Zeitschrift fur Geburtshilfe und Neonatologie最新文献

{"title":"Use and Impact of Pessary, Cerclage, and Progesterone for the Secondary Prevention of Preterm Birth: Data from the German Neonatal Network.","authors":"Kathrin Hanke, Mats Ingmar Fortmann, Gesa Henrike Auerswald, Christoph Härtel, Dirk Olbertz, Claudia Roll, Berthold Grüttner, Christian Wieg, Stephanie Breunig, Achim Rody, Ursula Felderhoff-Müser, Egbert Herting, Wolfgang Göpel, Verena Bossung","doi":"10.1055/a-2217-9463","DOIUrl":"10.1055/a-2217-9463","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the use and effect of cervical stitch cerclage, pessary, and progesterone on pregnancy outcome in mothers of very low birth weight infants (VLBWI) born<32 weeks of gestation in the German Neonatal Network (GNN).</p><p><strong>Methods: </strong>The GNN is a population-based cohort study enrolling VLBWI since 2009. We included 575 neonates from 424 mothers into our analysis, who were born between 2015 and 2019, after prenatal intervention with cerclage, pessary, progesterone or a combination between 20/0 to 25/0 weeks of gestation to prevent preterm birth. Median intervention-to-birth interval was the primary endpoint.</p><p><strong>Results: </strong>231 of 424 pregnant women had a cerclage only (54.5%), 76 women a pessary only (17.9%), and 27 were prescribed progesterone only (15.3%). The most common combination treatment (>1 intervention group) was cerclage plus progesterone (n=27), followed by cerclage plus pessary (n=13). The median intervention-to-birth interval for the whole cohort was 24 days (IQR 19.0 days). The earlier the intervention was started, the longer the intervention-to-birth interval lasted: When started at 20 weeks, the interval was 34 days in contrast to 11.5 days, when started at 25 weeks. The >1 group was born at a significantly higher median GA with 27.0 weeks (IQR 2.9 weeks) and a higher median birth weight of 980 g (IQR 394 g) accordingly.</p><p><strong>Conclusion: </strong>We propose that the earliest possible start of intervention leads to the most efficient pregnancy prolongation.</p>","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"246-254"},"PeriodicalIF":0.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479237","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":"[Hyperemesis Gravidarum - an Interprofessional and Interdisciplinary Challenge - Evidence-Based Review].","authors":"Werner Rath, Holger Maul, Harald Abele, Jan Pauluschke","doi":"10.1055/a-2200-9686","DOIUrl":"10.1055/a-2200-9686","url":null,"abstract":"<p><p>Hyperemesis gravidarum (HG) is a multifactorial disease characterized by severe and persisting nausea and vomiting, impairment of oral intake, weight loss of at least 5%, electrolyte abnormalities, and dehydration. The prevalence of HG ranges from 0.3 to 10% worldwide. The diagnosis is made by the patient's prehistory, clinical symptoms, physical examination, and the typical laboratory abnormalities. Therapeutic cornerstones are nutrition advice, consultation of life style, psychological/psychosocial support of the mother as well as the administration of antiemetics in a stepwise approach, depending on the severity of symptoms, and finally admission to hospital in severe cases. Treatment of patients requires close interprofessional and interdisciplinary cooperation.</p>","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"218-231"},"PeriodicalIF":0.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138803874","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":"Does Accidental Hypothermia Increase Morbidity and Mortality in Mature Neonates?","authors":"Lisa Petersen, Franz Kainer, Michael Andreas Schroth","doi":"10.1055/a-2222-6627","DOIUrl":"10.1055/a-2222-6627","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Accidental hypothermia in mature neonates requiring hospitalization is a clinical complication that has not been studied in detail. In the present study, the effect of accidental hypothermia on common morbidity in neonates in the postnatal period was investigated. We did temperature measurements in 616 mature neonates after birth, after transfer to the maternity ward and at check-up at age of 48-72 hours of life. Additionally, nurses checked temperature until discharge at every diaper change in 302 of all included neonates who were small for gestational age (SGA) or whose mothers had green fluid or premature rupture of membranes (PROM). We investigated if there was a correlation between infection, hyperbilirubinemia, hypoglycemia, SGA, gestational diabetes, PROM, green amniotic fluid, positive GBS status of the mother, and accidental hypothermia in the first 48-72 hours of life. Mature neonates showed transient accidental hypothermia in the first 24 hours of life. No significant correlation