Terapevticheskii Arkhiv最新文献

{"title":"[Expert consensus on approaches to risk stratification and choice of therapy in patients with inoperable and residual chronic thromboembolic pulmonary hypertension].","authors":"I E Chazova, T V Martynyuk, S N Avdeev, Z S Valieva, O Y Vasiltseva, T N Veselova, V V Gramovich, D S Grankin, N M Danilov, A G Edemskiy, A L Komarov, K V Mershin, O M Moiseeva, A M Chernyavskiy, N A Tsareva, S Y Yarovoy","doi":"10.26442/00403660.2025.03.203237","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203237","url":null,"abstract":"<p><p>On December 13, 2024, the final working group meeting was held, the purpose of which was to discuss the common position of experts on the problem of chronic thromboembolic pulmonary hypertension of various specialties: cardiologists, cardiac surgeons, pulmonologists, on issues of assessing the operability of patients, risk stratification and choice of therapy in patients with inoperable and residual forms of pathology. The discussion field included a wide range of issues that often arise in real clinical practice, but specific answers to them are not given in national and foreign guidelines. On November 8, 2024, at the preparatory stage, 16 experts under the leadership of Academician of the Russian Academy of Sciences I.E. Chazova (chairman) formulated questions for the preparation of a consensus document (without discussion), consistently discussing the feasibility of including each issue in the document and distributing tasks for the final session. Then, at the intermediate stage, experts searched and systematized scientific information on the formulated questions in the PubMed and eLIBRARY systems to prepare sections of the document in accordance with the established tasks. When finalizing the document, experts answered 28 questions: during anonymous voting an individual score was determined for each block from 1 - completely disagree, to 5 - completely agree. It was considered that a strong consensus was achieved with a mean score of <i>M</i>±<i>m</i> 2.5±2, and with a mean score below 2.5, consensus was not achieved. A strong consensus was reached on all issues.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"279-288"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040026","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":"[Historical milestones in the study of pulmonary hypertension].","authors":"A K Osokina, O V Rodnenkov, T V Martynyuk","doi":"10.26442/00403660.2025.03.203137","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203137","url":null,"abstract":"<p><p>The article describes the historical aspects of the discovery of the pulmonary circulation and the study of pulmonary hypertension (PH) as a pathophysiological condition with a key hemodynamic characteristic - an increase in pressure in the pulmonary artery. The complexity of PH treatment is due to the association with various cardiovascular and respiratory diseases, which requires a multifaceted holistic interdisciplinary approach with the active participation of the physician and the patient. Currently, the guide for successful clinical practice are clinical guidelines covering the full range of diagnostic and therapeutic measures for various groups of PH. The development of guidelines is the result of a long way of studying morphology, pathophysiology, creating and researching of pathogenetic medical drugs, clinical observation of patients in the framework of studies and registries.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"289-295"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982776","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":"[Efficiency and safety of the integrated use of medical gases thermal heliox, nitric oxide and molecular hydrogen in patients with exacerbation of chronic obstructive pulmonary disease complicated by hypoxemic, hypercapnic respiratory failure and secondary pulmonary arterial hypertension in the post-COVID period].","authors":"L V Shogenova","doi":"10.26442/00403660.2025.03.203131","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203131","url":null,"abstract":"<p><strong>Aim: </strong>To study the efficacy and safety of the combined use of thermal heliox (t-He/O₂), nitric oxide (NO) and molecular hydrogen (H₂) in patients with exacerbation of chronic obstructive pulmonary disease (COPD) complicated by hypoxemic, hypercapnic respiratory failure (RF) and secondary pulmonary arterial hypertension (PAH) in the post-COVID period.</p><p><strong>Materials and methods: </strong>The randomized, comparative, controlled, parallel study included patients (<i>n</i>=100, 52 men and 48 women) with exacerbation of COPD levels of evidence C and D (GOLD 2021-2023) with hypoxemic, hypercapnic respiratory failure and secondary PAH, who had pneumonia caused by SARS-CoV-2 before hospitalization. Patients with similar demographic, clinical, and functional parameters, who received non-invasive ventilation (NIV) and oxygen (O₂) along with standard drug therapy, were divided into 5 groups: Group 1 (main): (<i>n</i>=22: 12 men, 10 women, who received t-He/O₂, NO, and H₂ sequentially); Group 2 (<i>n</i>=20: 10 men, 10 women, who received t-He/O₂ and NO); Group 3 (n=20: 11 men, 9 women, who received t-He/O₂ and H₂); Group 4 (<i>n</i>=18: 10 men, 8 women, who received NO and H₂); Group 5 (control) (<i>n</i>=20: 9 men, 11 women). The dynamics of the clinical condition of patients, gas exchange in the lungs, acid-base balance, left-to-right discharge fraction, hemodynamic parameters, and exercise tolerance were assessed.