Seminars in oncology最新文献

{"title":"Seminars in oncology 50th anniversary","authors":"Tito Fojo","doi":"10.1053/j.seminoncol.2024.02.003","DOIUrl":"10.1053/j.seminoncol.2024.02.003","url":null,"abstract":"","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"51 1","pages":"Page 1"},"PeriodicalIF":4.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120574","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":"PARP inhibitors: A review of the pharmacology, pharmacokinetics, and pharmacogenetics","authors":"Yi Zeng ,&nbsp;Oluwatobi Arisa ,&nbsp;Cody J. Peer ,&nbsp;Antonio Fojo ,&nbsp;William D. Figg","doi":"10.1053/j.seminoncol.2023.09.005","DOIUrl":"10.1053/j.seminoncol.2023.09.005","url":null,"abstract":"<div><p>PARP<span><span><span><span><span> inhibitors have emerged as a promising class of anticancer<span> agents approved for the treatment of ovarian, breast, prostate, and </span></span>pancreatic cancer<span><span>. These inhibitors target PARP </span>enzymes<span> involved in DNA repair pathways and exhibit remarkable efficacy in cancers with </span></span></span>genetic<span> deficiencies in the homologous recombination<span> pathway responsible for mending DNA double-strand breaks. While all </span></span></span>PARP inhibitors<span> demonstrate potent and selective inhibition of PARP1 and </span></span>PARP2, the key enzymes involved in DNA repair, each agent within the class possesses unique pharmacological profiles distinguishing them from one another.</span></p><p><span><span>This review aims to comprehensively examine the properties of the entire PARP inhibitor class while emphasizing individual pharmacologic and pharmacokinetic distinctions that inform clinical recommendations. Currently, four agents, namely </span>olaparib, </span>rucaparib<span>, niraparib<span>, and talazoparib<span>, have obtained approval in the United States and Europe. Olaparib, the first approved PARP inhibitor, has been extensively studied and is indicated for a wider range of cancer types.</span></span></span></p><p>Niraparib and talazoparib, the more recent additions to the PARP inhibitor class, possess the longest half-lives and are formulated for convenient once-daily dosing, alleviating the pill burden for patients when compared to older agents. Moreover, talazoparib undergoes minimal hepatic metabolism, reducing the potential for drug-drug interactions. Notably, niraparib is the sole PARP inhibitor recommended for dose reduction in hepatically impaired populations, whereas talazoparib and olaparib should be dose reduced in renally impaired populations. The mechanisms underlying these dose adjustment recommendations are further explored in this review.</p><p>Additionally, this review briefly covers veliparib<span>, a PARP inhibitor under development, and two recently approved PARP inhibitors in China, fuzuloparib and pamiparib<span>. Although significant progress has been made in understanding PARP inhibitors, there are several unanswered questions that remain, necessitating further research across a broader spectrum of cancer types within this evolving class of anticancer agents.</span></span></p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"51 1","pages":"Pages 19-24"},"PeriodicalIF":4.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50162806","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":"Beyond BRCA: Diagnosis and management of homologous recombination repair deficient pancreatic cancer","authors":"Meredith LaRose,&nbsp;Gulam A. Manji,&nbsp;Susan E. Bates","doi":"10.1053/j.seminoncol.2023.11.001","DOIUrl":"10.1053/j.seminoncol.2023.11.001","url":null,"abstract":"<div><p><span><span><span>Approximately 4%–7% of patients diagnosed with pancreatic adenocarcinoma (PDAC) are found to harbor deleterious </span>germline mutations in </span>BRCA1<span> and/or BRCA2<span>. Loss of function of BRCA1<span> and/or BRCA2 results in deficiency in homologous </span></span></span></span>recombination repair<span><span><span> (HRR), a critical DNA repair<span> pathway, and confers sensitivity to certain DNA damaging agents, including platinum chemotherapy and </span></span>PARP inhibitors<span>. The PARP inhibitor </span></span>olaparib<span><span><span> is food and drug administration (FDA) approved for use in pancreatic cancer based on the POLO trial, which found that maintenance olaparib significantly prolonged </span>progression free survival<span> compared to placebo among patients with germline BRCA1 or BRCA2 mutations and metastatic PDAC that had not progressed following frontline platinum-based chemotherapy. Recently, there has been considerable interest in identifying patients without BRCA inactivation whose tumors also exhibit properties of HRR deficiency and thus may be susceptible to therapies with proven benefit in cancers harboring </span></span>BRCA mutations. Here, we discuss methods for identification of HRR-deficiency and review the management of HRR-deficient cancers with a focus on HRR-deficient PDAC.</span></span></p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"51 1","pages":"Pages 36-44"},"PeriodicalIF":4.