Transactions of The Royal Society of Tropical Medicine and Hygiene最新文献

{"title":"Cutaneous leishmaniasis in Afghanistan.","authors":"Bilal Ahmad Rahimi, Mohammad Amin Ghatee, Muhammad Naeem Habib, Khushhal Farooqi, Koert Ritmeijer, Huma Syed Hussain, M Asim Beg, Walter R Taylor","doi":"10.1093/trstmh/traf028","DOIUrl":"https://doi.org/10.1093/trstmh/traf028","url":null,"abstract":"<p><p>Old World cutaneous leishmaniasis (OWCL) is a sand fly-transmitted skin infection caused by Leishmania species that extends from West Africa to China. Afghanistan probably has the highest burden of OWCL and is home chiefly to Leishmania  tropica and Leishmania  major, which cause anthroponotic and zoonotic CL, respectively. Although data on the species distribution in Afghanistan are patchy, L. tropica predominates over L. major, reflecting its concentration in large cities. CL prevalence in Afghanistan increases with increasing age to peak at 5-10 y, depending on the local epidemiology. Clinically, there is a spectrum of lesions common to both main species with nodules, ulcerated nodules and papules accounting for the majority (50-80%) of lesions at presentation. When healed, CL lesions leave pale scars that often have deleterious psychosocial effects. Leishmania control involves vector control and treating patients, but these are severely challenged by decades of war and disruption to the health system. In the public sector, only injectable antimonials, sodium stibogluconate or meglumine antimoniate, are available and, anecdotally, efficacy remains high. Few clinical trials have been conducted in Afghanistan and data support antimonial efficacy; small clinical series suggest good efficacy of oral miltefosine against the two main species. Herein, we focus our review on the epidemiological and clinical aspects of CL in Afghanistan and suggest avenues of future research.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033274","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":"Redefining the severity of orofacial tissue damage caused by noma: a novel classification approach.","authors":"Heron Gezahegn Gebretsadik","doi":"10.1093/trstmh/trae137","DOIUrl":"10.1093/trstmh/trae137","url":null,"abstract":"<p><strong>Background: </strong>Noma is a severe orofacial disease with high mortality and morbidity. Although severity scales exist, they fail to fully capture the extent of damage caused by the disease.</p><p><strong>Methods: </strong>This study analysed 404 photos of 260 noma cases from Facing Africa (n=228) and Project Harar (n=32) to create a new severity classification system. Photos were displayed on a large screen for better visualization. Tissue damage was assessed in terms of width, depth and surface area using the American Burn Association's grading system. A mathematical formula was also developed to quantify the extent of noma-induced orofacial damage.</p><p><strong>Results: </strong>Fifteen orofacial anatomical units vulnerable to noma were identified, leading to the development of a new severity classification system that enhances the assessment of noma. This system evaluates tissue damage qualitatively as minor, moderate or major and quantitatively using a purpose-built mathematical formula.</p><p><strong>Conclusions: </strong>Current classification systems inadequately capture noma severity due to vague definitions and limited consideration of the affected anatomical units. The new approach addresses these gaps by considering all tissue damage, including dentition, and allows for precise qualitative and quantitative assessment of disease severity. Continued research and validation are essential to refine this method, improving its clinical and research applications and enhancing outcomes for noma patients worldwide.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"506-513"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955695","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":"Comparison of clinical and laboratory data between hantavirus infection and leptospirosis: a retrospective case series study in southern Taiwan.","authors":"Shih-Hao Lo, Tun-Chieh Chen, Chun-Yu Lin, Hsiao-Chen Hsieh, Ping-Chang Lai, Wei-Li Lien, Yen-Cheng Yeh, Ing-Kit Lee, Yen-Hsu Chen, Po-Liang Lu, Ko Chang","doi":"10.1093/trstmh/trae121","DOIUrl":"10.1093/trstmh/trae121","url":null,"abstract":"<p><strong>Background: </strong>Leptospirosis (LS) and hantavirus (HV) are rodent-borne diseases and share similar clinical manifestations, posing diagnostic challenges.</p><p><strong>Methods: </strong>This retrospective study compared clinical characteristics, laboratory data, complications and outcomes of 33 LS and nine HV cases in Kaohsiung, Taiwan, from 2006 to 2021.