</p><p><strong>Results: </strong>A positive effect of the complex use of medical gases on the clinical condition of patients, gas exchange parameters in the lungs, metabolism, hemodynamic parameters and exercise tolerance was found in comparison with these parameters in patients who received medical gases separately and with the control group.</p><p><strong>Conclusion: </strong>The combination of t-He/O₂, NO and H₂ with simultaneous pathogenetic therapy and NIV in patients with exacerbation of COPD complicated by hypoxemic, hypercapnic RF and secondary PAH in the post-COVID period is safe and more effective compared to groups receiving each medical gas separately. Complex therapy improves the clinical condition of patients, reduces signs of hypoxemia and hypercapnia, vascular endothelial dysfunction, metabolic disorders and increases tolerance to physical activity by normalizing gas exchange in the lungs, increasing oxygen delivery to tissues, reducing the shunt fraction, and restoring metabolism.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"242-249"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035729","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":"[GERD-associated laryngeal granuloma: a series of clinical observations. Case report].","authors":"S V Starostina, O V Tashchyan, M G Mnatsakanyan, K A Nazarov, L S Karapetyan, P A Loskutova, I V Kuprina","doi":"10.26442/00403660.2025.03.203133","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203133","url":null,"abstract":"<p><p>Laryngeal granuloma is a benign neoplasm located on the vocal processes of the arytenoid cartilage. The causes of development may be prolonged or traumatic intubation (23%), gastroesophageal reflux disease leading to chronic cough (30%), excessive vocal load (33%); respectively, post-intubation, contact and idiopathic granulomas are distinguished. In laryngopharyngeal reflux, an extraesophageal manifestation of gastroesophageal reflux disease, morphological changes in the mucous membrane of the larynx and pharynx occur as a result of direct exposure to acidic stomach contents, pepsin, bile and pancreatic enzymes that cause the development of contact laryngeal granuloma. Diagnosis of laryngopharyngeal reflux includes analysis of the patient's life history, registration of complaints using questionnaires, assessment of the clinical and functional state of the larynx using visual analog scales of reflux signs, the use of instrumental methods and laboratory tests. The latter determine the acidity of gastric juice, bile acids, pepsin, as well as the presence of <i>Helicobacter</i><i> </i><i>pylori</i>. Instrumental methods include esophagogastroduodenoscopy, videolaryngostroboscopy, esophageal manometry and 24-hour pH impedancometry - the most accurate method for diagnosing reflux in the esophagus, regardless of the pH of the bolus. During videolaryngostroboscopy in patients with the laryngopharyngeal reflux, laryngeal lesion is often detected in the form of swelling, hyperplasia of the mucous membrane of the intercostal fold and posterior vocal folds. The treatment of patients with laryngeal contact granulomas is based on a combination of antireflux therapy and phonopedia. Surgical intervention is necessary only in the case of large granuloma sizes for morphological verification and restoration of glottis patency. Complex rational therapy of patients with laryngopharyngeal reflux, including the use of proton pump inhibitors, prokinetics and antacids, can increase the effectiveness of surgical treatment of patients with laryngeal granuloma and reduce the risk of recurrence. The own clinical observations presented in the article emphasize the importance of an interdisciplinary approach of laryngologists and gastroenterologists to the diagnosis and treatment of patients with reflux-associated laryngeal granulomas, which makes it possible to minimize and in some cases avoid surgery.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"263-271"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049260","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":"[Localized AL amyloidosis].","authors":"N A Kashchavtseva, I G Rekhtina, A M Kovrigina, T P Danilina, L P Mendeleeva","doi":"10.26442/00403660.2025.03.203136","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203136","url":null,"abstract":"<p><p>Localized light chain (AL) amyloidosis (amyloidoma) is a rare disease with unclear pathogenesis and undeveloped approaches to therapy. This article presents 3 clinical observations of localized AL amyloidosis with lesions of the respiratory tract, eyes, and soft tissues of the face. Tumor masses consisted of amyloid masses in which single monotypic plasma cells were \"embedded\". To verify the cell substrate, the method of chromogenic<i> </i><i>in</i><i> </i><i>situ</i> hybridization with probes to immunoglobulin light chains was used. Amyloid typing was performed using FITC-labeled antibodies to kappa and lambda light chains after enzymatic treatment of paraffin sections with pronase. The absence of monoclonal secretion (in two cases) made it difficult to assess the efficacy of the therapy. Taking into account the prevalence and severity of vital organs damage, as well as the recurrent nature of the disease course, systemic combination therapy with targeted drugs was prescribed. Stabilization of the process in all patients was stated during one year of follow-up. Nevertheless, clonreducing therapy in localized AL amyloidosis is not considered as a standard option, its feasibility and efficacy requires further confirmation.