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138520725","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":"CDK4/6 inhibitors in the treatment of metastatic breast cancer: Focus on toxicity and safety","authors":"Demi Wekking, Matteo Lambertini, Mariele Dessì, Nerina Denaro, Fabio Bardanzellu, Ornella Garrone, Mario Scartozzi, Cinzia Solinas","doi":"10.1053/j.seminoncol.2024.01.002","DOIUrl":"https://doi.org/10.1053/j.seminoncol.2024.01.002","url":null,"abstract":"<p>The development of oral cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors, including palbociclib, ribociclib, and abemaciclib, has revolutionized the treatment landscape for patients with hormone-receptor-positive (HR+) and human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (BC). When combined with an aromatase inhibitor or fulvestrant, these agents have been approved as first-line therapy in the metastatic setting. Abemaciclib has also gained FDA approval for patients with HR-positive, HER2-negative, node-positive, early BC at high risk of recurrence. Moreover, ribociclib has recently improved disease-free survival in patients with stage II or III HR+/HER2-negative early BC. CDK4/6 inhibitors have favorable safety profiles. However, the available agents have different toxicity profiles that must be clearly discussed with the patients for optimal clinical decisions. This manuscript aims to review CDK4/6 inhibitor-related treatment-associated adverse events, identify risk factors for intolerable adverse events, and assess their safety in special patient populations such as the elderly and those with renal insufficiency. Enhanced knowledge and understanding of CDK4/6 inhibitor-related toxicities can improve treatment strategies and ultimately enhance patient care.</p>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139460063","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":"Cancer genetic mutation prevalence in sub-Saharan Africa: A review of existing data","authors":"Joshua Shain, Alissa Michel, Michael S. May, Lindor Qunaj, Wafaa El-Sadr, Wendy K. Chung, Paul S. Appelbaum, Judith S. Jacobson, Jessica Justman, Alfred I. Neugut","doi":"10.1053/j.seminoncol.2023.12.001","DOIUrl":"https://doi.org/10.1053/j.seminoncol.2023.12.001","url":null,"abstract":"<h3>Background</h3><p>Cancer represents a leading cause of death worldwide. Germline mutations in several genes increase the risk of developing several cancers, including cancers of the breast, ovary, pancreas, colorectum, and melanoma. An understanding of the population prevalence of pathogenic germline mutations can be helpful in the design of public health interventions, such as genetic testing, which has downstream implications for cancer screening, prevention, and treatment. While population-based studies of pathogenic germline mutations exist, most such studies have been conducted in White populations. Limited data exist regarding the prevalence of germline mutations within sub-Saharan African populations.</p><h3>Materials and Methods</h3><p>We identified countries defined as sub-Saharan Africa by the World Bank and conducted a scoping literature review using PubMed. For each country, we identified and summarized studies that focused on the prevalence of germline genetic mutations with sample sizes &gt;10 and in a population directly from sub-Saharan Africa, either with or without diseases associated with the relevant genetic mutations. Studies that evaluated the prevalence of somatic or likely benign variants were excluded.</p><h3>Results</h3><p>Within the 48 countries in sub-Saharan Africa, we identified 34 studies which meet the inclusion criteria. Twenty studies were conducted in South Africa, Nigeria, or Burkina Faso; four countries had more than two published papers. We found that 33 of 48 countries in sub-Saharan Africa lacked any genetic studies. Notably, there has been an increase in relevant studies starting in 2020. Importantly, of the 34 studies identified, 29 included data on <em>BRCA</em>1 or <em>BRCA</em>2. Data on the prevalence of mutations contributing to familial cancer syndromes other than <em>BRCA</em>1 and <em>BRCA</em>2 was limited.</p><h3>Conclusions</h3><p>While some progress has been made towards understanding the prevalence of germline mutations in cancer susceptibility genes, the characterization of genetic mutations among sub-Saharan African populations remains strikingly incomplete. Given the genetic diversity in the region, there remains a great need for large-scale, population-based studies to understand the prevalence of germline pathogenic mutations and adequately capture all the subpopulations in this part of the world.