</p><p><strong>Results: </strong>Both LS and HV diseases had high rates of acute kidney injury (84.8% vs 66.7%) and hepatitis (65.6% vs 88.9%); LS showed more hyperbilirubinemia (70% vs 12.5% in HV, p=0.005), higher initial creatinine levels (2.9 vs 1.37, p=0.018) and elevated initial C-reactive protein (218.3 vs 28.6 mg/dl, p<0.001), but lower initial lymphocyte percentage (6.63% vs 14.2%, p=0.005) and platelets (138.7/mm3 vs 68.9, p=0.016) compared with HV. Microscopic hematuria was significantly more prevalent in LS (80% vs 28.65% in HV, p=0.016). Notably, the LS and HV groups exhibited statistically significant differences in thrombocytopenia (57.5% vs 100%, p=0.019), hyperbilirubinemia (70% vs 12.5%, p=0.005), shock (45.5% vs 0%, p=0.016) and hematuria (80% vs 28.6%, p=0.016). Neither group experienced fatalities.</p><p><strong>Conclusions: </strong>Fever, thrombocytopenia and acute kidney injury alert physicians to consider LS and HV for differential diagnosis. Elevated bilirubin, along with hematuria or shock, suggests a preferred diagnosis for LS.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"464-471"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830007","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":"Role of IL-6, TNF-α and VCAM-1 as predictors of renal impairment in patients with spontaneous bacterial peritonitis.","authors":"Maissa El Raziky, Mennatallah Rashwan, Hend Hamed Tamim, Shimaa Afify, Rania M Lithy","doi":"10.1093/trstmh/trae139","DOIUrl":"10.1093/trstmh/trae139","url":null,"abstract":"<p><strong>Background: </strong>Multiple mechanisms may contribute to the occurrence of renal impairment (RI) in patients with spontaneous bacterial peritonitis (SBP). One such mechanism is systemic inflammatory response syndrome, which involves the release of pro-inflammatory cytokines (tumour necrosis factor [TNF]-α, interleukin [IL]-6 and vascular cell adhesion molecule [VCAM]-1). The goal of this research was to evaluate the role of IL-6, TNF-α and VCAM-1 as potential predictors of RI and mortality in cirrhotic patients with SBP.</p><p><strong>Methods: </strong>This study included 90 cirrhotic patients with SBP, divided into two equal groups: group A was patients without RI and group B was patients with RI. Based on mortality outcomes, the patients were further categorized into group 1 (recovery, n=70) and group 2 (death, n=20). TNF-α, IL-6 and VCAM-1 serum levels were measured using enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>RI occurred in 50% (45/90) of the study population. Among the 90 patients, 10 (11.1%) had elevated IL-6 levels, 8 (8.9%) had elevated TNF-α levels and 6 (6.7%) had elevated VCAM-1 levels. There were no significant variations in cytokine levels between groups A and B. With an area under the curve of 0.5, the three cytokines showed comparable sensitivity and specificity as predictors of RI.</p><p><strong>Conclusions: </strong>The use of TNF-α, IL-6 and VCAM-1 as predictive markers for RI and mortality in SBP patients is not recommended, as these biomarkers demonstrated limited diagnostic value.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"524-533"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932748","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":"Detection of diarrhoeagenic Escherichia coli in the abattoir wastewater-impacted Iyi-Etu River and other water types at the Amansea livestock market settlement, Anambra State, Nigeria: a matter of public health concern.","authors":"Gilbert Karngong Nfor, Cornelius Arome Omatola, Olubunmi Marvelous Emurotu, Kehinde Charles Mofolorunsho","doi":"10.1093/trstmh/trae138","DOIUrl":"10.1093/trstmh/trae138","url":null,"abstract":"<p><strong>Background: </strong>Globally, diarrhoeagenic Escherichia coli (DEC) has been implicated in the spread of waterborne diseases and abattoir wastewater has played a role in its dissemination into watersheds. This study isolated and characterised DEC from the abattoir wastewater-impacted Iyi-Etu River and other water sources at the Amansea livestock market settlement.</p><p><strong>Methods: </strong>A total of 96 water samples comprising river water (upstream, downstream 1, downstream 2), borehole, well, sachet and abattoir wastewater samples were tested for DEC. In the inoculation process, membrane filtration was used, and selective media such as Eosin Methylene Blue, Chromoselect agar and Sorbitol Maconkey agar were used to screen for E. coli and Shiga toxin-producing E. coli (STEC) O157. Escherichia coli pathotypes were characterised using molecular techniques.</p><p><strong>Results: </strong>Overall, E. coli was presumptively detected in 28.1% (27/96) of all samples. Of the 27 isolates, three (11.1%) were non-sorbitol fermenters (typical of E. coli O157), while 20 (74.1%) were confirmed as E. coli based on uidA housekeeping gene positivity. The detected circulating pathotypes were enteropathogenic E. coli (EPEC) (35.0%; 7/20), enteroinvasive E. coli (EIEC) (40.0%; 8/20), enterotoxigenic E. coli (15.0%; 3/20), STEC (40.0%; 10/20) and enteroaggregative E. coli (5.0%; 1/20). Escherichia coli as well as EPEC, EIEC and STEC pathotypes were most prevalent at the downstream 1 sampling point compared with the upstream. EPEC, EIEC and STEC were also detected in borehole samples (5.0%, 1/20).