Vaccine最新文献

{"title":"Factors associated with COVID-19 vaccination or intent to be vaccinated across three U.S. states","authors":"","doi":"10.1016/j.vaccine.2024.126457","DOIUrl":"10.1016/j.vaccine.2024.126457","url":null,"abstract":"<div><div>Objectives: Vaccine hesitancy represents an important challenge to the effective control of the COVID-19 pandemic. In prior research on seasonal influenza, childhood vaccination, and emergency vaccination programs, hesitancy has been associated with a wide range of demographic, psychological, and compliance factors.</div><div>Methods: In January 2021, an online survey was distributed using the Qualtrics (Provo, UT) platform to a proportional quota sample of individuals in three states: Louisiana, New York, and Washington. Crude and adjusted risk differences and 95 % confidence intervals were calculated to describe the relationship between vaccination or intent to be vaccinated and demographic, psychological, compliance, and pandemic impact variables.</div><div>Results: Of 812 respondents, 696 indicated their vaccination status or intent to be vaccinated. Sixty-six percent indicated they were vaccinated or intended to be when available (<em>n</em> = 457) and 34 % were not vaccinated and did not intend to be vaccinated (<em>n</em> = 239). In bivariate analysis, respondents who were older, male, married, white, and reported higher household incomes were more likely to be vaccinated or intend to be. Those who complied with mask wearing, social distancing, and avoided gatherings with people outside their household were also more likely to report vaccination or intention. In the multivariable model, backward elimination resulted in a model that retained sex, race, household income, and avoiding large gatherings.</div><div>Conclusion: There are important demographic, behavioral, and other factors that influence vaccine acceptance. Identifying those factors is vital for targeted and effective messaging, education, and engagement to reach those most hesitant, increase vaccination coverage, and effectively address the COVID-19 pandemic.</div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446455","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":"Gender differences in adverse effects following the second dose of AstraZeneca COVID-19 vaccine: a cross-sectional study among healthcare workers","authors":"","doi":"10.1016/j.vaccine.2024.126424","DOIUrl":"10.1016/j.vaccine.2024.126424","url":null,"abstract":"<div><div>Background: Vaccination in pandemic diseases, in addition to positive effects on controlling the prevalence and reducing the resulting socioeconomic effects, can have adverse effects with different intensity based on gender, type and dose of vaccine. We aimed to investigate gender differences in adverse effects following the second dose of AstraZeneca Covid-19 vaccine among healthcare workers (HWs).</div><div>Method: This cross-sectional study was conducted on 780 HWs who worked in two educational hospitals in Kermanshah city, western Iran, and had received the second dose of AstraZeneca vaccine. The duration of the investigation of the adverse effects was a maximum of one month after receiving the second dose of AstraZeneca vaccine.</div><div>Results: The overall proportion of adverse effects following the second dose of the AstraZeneca Covid-19 vaccine was higher in female participants, but it was not significant (OR=1.83, p=0.056). The results of adjusted logistic regression showed that the odds of chills (OR=2.17, p=0.001), nausea (OR=2.98, p=0.012), and gastrointestinal symptoms (OR=2.1, p=0.001), runny nose (OR=1.5, p=0.047), fever (OR=1.64, p=0.002), body pain (OR=1.4, p=0.04), and fatigue (OR=1.85, p=0.001) were significantly higher in females than in males. The maximum gap of 15% (attributable risk) was shown for fever adverse between genders.</div><div>Conclusion: The higher occurrence rate of side effects after second dose of AstraZeneca Covid-19 vaccine in women, indicates that gender factors influence the response to the vaccine, consequently, it is imperative that women undergo further examination to mitigate the risk of complications arising from injection procedures.</div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441829","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":"Cellular and humoral immunity and IgG subclass distribution after omicron XBB.1.5 monovalent vaccination in Japan","authors":"","doi":"10.1016/j.vaccine.2024.126452","DOIUrl":"10.1016/j.vaccine.2024.126452","url":null,"abstract":"<div><h3>Background</h3><div>Up to seven doses of coronavirus disease 2019 (COVID-19) mRNA vaccines (BNT162b2) were administered to Japanese healthcare workers, until February 2024. The monovalent Omicron XBB.1.5 vaccine (hereafter called XBB.1.5 vaccine) was used for dose 7.</div></div><div><h3>Objective</h3><div>Although the XBB.1.5 vaccine has been reported to induce a robust increase in neutralizing antibodies against the currently circulating Omicron variant BA.2.86, little is known about its serological effects in Japan, where the BNT162b2 mRNA vaccine is the most frequently administered in the world.