muscles [ΔP_mus] and pressure-time product from the start of inspiratory flow [PTP_insp]) was evaluated using linear mixed effects models. The discrimination capacity (area under the curve [AUC]) of the Flow Index to identify low and high inspiratory effort breaths was analyzed. <b>Results:</b> A total of 1,095 breaths from 38 subjects were included in the analysis. Flow Index had moderate discriminatory power in identifying low inspiratory effort breaths (AUC of 0.73 and 0.77 for low inspiratory effort defined with ΔP_mus and PTP_insp, respectively). Discriminatory power in identifying high inspiratory effort breaths was low (AUC of 0.68 and 0.65 for ΔP_mus and PTP_insp, respectively). <b>Conclusions:</b> Flow Index demonstrated moderate discriminatory power in identifying low inspiratory effort breaths, whereas discriminatory power in identifying high inspiratory effort breaths was low.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120530","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}