</p><p><strong>Conclusions: </strong>The Iyi-Etu River and borehole water sources used for domestic and drinking purposes, respectively, at Amansea livestock market settlement are contaminated with some pathotypes of E. coli and the level of pollution may pose a public health risk to humans and animals during contact. Thus, public health measures including proper treatment of wastewater before disposal and continuous monitoring may help to learn the associated effect of DEC pollution in the area.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"514-523"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923327","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":"Risk perception and mpox vaccine acceptability among people living with HIV in northern Nigeria.","authors":"Zubairu Iliyasu, Aminatu A Kwaku, Nafisa S Nass, Amina A Umar, Taiwo G Amole, Hadiza M Abdullahi, Fatimah I Tsiga-Ahmed, Abubakar M Jibo, Brittany R Fontana, Hamisu M Salihu, Muktar H Aliyu","doi":"10.1093/trstmh/trae135","DOIUrl":"10.1093/trstmh/trae135","url":null,"abstract":"<p><strong>Background: </strong>There is a dearth of information regarding mpox risk perception and vaccine acceptance among people living with human immunodeficiency virus (HIV), especially in countries with a dual burden of HIV and mpox, such as Nigeria.</p><p><strong>Methods: </strong>We used an explanatory mixed methods design and structured questionnaires administered to a clinic-based sample of people living with HIV (n=430), followed by in-depth interviews with a purposive subsample (n=20). Data were analysed using binary logistic regression and the framework approach.</p><p><strong>Results: </strong>More than one-third (38.1% [n=164]) of the respondents self-perceived a high risk of mpox and 64.4% (n=277) indicated a willingness to receive the vaccine. Willingness to accept the mpox vaccine was positively associated with male sex, older age, non-Muslim faith, unmarried status, post-secondary education and current civil service employment. The odds of accepting the mpox vaccine was also higher among respondents who perceived mpox as a serious disease (adjusted odds ratio [aOR] 1.41 [95% confidence interval {CI} 1.12 to 2.35]), self-assessed a higher risk (aOR 1.66 [95% CI 1.19 to 3.06]) and were concerned about contracting the disease (aOR 1.78 [95% CI 1.12 to 3.94]). Reasons for hesitancy included anxiety about vaccine-antiretroviral drug interactions, low risk perception, perceived protection from antiretroviral treatment, the newness of the vaccine, mistrust of authorities and pharmaceutical companies and concerns regarding vaccine safety.</p><p><strong>Conclusions: </strong>Mpox risk perception and vaccine acceptance were suboptimal. Vaccine acceptance was influenced by sociodemographic, perceived susceptibility and health behaviour-related factors. Targeted risk communication will enhance acceptance of mpox vaccination among people living with HIV in Nigeria.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"487-497"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mass drug administration coverage evaluation for lymphatic filariasis in selected endemic districts of Jharkhand, India.","authors":"Bijit Biswas, Pratima Gupta, G Jahnavi, Nishit Ranjan, Satya Ranjan Patra, Saurabh Varshney","doi":"10.1093/trstmh/trae136","DOIUrl":"10.1093/trstmh/trae136","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate mass drug administration (MDA) coverage for lymphatic filariasis (LF) in selected endemic districts of Jharkhand, India, and to identify household-level determinants of drug consumption.</p><p><strong>Methods: </strong>A cross-sectional coverage evaluation survey was conducted in the Deoghar, Giridih and Godda districts of Jharkhand in 2023 within 6 wk of the completion of the MDA campaign. The survey included 9039 individuals from 1680 households across 56 randomly selected clusters (three urban, eight tribal and 45 rural).</p><p><strong>Results: </strong>Approximately 78.5% of households reported that at least one member consumed MDA drugs, with 54.5% reaching 'complete epidemiological drug coverage'. Factors positively associated with achieving 'complete epidemiological drug coverage' included higher education levels (adjusted OR [AOR] 1.02), awareness of LF (AOR 2.32), prior communication about MDA (AOR 1.38) and previous MDA participation (AOR 4.42). By contrast, larger family sizes were associated with a lower likelihood of achieving complete coverage (AOR 0.78). Adverse events were experienced by 14.9% of participants, primarily when MDA drugs were consumed on an empty stomach. Key reasons for non-compliance included perceived absence of disease (25.5%), fear of side effects (22.4%) and absence during the campaign (20.9%).