</div></div><div><h3>Study design</h3><div>Twenty-five recipients of the XBB.1.5 vaccine, categorized as seronegative (<em>n</em> = 18) or seropositive (<em>n</em> = 7) based on their recent history of COVID-19, were analyzed. Neutralizing antibody titers against Omicron subvariants, receptor binding domain (RBD) IgG levels, IgG subclass distribution, and T-cell responses were assessed.</div></div><div><h3>Results</h3><div>We found a significant increase in neutralizing antibody titers against XBB.1.5 and BA.2.86 variants following XBB.1.5 vaccination, particularly in seropositive individuals. No significant change in total RBD IgG levels was observed, indicating efficient induction of antibodies targeting regions outside the RBD by XBB.1.5 vaccination. IgG subclass analysis demonstrated no significant subclass switching after vaccination. T-cell responses against the virus were comparable between seropositive and seronegative groups.</div></div><div><h3>Conclusions</h3><div>The study suggests that XBB.1.5 vaccination enhances humoral immunity against Omicron variants without significant IgG subclass switching. However, some individuals with low pre-vaccination IgG titers did not exhibit increased antibody levels post-vaccination, raising concerns about potential immune tolerance.</div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441825","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":"Development and characterization of HCMV recombinant subunit vaccines based on T-cell epitopes","authors":"","doi":"10.1016/j.vaccine.2024.126454","DOIUrl":"10.1016/j.vaccine.2024.126454","url":null,"abstract":"<div><div>Human cytomegalovirus (HCMV), a ubiquitous β-herpes virus, mostly causes asymptomatic infections in adults with healthy immune systems. Due to immunosuppressive therapy, solid organ transplantation (SOT) recipients are at increased risk of HCMV infection. In recent years, the interdisciplinary, filed of immunoinformatics, based on computer science, and modern immunology, has emerged. In this study, we designed three types of recombinant subunit vaccines, which are expressed by the <em>E. coli</em> BL21 strain according to immunoinformatics prediction. Subsequently, we evaluated the innate and cellular immune responses of recombinant subunit vaccines <em>in vivo</em> and/or <em>in vitro</em>. Flow cytometry analysis, revealed that recombinant subunit vaccines enhanced both innate and cellular immune responses <em>in vivo</em> and/or <em>in vitro</em>. We also found that the novel herb adjuvant hesperetin (HES) increased memory T cell inflation. Overall, we developed three types of recombinant subunit vaccines based on HCMV antigen fragments containing multiple T-cell epitopes and assessed the innate and cellular immune responses <em>in vivo</em> and/or <em>in vitro.</em></div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446462","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":"Safety and immunogenicity of a ChAd155-vectored rabies vaccine compared with inactivated, purified chick embryo cell rabies vaccine in healthy adults","authors":"","doi":"10.1016/j.vaccine.2024.126441","DOIUrl":"10.1016/j.vaccine.2024.126441","url":null,"abstract":"<div><h3>Background</h3><div>Rabies is a zoonotic viral encephalitis that is endemic in many countries and confers a high mortality. Licensed vaccines require several doses to ensure efficacy. To investigate a logistically favorable approach, we assessed the safety and immunogenicity of ChAd155-RG, a novel investigational rabies vaccine using a replication-defective chimpanzee adenovirus vector.</div></div><div><h3>Methods</h3><div>We conducted a first-in-human, phase 1, randomized, double-blind, dose-escalation trial comparing ChAd155-RG with a licensed inactivated vaccine (RabAvert) in healthy adults. Participants received either RabAvert at standard dosing or ChAd155-RG at a low dose for one immunization or a high dose for one or two immunizations. To assess safety, we evaluated reactogenicity, unsolicited adverse events, and thrombotic events. To measure immunogenicity, we measured rabies viral neutralizing antibody (VNA) titers and anti-ChAd155 neutralizing antibodies.</div></div><div><h3>Results</h3><div>Mild to moderate systemic reactogenicity and transient lymphopenia and neutropenia were more common among recipients of ChAd155-RG compared with those who received RabAvert. No thrombotic events or serious adverse events were reported. Only the groups receiving RabAvert or two doses of high-dose ChAd155-RG achieved 100 % seroconversion, and seroprotection was most durable in the RabAvert group. Most participants had preexisting anti-vector antibodies, which were boosted by ChAd155-RG. Baseline and post-vaccination anti-vector antibody titers were negatively associated with post-vaccination rabies VNA titers.</div></div><div><h3>Conclusions</h3><div>In this phase 1 clinical trial, a novel rabies vaccine using a simian adenovirus vector was safe and tolerable, but generated lower, less durable rabies VNA titers than a standard inactivated rabies virus vaccine, which may be due to preexisting, anti-vector immunity.