Therapeutic hypothermia and temperature management最新文献

{"title":"Therapeutic Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy-Drift in Clinical Practice in Swiss Neonatal (Intensive Care) Units?","authors":"Charlotte Lengauer, Mark Adams, Barbara Brotschi, Michael Kleber, Vera Bernet, Maren Tomaske, Dirk Bassler, Beate Grass","doi":"10.1089/ther.2025.0019","DOIUrl":"https://doi.org/10.1089/ther.2025.0019","url":null,"abstract":"<p><p>The objective of this study was to assess the adherence to inclusion criteria for therapeutic hypothermia (TH) in neonates with hypoxic-ischemic encephalopathy (HIE) and to survey current attitudes on TH. This multicenter observational study therefore combined a retrospective analysis of the Swiss National Asphyxia and Cooling Register (2011-2023) and a prospective survey (2024) among neonatologists in the Canton of Zurich, Switzerland. A total of 456 neonates with HIE were registered in the Swiss National Asphyxia and Cooling Register in the Canton of Zurich, Switzerland, between 2011 and 2023. The rate of TH (52.6% [2011-2017] versus 52.0% [2018-2023]) as well as the incidence of off-protocol cooling remained stable over time (<i>p</i> = 0.614). The survey response rate was 69.5% (57/82). Difficulties with clinical grading of encephalopathy were identified. Subjectively, respondents considered themselves more generous to initiate TH. In conclusion, register data reflected good adherence to inclusion criteria for TH. The survey confirmed willingness to consider TH in milder HIE cases. However, there was no drift in clinical practice-yet?</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080545","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":"Heated High-Flow Nasal Cannula for the Treatment of Unintended Perioperative Hypothermia: A Feasibility Study.","authors":"Kirklen Petersen, Spencer Rice, Kenneth Potter, Shannon Boylan, Kristina Clark, Megan McCartney, Laura Lahaye","doi":"10.1089/ther.2025.0010","DOIUrl":"https://doi.org/10.1089/ther.2025.0010","url":null,"abstract":"<p><p>There are many established strategies to target normothermia in the perioperative period; however, hypothermia remains a common occurrence and can have significant impacts on patient outcomes, unanticipated admissions, and postanesthesia care unit (PACU) throughput. This pilot study serves to shed light on the effectiveness of using high-flow nasal cannula (HFNC) as an alternative to a Bair Hugger (BH). This pilot study compares 10 patients warmed to normothermia with HFNC in the PACU with 15 patients warmed with traditional BH. Patients in the HFNC group reached the goal temperature of 36°C 9.1 minutes faster than the BH group. However, these findings were not statistically significant (mean time: 72.1 minutes vs 81.2; <i>p</i> = 0.247). In addition, phase 1 recovery times were about 8 minutes longer in the HFNC group compared with the BH group but were also not statistically significant (mean time: 180.8 minutes vs 172.4; <i>p</i> = 0.338). Based on the initial data, HFNC may play an important role in the future by making PACU rewarming more efficient and therefore having a huge impact on PACU discharge times, unanticipated hospital admissions, delayed emergence from anesthesia, and morbid cardiac events. Further large scale, randomized control studies need to be done to investigate HFNC as an alternative rewarming method for hypothermic patients in the PACU.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049058","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":"Development and Internal Validation of a Risk Model to Estimate Probability of Intraoperative Hypothermia in Adult Surgical Patients.","authors":"Wenjun Liu, Xuetao Jiang, Haolin Zhang, Guiying Yang","doi":"10.1089/ther.2024.0058","DOIUrl":"https://doi.org/10.1089/ther.2024.0058","url":null,"abstract":"<p><p>Intraoperative hypothermia is associated with various perioperative complications and an increased risk of mortality. This study aims to develop and validate a reliable risk model, the Intraoperative Hypothermia Risk Estimating Model (IHREM), for assessing the likelihood of intraoperative hypothermia in adult patients receiving different types of surgery and anesthesia. Data from 1815 surgical patients were collected, with 1521 used to develop the IHREM training set. Univariate logistic regression was utilized to evaluate the parameters included in the study. For the first time, parameters showing non-linear associations with the risk of intraoperative hypothermia were evaluated and then incorporated into a primary model using restricted cubic splines (RCS), based on the result of multivariate logistic regression. The final model was comprised of 12 risk factors, including body mass index (BMI), fasting time, preoperative heart rate, preoperative tympanic temperature, intravenous fluid administration volume, intraoperative irrigation volume, estimated blood loss, duration of anesthesia, surgical position, intraoperative warming, operation room temperature, and humidity. The IHREM model demonstrated satisfactory performance