</p>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"72 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139052412","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":"Primary adrenal insufficiency induced by immune checkpoint inhibitors: Biological, clinical, and radiological aspects","authors":"Serafina Martella, Minke Lucas, Michele Porcu, Laura Perra, Nerina Denaro, Andrea Pretta, Giulia Deias, Karen Willard-Gallo, Hector Soto Parra, Luca Saba, Mario Scartozzi, Demi Wekking, Marleen Kok, Marco Maria Aiello, Cinzia Solinas","doi":"10.1053/j.seminoncol.2023.11.003","DOIUrl":"https://doi.org/10.1053/j.seminoncol.2023.11.003","url":null,"abstract":"<p>Immune checkpoint inhibitors (ICI) have become a cornerstone in medical oncology, continually evolving therapeutic strategies and applications. These monoclonal antibodies, designed to enhance immune responses, have revealed a spectrum of immune-related adverse events (irAEs). While many irAEs exhibit favorable responses to corticosteroid or immunosuppressive therapy, most ICI-related endocrinopathies necessitate lifelong replacement therapy and pose significant clinical challenges. Adrenal insufficiency (AI), a noteworthy endocrine irAE, can manifest as primary AI (PAI) or secondary AI (SAI), resulting from adrenal or pituitary gland dysfunction, respectively. ICI-induced AI, albeit relatively infrequent, occurs in 1%–2% of patients receiving single-agent anti-Programmed Death-1/Programmed Death-Ligand 1 (PD-1/PD-L1) or Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) therapies and in a higher range of 4%–9% when ICIs are used in combinations. Recognizing and addressing ICI-induced PAI is crucial, as it often presents with acute and potentially life-threatening symptoms, especially considering the expanding use of ICI therapy. This review provides an updated overview of ICI-induced PAI, exploring its clinical, diagnostic, and radiological aspects.</p>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"49 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138546818","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":"Overcoming barriers to opioid-induced constipation management in cancer patients.","authors":"Esther Holgado Martín, Ana Blasco Cordellat, Marta Guix Arnau, Rosa Villatoro Roldán, Almudena Sanz Yagüe, Diana Monge Martín, Fernando Caballero Martínez, Francisco J Campos Lucas, Almudena García Castaño","doi":"10.1053/j.seminoncol.2023.07.001","DOIUrl":"10.1053/j.seminoncol.2023.07.001","url":null,"abstract":"<p><strong>Purpose: </strong>Opioid-induced constipation (OIC) is a common adverse effect of opioid therapy. We aim to identify the main barriers hindering clinical recommendations implementation and propose consensus solutions to improve OIC control in cancer patients.</p><p><strong>Methods: </strong>Following collaborative and prioritization techniques, a scientific committee generated statements addressing possible barriers to optimal OIC management (related to patients, health providers and health care system), and potential interventions to overcome these barriers. An expert panel of 36 oncologists assessed the statements to reach a consensus.</p><p><strong>Results: </strong>The survey consisted of 70 statements. Consensus was reached on 12/45 items related to barriers (26.6%) and on 19/25 items about corrective interventions (76%). The panel considered that patients are unaware of the existence of a specific OIC treatment, and their information sources are highly variable and unreliable. Regarding health providers, the panel considered that the oncologists prioritize symptoms such as diarrhea, pain, anxiety, or other treatment toxicities, over constipation. Work overload and bureaucratic requirements were the main barriers related to health care system. Regarding potential interventions, best-rated proposals included specific training programs development for primary care physicians and nurses, and multiplatform informative resources development for patients and caregivers, including precisely written instructions about OIC recognition and management. Oncologists assessed positively measures aiming to improve coordination between primary care physicians and oncologists, and nursing consultations implementation. The panel considered useful the OIC treatment algorithms simplification.</p><p><strong>Conclusions: </strong>The expert panel identified the main barriers to optimal OIC management and suggested some feasible approaches to overcome these barriers.</p>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"1 1","pages":"149-154"},"PeriodicalIF":4.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47447482","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":"Immune-checkpoint inhibitors in anal squamous cell carcinoma: a systematic review and meta-analysis","authors":"Laura Pala, Tommaso De Pas, Erika Stucchi, Chiara Catania, Emilia Cocorocchio, Maria Giulia Zampino, Giovanna Rossi, Emma Zattarin, Antonio Di Muzio, Daniele Laszlo, Sara Stucchi, Fabio Conforti","doi":"10.1053/j.seminoncol.2023.11.002","DOIUrl":"https://doi.org/10.1053/j.seminoncol.2023.11.002","url":null,"abstract":"<h3>Introduction</h3><p>Squamous cell carcinoma of the anus (SCCA) is a rare tumor. While most patients with locally advanced disease are cured with chemo-radiotherapy, about a quarter eventually experience metastatic recurrence. Standard treatment for advanced disease is chemotherapy, but recently evidence on the activity of immunotherapy has been reported. We performed a systematic review and meta-analysis of prospective trials testing immune-checkpoint inhibitors (ICIs) in patients with SCCA.</p><h3>Objective</h3><p>We aimed to evaluate the overall response rate (ORR) and the disease control rate (DCR) of ICIs in patients with advanced SCCA.</p><h3>Methods</h3><p>We systematically searched PubMed, Embase, and Scopus, through December 31, 2022, for prospective trials assessing ICIs in patients with advanced SCCA. The primary and secondary endpoints were respectively ORR and DCR.