</div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441830","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":"Attitudes and beliefs of healthcare providers toward vaccination in the United States: A cross-sectional online survey","authors":"","doi":"10.1016/j.vaccine.2024.126437","DOIUrl":"10.1016/j.vaccine.2024.126437","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare providers' (HCPs') beliefs and practices regarding vaccination influence vaccine acceptance in patients.</div></div><div><h3>Objective</h3><div>To describe HCPs' beliefs and practices regarding vaccines and perceptions of patient perspectives related to vaccine hesitancy.</div></div><div><h3>Methods</h3><div>This was a non-interventional, cross-sectional, online survey administered to 1213 HCPs based in the United States from December 2021 through January 2022. HCPs provided responses regarding their demographic and professional characteristics, beliefs about vaccine safety and effectiveness, vaccination practices, and their views regarding patients' willingness to receive vaccination.</div></div><div><h3>Results</h3><div>Study participants included doctors (55.4 %); physician assistants (11.2 %); pharmacists (11.7 %); nurse practitioners (11.1 %); and registered nurses (10.6 %) from across the United States (West, 35.6 %; Midwest, 27.0 %; South, 25.6 %; Northeast, 11.9 %). HCPs belonged to group practices or clinics (34.5 %), private practices (31.9 %), hospital-based practices (21.9 %), or pharmacies (11.7 %). Most HCPs strongly believed it was their duty to promote vaccination (78.1 %) and used in-person conversations to educate patients about vaccines (85.0 %); 95.1 % had been vaccinated against COVID-19. HCPs reported that 54.9 % of patients accept all vaccines without hesitation, 21.0 % accept all vaccines but hesitate, 16.8 % accept only select vaccines, and 7.2 % reject all vaccines. Reasons commonly cited by patients for being hesitant to accept vaccines or refusal included negative media (hesitancy: 64.6 %; refusal: 73.2 %), the influence of friends or family (hesitancy: 60.5 %; refusal: 68.7 %), distrust of the government (hesitancy: 45.8 %; refusal: 68.4 %), concerns over long-term side effects (hesitancy: 56.1 %; refusal: 68.3 %), and worries about vaccine-related autism or infertility (hesitancy: 49.7 %; refusal: 71.9 %). HCPs reported that the largest contributors to vaccine misinformation among patients were social media (91.0 %), celebrities/TV personalities (63.5 %), and mass media (61.1 %).</div></div><div><h3>Conclusions</h3><div>Despite most HCPs being active proponents of vaccination, misconceptions about vaccination and vaccine hesitancy persists. Consideration should be given to HCP training to support their efforts to promote vaccine acceptance.</div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chikungunya virus E2 B domain nanoparticle immunogen elicits homotypic neutralizing antibody in mice","authors":"","doi":"10.1016/j.vaccine.2024.126405","DOIUrl":"10.1016/j.vaccine.2024.126405","url":null,"abstract":"<div><div>Alphaviruses are enveloped, positive-sense single-stranded RNA viruses that cause severe human and animal illness. Arthritogenic alphaviruses, such as Chikungunya virus (CHIKV) and Mayaro virus (MAYV), are globally distributed, transmitted by mosquitoes, and can cause rheumatic disease characterized by fever, rash, myalgia, and peripheral polyarthralgia that can persist for years post-infection. These infections can also result in more severe clinical manifestations such as hemorrhage, encephalopathy, and mortality. Several potent monoclonal antibodies (mAbs) with broad neutralizing activity have been shown to bind to the E2 B domain (E2-B) of the alphavirus glycoprotein, suggesting that E2-B epitopes are a site of susceptibility for multiple arthritogenic alphaviruses. However, it is unknown whether E2-B alone can elicit a broadly neutralizing humoral response. Here, we generate and characterize nanoparticle-based immunogens containing CHIKV and MAYV E2-B. Immunization with the CHIKV E2-B nanoparticle elicited sera that were cross-reactive toward CHIKV and MAYV E2-B, but had only homotypic neutralizing activity (serum titer of 1:512) against CHIKV vaccine strain 181/25. Furthermore, immunization with MAYV E2-B nanoparticles elicited non-neutralizing antibody, but sera were cross-reactive for both CHIKV and MAYV E2-B. Our findings suggest that the immunodominant epitopes within CHIKV and MAYV E2-B are bound by cross-reactive, but not cross-neutralizing antibody. Therefore, development of broad E2-B based vaccines that induce broadly neutralizing antibody responses will require engineering to alter the immunodominant landscape.