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"257-262"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038405","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":"[Markers of T2-airway inflammation in patients with chronic obstructive pulmonary disease].","authors":"G R Sergeeva, A V Emelyanov, E V Leshenkova, A A Znakhurenko","doi":"10.26442/00403660.2025.03.203147","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203147","url":null,"abstract":"<p><strong>Aim: </strong>To assess biomarkers of T2-inflammation in patients with chronic obstructive pulmonary disease (COPD).</p><p><strong>Materials and methods: </strong>We examined 173 adult outpatients (80% male, age 40-89 yrs) with COPD. Lung function tests were assessed by using the Spirograph 2120 (Vitalograph, UK). Blood eosinophils (Eos) were measured by automatic haemoanalyser. Atopic status was determined by serum specific immunoglobulin E to common inhalant allergens. Fractional exhaled nitric oxide (FeNO) was measured by a chemiluminescence analyzer (LR4100, Logan Research, Rochester, UK). Symptoms and quality of life were assessed by using Russian versions of St. George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test. Statistical analyses were performed with Statistica ver. 10.0 (StatSoft, Inc., USA).</p><p><strong>Results: </strong>The most frequent marker was blood Eos ≥150 cell/μl (36%), less often was elevated level FeNO≥20 ppb, allergy was rare (5%) and house dust mites were the common allergen. T2-associated diseases (allergic rhinitis, nasal polyposis, atopic dermatitis) were diagnosed in 7% patients.</p><p><strong>Conclusion: </strong>Forty percent of patients with COPD without concomitant asthma have markers of T2-airway inflammation in a real clinical practice. The most frequent marker was blood Eos≥150 cell/μl that was associated with rate of COPD exacerbation. Frequency of concomitant T2-diseases (allergic rhinitis, nasal polyps, atopic dermatitis) was low.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"250-256"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982779","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":"[Chronic bronchitis - new clinical recommendations (main provisions): A review on behalf of the working group for the development and revision of clinical guidelines for chronic bronchitis].","authors":"I V Leshchenko, S N Avdeev, A A Zaytsev, S I Ovcharenko","doi":"10.26442/00403660.2025.03.203134","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203134","url":null,"abstract":"<p><p>Chronic bronchitis (CB) is one of the most commonly diagnosed non-communicable chronic diseases. At the same time, with such a high incidence of CB registered in the Russian Federation, this pathology requires a balanced approach to the interpretation of clinical and functional indicators and their differentiated approach. The main provisions of the new clinical recommendations on CB, which are reflected in the article, will be useful in the practical work of an internist.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"272-278"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043404","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 influence of the interaction of right ventricle and pulmonary artery system on the development of adverse outcomes in acute decompensation of chronic heart failure].","authors":"M R Islamova, A F Safarova, Z D Kobalava","doi":"10.26442/00403660.2025.03.203135","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203135","url":null,"abstract":"<p><strong>Aim: </strong>To determine the frequency and prognostic significance of right ventricular-pulmonary artery (RV-PA) uncoupling, in the development of cardiovascular complications in patients with acute decompensation of chronic heart failure (ADCHF).</p><p><strong>Materials and methods: </strong>The prospective single-center observational study included 171 patients with ADCHF. Tricuspid Annular Plane Systolic Excursion (TAPSE)/PA systolic pressure <0.36 mm/mmHg by 2D echocardiography was used as the indicator of the right ventricular-pulmonary artery RV-PA uncoupling.