</p><p><strong>Conclusions: </strong>MDA coverage was suboptimal, with only one-half of households achieving 'complete epidemiological drug coverage'. Enhancing MDA coverage and compliance requires intensified Information, Education, and Communication efforts, especially among marginalized communities, both during campaigns and all year round.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"498-505"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898341","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":"Local swelling in snakebite envenomation: Are we missing something for want of a name?","authors":"Tamilarasu Kadhiravan","doi":"10.1093/trstmh/trae072","DOIUrl":"10.1093/trstmh/trae072","url":null,"abstract":"<p><p>Envenomations caused by viperid and some elapid snakebites are typically accompanied by local swelling and signs of inflammation that appear within a few hours of bite and spread centripetally for a few days. Often these changes are mistaken for signs of infection and are misdiagnosed as 'cellulitis'. This potentially results in unwarranted use of antibiotics. There are important clinical differences between the swelling caused by local envenomation vis-à-vis cellulitis. The term venom-induced spreading sterile inflammation (VISSI) is more appropriate as a diagnosis name for the local swelling caused by snakebite envenomation.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"538-540"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922054","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":"Determinants of seeking or foregoing allopathic treatment after snakebite: a population-based study from rural Sri Lanka.","authors":"Subashini Jayawardana, Thashi Chang, Ariaranee Gnanathasan, Carukshi Arambepola","doi":"10.1093/trstmh/trae071","DOIUrl":"10.1093/trstmh/trae071","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of antivenom, not all snakebite victims choose to seek allopathic care. This choice of care is likely to be determined by unexplored personal and external factors. We studied the factors influencing the choice of treatment and first aid measures among snakebite victims.</p><p><strong>Methods: </strong>We conducted a population-based study integrating quantitative and qualitative research methods among snakebite victims in the preceding 12 months, selected from 8707 residents in Ampara District, representing typical rural Sri Lanka with a high snakebite burden. Interviewers collected data using questionnaires and in-depth interviews. Logistic regression and thematic analysis were performed.</p><p><strong>Results: </strong>Among the 153 victims, 57.5% were farmers. As first aid, 19.6% practiced the application of tourniquets. The treatment choices were allopathic medicine (65.4%), ayurvedic/traditional (26.1%), faith healing (3.3%), self-medication (2.0%) and none (3.3%). Visible ambient light at the time of bite (adjusted odds ratio [aOR] 2.3 [95% confidence interval {CI} 1.1 to 4.7]), absence of local swelling (aOR 2.5 [95% CI 1.1 to 5.3]) and prolonged bleeding (aOR 8.6 [95% CI 1.9 to 33.3]) determined failure to seek allopathic treatment, while personal characteristics showed no influence. Qualitative inquiry revealed that the treatment choice was influenced by the ability of the victim or others to recognize envenoming features and the snake as venomous and awareness of the facilities available in hospitals.</p><p><strong>Conclusions: </strong>The time of snakebite, recognition of the snake/envenoming and awareness of accessible medical services determined the treatment choice following snakebite.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"550-559"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923329","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":"National Action Plan for the prevention and control of snakebite envenoming in India: strategies and challenges.","authors":"Hrishikesh Munshi, Rahul K Gajbhiye","doi":"10.1093/trstmh/trae068","DOIUrl":"10.1093/trstmh/trae068","url":null,"abstract":"<p><p>India accounts for one-half of global snakebite-related deaths. The recently launched National Action Plan for the Prevention and Control of Snakebite Envenoming in India is a comprehensive initiative designed to address this burden. It aims to ensure universal access to antivenom, strengthen healthcare systems, train healthcare professionals and engage traditional healers to enhance public awareness. The plan also promotes democratization and inter-sectoral collaboration, allowing states to customize their approaches, and advocates for a One Health strategy. While the plan reinforces India's commitment to sustainable development, continued political commitment, robust monitoring and evaluation, global collaborations and community ownership remain crucial for its effective implementation.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"560-562"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922240","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}