</div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442113","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":"Field production efficiency investigation of broilers immunized with a turkey herpesvirus vector vaccine expressing hemagglutinin from H9N2 subtype avian influenza virus","authors":"","doi":"10.1016/j.vaccine.2024.126436","DOIUrl":"10.1016/j.vaccine.2024.126436","url":null,"abstract":"<div><div>Turkey herpesvirus (HVT) vector vaccine expressing hemagglutinin from the H9N2 AIV, namely HVT-H9, were demonstrated to block H9N2 AIV infection and transmission in chickens. In this study, we evaluated the protection efficiency and production performance of broilers in HVT-H9 field trials in the presence or absence of the H9N2 AIV natural infection. HI titers against H9N2 AIV in broilers harboring maternal antibodies were successfully induced by HVT-H9. In the presence of H9N2 AIV natural infection, immunization with HVT-H9 blocked H9N2 AIV infection and reduced the mortality rate. Importantly, HVT-H9 vaccination slightly increased broiler weight and decreased the feed conversion rate in the absence of the H9N2 AIV natural infection but significantly reduced mortality rates and increased production efficiency during the H9N2 AIV natural infection. In summary, HVT-H9 immunization might block H9N2 AIV infection and improve production efficiency in the field, especially in the presence of H9N2 AIV natural infection.</div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142438128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of 9R live attenuated vaccine against fowl typhoid in partridge's species","authors":"","doi":"10.1016/j.vaccine.2024.126413","DOIUrl":"10.1016/j.vaccine.2024.126413","url":null,"abstract":"<div><div>Fowl typhoid is a significant avian disease worldwide affecting mainly chickens, turkeys and other bird species, such as partridges. In Morocco, the disease causes a high mortality rate in farmed partridges. Vaccination of partridges is a priority to preserve the breed however; the vaccine has never been evaluated in this species. The study was conducted to assess safety and efficacy of a locally produced Salmonella 9R live vaccine in partridges.</div><div>Groups of vaccinated partridges received the vaccine at 6 weeks of age, followed by a second injection 6 weeks after. The challenge test was performed at 14 weeks with <em>Salmonella gallinarum</em> MSG1 virulent strain.</div><div>The challenge demonstrated 65 % protection in vaccinated challenged partridges, with a reduction in organ invasion compared to unvaccinated control birds, which exhibited 70,6 % mortality.</div><div>The live attenuated 9R vaccine, could be safely used to reduce flock losses and contribute to the reduction of infection.</div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407371","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":"Direct quantitative comparison of benefits and risks of COVID-19 vaccines used in National Immunization Technical Advisory Groups Guidance during the first two years of the pandemic","authors":"","doi":"10.1016/j.vaccine.2024.126406","DOIUrl":"10.1016/j.vaccine.2024.126406","url":null,"abstract":"<div><h3>Introduction</h3><div>The balance of benefits and harms of vaccines are assessed by regulatory agencies and National Immunization Technical Advisory Groups (NITAGs) to inform vaccine authorization or guidance. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach has been adopted by many NITAGs to develop recommendations. During the COVID-19 pandemic, several NITAGs additionally used direct quantitative comparisons (DQCs) between benefits and risk of vaccination with or without a GRADE framework to support timely decision-making relating to emerging safety signals. This study aimed to document the role of DQCs as novel tools in NITAGs' work by identifying situations where DQCs have been clearly leveraged in NITAG guidance, as well as identifying their strengths and limitations.</div></div><div><h3>Methods</h3><div>The MEDLINE database and NITAGs' websites listed in the Global NITAG Network were searched for NITAG publications on COVID-19 vaccines. Publications were included if a DQC between benefits and risks of any COVID-19 vaccine was explicitly used for NITAG decision-making. Two reviewers independently assessed publication eligibility and extracted data. A narrative description of the role of DQCs in NITAG guidance, DQCs' methods and limitations was conducted.</div></div><div><h3>Results</h3><div>Overall, 23 publications with 18 DQCs used by seven NITAGs were included. Situations prompting these publications included new safety signals (<em>n</em> = 7), additional information available on previously identified safety signals (<em>n</em> = 4) and changing contexts (<em>n</em> = 15) (e.g., vaccine supply, and epidemiology). DQC simplicity made them accessible, timely, and allowed for transparent communication. DQCs heavily relied on assumptions making them sensitive to changes in model parameters. DQCs limitations made them not easily transferable to other contexts and they quickly became obsolete in the evolving context of the COVID-19 pandemic.</div></div><div><h3>Conclusions</h3><div>The use of DQCs by NITAGs during the COVID-19 pandemic allowed for rapid evidence-based decision-making in an evolving environment while maintaining public trust. However, if their use becomes standard practice, efforts should be made to address their limitations.</div></div>","PeriodicalId":23491,"journal":{"name":"Vaccine","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}