</p><p><strong>Results: </strong>The incidence of RV-PA uncoupling in the general population of patients with ADCHF was 67.2% (<i>n</i>=129). Patients with RV-PA uncoupling had a more severe clinical status. RV-PA uncoupling was associated with male sex (odds ratio, OR 2.6, 95% CI 1.35-5.04; <i>p</i>=0.004), myocardial infarction (OR 2.06, 95% CI 1.04-4.09; <i>p</i>=0.037), and a history of cerebrovascular accident (OR 10.89, 95% CI 1.42-83.55; <i>p</i>=0.005). Echocardiography showed more pronounced deviations in the structural and functional parameters of the right and left heart compartments and a higher PA systolic pressure. In ischemic heart disease, the risk of RV-PA uncoupling increased 2.85 times (95% CI 0.99-8.23; <i>p</i>=0.053), and in diabetes mellitus, it increased 4.31 times (95% CI 1.19-15.56; <i>p</i>=0.026). With an increase in the diameter of the inferior vena cava per unit, the risk of RV-PA uncoupling increased 9.49 times (95% CI 2.17-41.40; <i>p</i>=0.003), and with an increase in the transverse size of the right atrium, it increased 2.83 times (95% CI 1.28-6.26; <i>p</i>=0.010). In patients with RV-PA uncoupling, higher liver density was identified using transient elastography and reduced active and reactive resistance using bioimpedance vector analysis, regardless of right ventricular dysfunction. The effect of the RV-PA uncoupling on the overall hospitalization rate and related to ADCHF was shown.</p><p><strong>Conclusion: </strong>The high frequency, clinical association, and prognostic significance of RV-PA uncoupling support RV-PA assessment in patients with ADCHF.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"234-241"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048985","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":"[Frequent severe exacerbations of chronic obstructive pulmonary disease: markers of bacterial infection and features of antibiotic therapy].","authors":"A R Zinnatullina, R F Khamitov","doi":"10.26442/00403660.2025.03.203130","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203130","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate markers of bacterial infection and features of antibiotic therapy in patients hospitalized with exacerbation of chronic obstructive pulmonary disease (COPD) once and again during the year.</p><p><strong>Materials and methods: </strong>Analysis of 423 medical records of inpatients hospitalized in the therapeutic department of a city hospital with exacerbation of COPD over 4 years. 276 cases were hospitalized once during the year (control group), 147 - hospitalized repeatedly (main group).</p><p><strong>Results: </strong>In the control group 36.9% of patients complained of cough with purulent sputum, while in the main group - 25.2% (<i>p</i><0.05). 31.5% of patients in the control group and 17% of the main group reported fever during hospitalization (<i>p</i><0.05). A high level of CRP during hospitalization was observed in 62.8% of patients in the control group and 49.1% in the main group (<i>p</i><0.05); 47.1% of patients in the control group and 28.6% of patients in the main group had an increased level of leukocytes in sputum. According to the results of bacteriological analysis of sputum, there were no differences in the inoculation of infectious agents in the groups. At the same time, in almost 90% of cases, patients in both groups were prescribed antibiotic therapy, and in some cases, the same antibiotic for 2 and 3 hospitalizations in a row. Patients of the main group had extremely severe obstructive disorders twice as often. The degree of respiratory failure in patients with repeated exacerbations increased by 2 times from the first to the third hospitalization. Arterial hypertension and chronic heart failure of the 2nd stage were more common in the main group.</p><p><strong>Conclusion: </strong>The severity of obstructive disorders, the severity of the comorbidity, and the general condition of patients may have a more significant effect on the recurrence of severe exacerbations requiring repeated hospitalizations than bacterial infection. In this regard, in this group of patients, special attention should be paid to assessing the indications for prescribing antibiotic therapy, as well as optimizing its regimens.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"228-233"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pulmonary health: From neonatology to gerontology].","authors":"A G Chuchalin","doi":"10.26442/00403660.2025.03.203235","DOIUrl":"https://doi.org/10.26442/00403660.2025.03.203235","url":null,"abstract":"<p><p>Pulmonary health is a key aspect of modern medicine, covering all age groups, from neonatology to gerontology. The article addresses the impact of genetic factors, environment, and human lifestyle on the development of respiratory diseases. Particular attention is paid to the role of genetic predisposition, embryonic disorders, and external factors such as air pollutants and tobacco smoking in the development of chronic lung diseases. Data on the structural and functional development of the respiratory system, its age-related changes, and the risks associated with the involution of the lung tissue are presented. An interdisciplinary approach, including cooperation between pediatricians, therapists, and pulmonologists, is essential for the early diagnosis and effective treatment of respiratory diseases. Particular attention is paid to the impact of new scientific advances, including genomic research and artificial intelligence systems, on diagnosing and treating respiratory diseases.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"97 3","pages":"222-227"},"PeriodicalIF":0.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043406","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}