in the training set, exhibiting reliable discrimination, calibration, overall performance, and clinical utility. In the temporal validation set (<i>n</i> = 294), the c-index, calibration intercept and calibration slope, Brier score, and <i>R</i>² were determined to be 0.763 (95% CI, 0.710-0.819), 0.394 (95% CI, 0.118-0.680), 0.865 (95% CI, 0.638-1.114), 0.204 (95% CI, 0.180-0.229), and 0.236, respectively. Meanwhile, decision curve analysis and clinical impact curve showed that IHREM provides promising clinical value. In addition, RCS analysis indicated that maintaining the operation room temperature above 20°C is sufficient to prevent hypothermia while increasing or sustaining the preoperative core temperature to around 36.7-36.8°C significantly reduces the risk of hypothermia. IHREM holds promise as a valuable tool for identifying adult patients at risk of intraoperative hypothermia under various types of surgery and anesthesia, thereby supporting clinical decision-making.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043565","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":"Cryotherapy Is Effective in Nulliparous Women with Primary Dysmenorrhea: A Randomized Controlled Trial.","authors":"Borja Perez-Dominguez, Lucia Gonzalez-Ruiz, Sara Muñoz-Ibañez, Maria Blanco-Diaz, Esther Diaz-Mohedo","doi":"10.1089/ther.2025.0008","DOIUrl":"https://doi.org/10.1089/ther.2025.0008","url":null,"abstract":"<p><p>Primary dysmenorrhea is a prevalent condition causing severe menstrual pain in nulliparous women, negatively impacting daily functioning and well-being. This randomized controlled trial investigated the efficacy of cryotherapy in alleviating pain and enhancing secondary outcomes such as sleep quality, quality of life, and physical activity. Fifty-eight nulliparous women were randomly assigned to a cryotherapy group or a control group. Pain intensity was measured using the Numeric Rating Scale, whereas secondary outcomes were evaluated with the Pittsburgh Sleep Quality Index, World Health Organization Quality of Life-Brief Version, and the International Physical Activity Questionnaire. Socioeconomic factors, including household income, education, and occupation, were also assessed. Cryotherapy significantly reduced pain intensity from a baseline of 7.1 ± 1.4 to 1.8 ± 1.7 (<i>p</i> < 0.001) compared with a modest reduction in the control group (5.9 ± 1.9-5.4 ± 2.1). Sleep quality improved more in the cryotherapy group (6.90 ± 3.0 to 5.03 ± 2.5) than in the control group (6.88 ± 3.6 to 5.68 ± 2.8). However, no statistically significant changes were observed in the quality of life or physical activity levels, likely because menstrual pain alone may not sufficiently influence these domains, which are affected by broader psychosocial and behavioral factors. These findings demonstrate that cryotherapy is a simple, cost-effective intervention for managing primary dysmenorrhea, providing substantial pain relief and modest improvements in sleep quality. Further research is recommended to evaluate its long-term benefits and potential for broader applications in menstrual health management.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019794","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 Effect of Different Temperature Management Strategies in Adult Sepsis Patients: A Meta-Analysis of Randomized Controlled Trials.","authors":"Yunyun Hu, Jun Jiang, Mei Wei, Tingting Dong, Yanzi Zhang, Yezhen Qin","doi":"10.1089/ther.2025.0017","DOIUrl":"https://doi.org/10.1089/ther.2025.0017","url":null,"abstract":"<p><p>This investigation seeks to assess the impact of various temperature management approaches on the rates of death and organ failure among adult patients suffering from sepsis. A comprehensive search of PubMed, Embase, and CENTRAL was performed to identify randomized controlled trials (RCTs) published up to September 2024. These trials examined the impact of temperature management strategies on sepsis patients. Two independent investigators conducted literature screening, quality assessment, and data extraction. A meta-analysis was conducted using a fixed-effect model to evaluate outcome measures, including mortality and organ dysfunction. This study is registered with PROSPERO, CRD42024627677. The analysis incorporated eight RCTs, involving 1843 patients. The findings demonstrated that the management of hyperthermia markedly diminished the mortality risk among individuals suffering from sepsis (risk ratio = 0.47, 95% confidence interval [CI]: 0.37-0.59, <i>p</i> < 0.001), exhibiting low heterogeneity (<i>I</i>² = 39%). However, the effects of hyperthermia on organ dysfunction remained unclear (Mean Difference <i>[MD] = -0.92</i>, 95% CI: -1.91 to 0.07, <i>p</i> = 0.07), exhibiting low heterogeneity (<i>I</i>² = 0%). However, these effects on organ dysfunction were based on only two studies and 215 patients, which made them prone to a type II error. Hyperthermia management strategies are effective in reducing mortality among adults with sepsis. However, their impact on organ dysfunction requires further investigation through high-quality RCTs. Despite the limitations of this study, hyperthermia strategies offer a promising approach to multidimensional intervention in sepsis. Further studies should strengthen structured subgroup analyses and mechanistic studies based on RCTs to optimize treatment strategies under various clinical scenarios.