between infection (p=0.571), hyperbilirubinemia (p=0.837), hypoglycemia (p=0.072), and accidental hypothermia could be seen. There was a significant correlation between SGA (p=0.020), PROM (p=0.008), and accidental hypothermia, while hyperthermia was associated with infection (p=0.009) and green amniotic fluid (p=0.004). SGA and PROM represent perinatal risk factors for postnatal transient accidental hypothermia in mature neonates. Increased morbidity or mortality associated with postnatal accidental hypothermia has not been demonstrated.Akzidentelle Hypothermie bei Reifgeborenen, die einer Hospitalisierung bedürfen, ist eine bisher nicht näher analysierte klinische Komplikation. In der vorliegenden Arbeit wurde die Abhängigkeit einer akzidentellen Hypothermie von typischen Erkrankungen der Postnatalperiode untersucht. Wir führten bei 616 Reifgeborenen Temperaturmessungen nach Geburt, nach Verlegung auf die Wochenstation und bei der Vorsorgeuntersuchung U2 durch. Zusätzlich kontrollierten wir bei 302 der 616 Neugeborenen mit Small for gestational age (SGA), grünem Fruchtwasser oder vorzeitigem Blasensprung (PROM) die Temperatur bei jedem Windelwechsel bis zur Entlassung. Wir untersuchten, ob es einen Zusammenhang zwischen Infektion, Hyperbilirubinämie, Hypoglykämie, SGA, Gestationsdiabetes, PROM, grünem Fruchtwasser, positivem GBS-Status der Mutter und akzidenteller Auskühlung innerhalb der ersten 48-72 Lebensstunden gab. Reifgeborene zeigten in den ersten 24 Lebensstunden transiente akzidentelle Hypothermien. Es konnte kein signifikanter Zusammenhang zwischen Infektion (P=0.571), Hyperbilirubinämie (p=0.837), Hypoglykämie (p=0.072) und akzidenteller Hypothermie festgestellt werden. Es bestand ein signifikanter Zusammenhang zwischen SGA (p=0.020), PROM (p=0.008) und akzidenteller Hypothermie, während Hyperthermie war mit Infektion (p=0.009) und grünem Fruchtwasser (p=0.004) assoziiert war. SGA und PROM stellen perinatale Risikofaktoren für postnatale tra","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"270-277"},"PeriodicalIF":0.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139503004","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":"[Obstetric Care for Gestational Diabetes in Refugee and Immigrant Women in Comparison to Non-Immigrant Women in Berlin: an Analysis of Quantitative Data of the Pregnancy and Obstetric Care for Refugees (PROREF)-study].","authors":"Vera Seidel, Louise Teschemacher, Jürgen Breckenkamp, Wolfgang Henrich, Theda Borde, Matthias David, Michael Abou-Dakn","doi":"10.1055/a-2238-3364","DOIUrl":"10.1055/a-2238-3364","url":null,"abstract":"<p><strong>Research question: </strong>Are there differences in the frequency of gestational diabetes between women of self-defined refugee status (SDRS), immigrant women, and women born in Germany? Does the perinatal data of women with gestational diabetes (GDM) differ depending on the migration status?</p><p><strong>Method: </strong>For the Pregnancy and Obstetric Care for Refugees (ProRef) study between June 2020 and April 2022, data was collected with the Migrant Friendly Maternity Care Questionnaire (MFMCQ) among women on the postpartum ward in three perinatal centers in Berlin. The data concerning GDM was statistically analyzed.</p><p><strong>Results: </strong>Women of SDRS were tested for GDM (3.2%, p=0.0025) significantly less often than immigrant women (1.4%) or women born in Germany (0.6%). The rate of GDM was higher among immigrant women (19.6%, p=0.001) than among women born in Germany (15.0%) and women of SDRS (14.1%). The rate of GDM varied depending on the country of origin. Vietnam (OR 3.41) and Turkey (OR 2.18) as countries of origin, corrected for age and body mass index, increased the chance of gestational diabetes. The perinatal outcome data among women with GDM did not differ depending on the migration status.</p><p><strong>Conclusion: </strong>As women of SDRS are tested for GDM less frequently, this potentially suggests a supply gap in the health care system. However, the perinatal outcome data does not differ for women of SDRS.</p>","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"260-269"},"PeriodicalIF":0.