</p><h3>Results</h3><p>Six prospective trials were included in the analysis, one of which was randomized. Overall, seven treatment arms and 347 patients have been analyzed. Five treatment arms tested ICIs as monotherapy and two arms examined ICIs in combination with cetuximab and bevacizumab, respectively. The pooled ORR was 13% (95%CI, 10%–17%), with a DCR of 57% (95%CI, 40%–74%). Results did not change in a sensitivity analysis, which excluded the two treatment arms testing the combination of ICIs with other drugs.</p><h3>Conclusions</h3><p>The efficacy of ICIs in SCCAs is low. Combination strategies with targeted drugs or chemotherapy might represent a better therapeutic strategy for these patients. Further studies are awaited to identify resistance mechanisms to ICIs and optimize their efficacy.</p>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"14 3","pages":""},"PeriodicalIF":4.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138520692","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":"Practice change: No benefit of extended lymphadenectomy at radical cystectomy in patients with muscle invasive bladder cancer","authors":"Omar Fahmy ,&nbsp;Maxim Kochergin ,&nbsp;Anastasios D. Asimakopoulos ,&nbsp;Georgios Gakis","doi":"10.1053/j.seminoncol.2023.09.001","DOIUrl":"10.1053/j.seminoncol.2023.09.001","url":null,"abstract":"<div><p><span>For many decades, extended pelvic lymph node dissection has been an integral part during </span>radical cystectomy<span> for patients with muscle invasive bladder cancer<span>. This practice was based on large retrospective meta-analyses suggesting an oncologic benefit to an extended dissection. This mini review and meta-analysis includes the two available randomized trials in the current literature. Therefore, it can be considered as the strongest level of evidence regarding the prognostic benefit of an extended pelvic lymphadenectomy. Based on current randomized data, standard pelvic lymph node dissection up to the level of iliac bifurcation is sufficient, and extension of the dissection above this level does not provide any additional oncologic benefit.</span></span></p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"50 3","pages":"Pages 102-104"},"PeriodicalIF":4.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10286453","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":"Efficacy of memantine in preventing neurocognitive dysfunction induced by radiation therapy in patients with brain metastases: A systematic review of clinical trials","authors":"Haripriya Parapparambil Surendran ,&nbsp;Sujit Kumar Sah ,&nbsp;Dhanya Mary Louis ,&nbsp;Sruthi Kalavagunta ,&nbsp;Narmadha Mukunthu Poornachary ,&nbsp;Selin Chiriyankandath Joy ,&nbsp;Debnarayan Dutta","doi":"10.1053/j.seminoncol.2023.09.004","DOIUrl":"10.1053/j.seminoncol.2023.09.004","url":null,"abstract":"<div><h3>Purpose</h3><p><span><span>About 50%–90% of patients with brain metastases who receive radiation therapy experience </span>cognitive impairment. This </span>systematic review<span> aims to gather credible sources of comprehensive information on the efficacy of memantine in preventing cognitive dysfunction.</span></p></div><div><h3>Methods</h3><p>A comprehensive review conducted in compliance with the PRISMA statement and systematic search was performed across five databases included PubMed^Ⓡ<span>, Embase</span>^Ⓡ<span>, Scopus</span>^Ⓡ<span>, Cochrane Library</span>^Ⓡ, and ClinicalTrial.gov.in from inception until November 2021.</p></div><div><h3>Results</h3><p>A total of four eligible studies were selected in this review that included 1,444 patients with brain metastases who received radiation therapy (Intervention group [n = 729] and control group [n = 715]). Overall, three of the four studies reported some improvement in neurocognitive function in at least one or more parameters such as recall and recognition (<em>P</em> = .39, <em>P</em> = .10 and <em>P</em> = .05), verbal fluency (<em>P</em> = .03 and <em>P</em> &lt; .0001), complex attention (<em>P</em> = .59) executive function (<em>P =</em> .92) and normal appearing white matter (<em>P</em><span> = .01) following memantine therapy compared to control group. Further, two of the four studies reported an improvement in the patients’ quality of life following memantine therapy compared to the control group, and there was no significant difference in the toxicity profile of the interventional compared to the control group as reported from two studies.</span></p></div><div><h3>Conclusion</h3><p>This review embraces the comprehensive evidence that the use of memantine therapy in patients<span><span> with brain metastases to prevent radiation-induced neurocognitive dysfunction has a modest and statistically significant beneficial impact in improving quality of life and preserving some neurocognitive function without any complications. Pending the completion of additional ongoing studies, one can argue that memantine is a reasonable treatment to consider in patients with brain metastases while they receive </span>whole brain radiation therapy.</span></p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"50 3","pages":"Pages 113-122"},"PeriodicalIF":4.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41150643","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}