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013788","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 Prognostic Findings in Newborns with Hypoxic Ischemic Encephalopathy: 5-Year Experience.","authors":"Ozlem Sahin, Derya Colak, Funda Yavanoglu Atay, Omer Guran, Ilke Mungan Akin","doi":"10.1089/ther.2025.0011","DOIUrl":"https://doi.org/10.1089/ther.2025.0011","url":null,"abstract":"<p><p>Hypoxic-ischemic encephalopathy (HIE) is a constellation of neurological signs as a result of hypoxia, hypercapnia, metabolic acidosis, and cerebral ischemia before birth. The aim was to evaluate risk factors, clinical and laboratory findings, and morbidity and mortality in neonates diagnosed with HIE who underwent therapeutic hypothermia (TH). Between January 2015 and December 2020, neonates diagnosed with HIE were evaluated in the neonatal intensive care unit. Risk factors, sociodemographic characteristics, degree of encephalopathy, clinical and laboratory findings, results of amplitude-integrated electroencephalography (aEEG), electroencephalography (EEG), magnetic resonance imaging (MRI) including diffusion weighted imaging (DWI) and cranial ultrasound (cUS), and mortality were retrospectively recorded. Of the 81 cases, we followed up with a diagnosis of HIE. When the patients were divided into groups and evaluated according to the Sarnat & Sarnat staging system, it was observed that 22 (27.2%) of the patients had mild HIE, 49 (60.5%) of the patients had moderate HIE, and 10 (12.3%) of the patients had severe HIE. The aEEG, EEG, DWI, and renal pathology of patients with seizures were statistically significantly higher than those of patients without seizures (<i>p</i> = 0.004, <i>p</i> = 0.002, <i>p</i> = 0.014, <i>p</i> = 0.025). MRI was performed in 66 patients within the first 7 days of life, and diffusional restriction was found in 22 of them. We found that DWI is superior to cUS in determining the severity of hypoxic injury and that renal involvement may be associated with poor neurodevelopmental outcomes. Due to the abnormal prognostic findings detected in infants with mild HIE, the existence of a standard definition of mild HIE that will determine the efficacy and reliability of therapeutic hypothermia will enable at risk infants to benefit from neuroprotective strategies.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754228","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":"Intraoperative Hypothermia Versus Normothermia in Breast Reconstruction: A Systematic Review and Meta-Analysis.","authors":"Teuku N Putra, Iqbal F Sayudo, Jesica P Sudarman, Krish Krish, Swathi Vellaichamy, Islah Nadila, Marcílio O Filho","doi":"10.1089/ther.2024.0038","DOIUrl":"10.1089/ther.2024.0038","url":null,"abstract":"<p><p>Despite advancements in breast reconstruction, the precise impact of intraoperative hypothermia on postoperative complications remains unclear. Recent literature suggests that intraoperative hypothermia is a risk factor for impaired wound healing and increases the incidence of surgical site infections. This study examines the effect of intraoperative hypothermia on postoperative outcomes in breast reconstruction. We searched PubMed, Embase, and Cochrane Library for studies comparing hypothermia with normothermia in breast reconstruction. A meta-analytical method was employed to estimate the risk of postoperative complications among patients undergoing breast reconstruction. Data synthesis employed the random-effects models, presenting the results as risk ratio (RR) with corresponding 95% confidence intervals (CIs). Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration), and heterogeneity was assessed using I² statistics. Four studies meeting our inclusion criteria were included in the meta-analysis, comprising 871 participants. The average age and body mass index were 52.98 years and 27.76 kg/m², with a follow-up duration of 3-6 months. In our analysis, intraoperative hypothermia was associated with an increase in the incidence of wound healing complications in breast reconstruction (RR 1.68; 95% CI 1.24 to 2.27; <i>p</i> = 0.0008). Despite lower incidence of infection, hematoma, seroma, and necrosis in the hypothermia group, no significant differences were observed. Our meta-analysis assessing intraoperative hypothermia in breast reconstruction indicates that hypothermia is a significant risk factor for wound healing complications.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"10-16"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393555","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":"Acknowledgment of Reviewers 2024.","authors":"","doi":"10.1089/ther.2024.58635.revack","DOIUrl":"https://doi.org/10.1089/ther.2024.58635.revack","url":null,"abstract":"","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":"15 1","pages":"53"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568149","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 Effectiveness of Target Temperature Management on Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.","authors":"Yang Liu, Mengyuan Xu, Pengzhao Zhang, Guang Feng","doi":"10.1089/ther.2024.0001","DOIUrl":"10.1089/ther.2024.0001","url":null,"abstract":"<p><p>The effectiveness of target temperature management (TTM) in poor-grade aneurysmal subarachnoid hemorrhage (aSAH) remains a topic of debate. In order to assess the clinical efficacy of TTM in patients with poor-grade aSAH, we conducted a systematic review and meta-analysis. This research was registered in PROSPERO (CRD42023445582) and included all relevant publications up until October 2023. We compared the TTM groups with the control groups in terms of unfavorable outcomes (modified Rankin scale [mRS] score > 3), mortality, delayed cerebral ischemia (DCI), cerebral vasospasm (CVS), and specific complications. Subgroup analyses were performed based on country, study type, follow-up time, TTM method, cooling maintenance period, and rewarming rate. Effect sizes were calculated as relative risk (RR) using random-effect or fixed-effect models. The quality of the articles was assessed using the methodological index for non-randomized studies scale. Our analysis included a total of 5 clinical studies (including 1 randomized controlled trial) and 219 patients (85 in the TTM group and 134 in the control group). Most of the studies were of moderate quality. TTM was found to be associated with a statistically significant improvement in mortality (mRS score 6) rates compared with the control group (RR = 0.61, 95% confidence interval [CI]: 0.40-0.94, <i>p</i> = 0.026). However, there was no statistically significant difference in unfavorable outcomes (mRS 4-6) between the TTM and control groups (RR = 0.94, 95% CI: 0.71-1.26, <i>p</i> = 0.702). The incidence of adverse events, including DCI, CVS, pneumonia, cardiac complications, and electrolyte imbalance, did not significantly differ between the two groups. In conclusion, our overall results suggest that TTM does not significantly reduce unfavorable outcomes in poor-grade aSAH patients. However, TTM may decrease mortality rates. Preoperative TTM may cause patients to miss the opportunity for surgery, although it temporarily protects the brain. Furthermore, the incidence of adverse events was similar between the TTM and control groups.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"1-9"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176397","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":"Comparing Hypothermic and Thermal Neutral Conditions to Induce Metabolic Suppression.","authors":"Jon C Rittenberger, Brian M Clemency, Brian Monaco, Jacqueline Schwob, Joshua T Murphey, David Hostler","doi":"10.1089/ther.2023.0085","DOIUrl":"10.1089/ther.2023.0085","url":null,"abstract":"<p><p>Suppressing metabolism in astronauts could decrease CO₂ production. It is unknown whether active cooling is required to suppress metabolism in sedated patients. We hypothesized that hypothermia would have an additive effect with dexmedetomidine on suppressing metabolism. This is a randomized crossover trial of healthy subjects receiving sedation with dexmedetomidine and exposure to a cold (20°C) or thermal neutral (31°C) environment for 3 hours. We measured heart rate, blood pressure, core temperature, resting oxygen consumption (VO₂), resting carbon dioxide production (VCO₂), and resting energy expenditure (REE) at baseline and each hour of exposure to either environment. We also evaluated components of the Defense Automated Neurobehavioral Assessment (DANA) Brief to evaluate the effect of metabolic suppression on cognition. Six subjects completed the study. Heart rate and core temperature were lower during the cold (56 bpm) condition than the thermal neutral condition (67 bpm). VO₂, VCO₂, and REE decreased between baseline and the 3-hour measurement in the cold condition (Δ = 0.9 mL/min, 56.94 mL/min, 487.9 Kcal/D, respectively). DANA simple response time increased between baseline and start of recovery in both conditions (20°C 136.9 cognitive efficiency [CE] and 31°C 87.83 CE). DANA procedural reaction time increased between baseline and start of recovery in the cold condition (220.6 CE) but not in the thermal neutral condition. DANA Go/No-Go time increased between baseline and start of recovery in both conditions (20°C 222.1 CE and 31°C 122.3 CE). Sedation and cold environments are required for metabolic suppression. Subjects experienced decrements in cognitive performance in both conditions. A significant recovery period may be required after metabolic suppression before completing mission critical tasks.</p>","PeriodicalId":22972,"journal":{"name":"Therapeutic hypothermia and temperature management","volume":" ","pages":"17-22"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040385","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}