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906559","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":"Spontaneous Heterotopic Pregnancy with Ovarian Localization: Case Report.","authors":"Rieke Lober, Maryam Zafarnia, Tomáš Kupec, Julia Wittenborn, Elmar Stickeler, Laila Najjari","doi":"10.1055/a-2233-6452","DOIUrl":"10.1055/a-2233-6452","url":null,"abstract":"<p><p>Heterotopic pregnancies are a rare phenomenon defined by the simultaneous occurrence of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy occurring through natural fertilization is low but is increased by risk factors such as assisted reproductive techniques or pelvic inflammatory disease increase. We report the case of a 36-year-old female patient in the 6th week of pregnancy who presented to the emergency unit with severe acute lower abdominal pain. Laboratory chemistry and sonography revealed a suspected heterotopic pregnancy. The patient was admitted for observation. The sonographic reevaluation on the next day confirmed the suspicion of extrauterine gravidity with intact intrauterine gravidity with additional decreasing hemoglobin and hematoperitoneum, so that laparoscopy was indicated. Intraoperatively, the mass on the left ovary was removed without complications. The patient could be discharged quickly postoperatively after a complication-free course and gave birth to a healthy child by spontaneous partus in the 38th week of gestation. Due to their rarity, there is limited research related to heterotopic pregnancies, and most scientific articles are case studies. Diagnostically, the most important thing in clinical practice is to think about the possibility of EUG even if there is evidence of an intact IUG. Transvaginal sonography is of particular importance in diagnostics. The performance of prospective cohort studies is desirable for the evidence-based diagnosis and therapy of affected patients in the future.</p>","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"286-289"},"PeriodicalIF":0.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933148","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 Duplicity of Incidents: Cervical Lymphatic Malformation in two Newborns].","authors":"Sarah Valerie Schnee, Maria Riedmeier, Theresa Hübner, Monika Rehn, Friedrich Georg Kapp, Christoph Härtel, Christine Silwedel","doi":"10.1055/a-2231-7148","DOIUrl":"10.1055/a-2231-7148","url":null,"abstract":"<p><p>We report on two neonates born the same day, both with an isolated cervical lymphatic malformation. Cervical masses were detected by ultrasound late in the third trimester. Following interdisciplinary case conferences, a caesarean section in the presence of a neonatal team was the chosen delivery mode in both cases. Delivery and transition of the newborns were uneventful. The suspected diagnosis was confirmed by postnatal MRIs, which demonstrated neither associated malformations nor compression of vital structures. Therefore, an expectant approach was chosen for the newborn with the smaller lesion. The other newborn featured a sizeable lymphatic malformation, and due to consecutive head tilt, sclerotherapy was initiated in its second week of life. Our case report outlines the challenges of a rare connatal malformation. Guidelines are often missing. Individual decisions regarding delivery mode, diagnostics and therapy have to be made on an interdisciplinary basis and patients as well as parents need counseling and support over a long period. All the more significant is good, interdisciplinary collaboration between the involved disciplines.</p>","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"303-308"},"PeriodicalIF":0.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724210","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":"[A Uncommon Case: Kasabach-Merritt syndrome with VACTERL Association].","authors":"Melanie Le, Katharina Wenke, Jochen Herrmann, Dominique Singer, Mario Lange","doi":"10.1055/a-2262-8607","DOIUrl":"10.1055/a-2262-8607","url":null,"abstract":"<p><p>The Kasabach-Merrit syndrome is characterized as the association of a vascular tumor, typically a caposiform hemangioendothelioma and rarely a tufted hemangioma, and a severe consumptive coagulopathy with potentially life-threatening thrombocytopenia. The severe coagulopathy with increased bleeding tendency must be considered before invasive procedures and often requires repeated platelet concentrate substitutions. We present a case of a mature male neonate with Kasabach-Merritt- Syndrome as well as VACTERL association. The VACTERL association describes a group of malformations. Our patient presented with anal atresia combined with tethered cord, and left renal agenesis. The VACTERL association as well as Kasabach-Merritt syndrome were found to be independent pathologies within this patient. A common occurrence or an association with each other has not been described in the literature so far. The challenging coagulation setting due to severe thrombocytopenia complicated the surgical management so far. Finally, mTOR-inhibitor sirolimus was successful in terms of tumor reduction and especially reduction of platelet consumption.</p>","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"298-302"},"PeriodicalIF":0.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013426","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":"Investigation of Serum Amphiregulin Concentrations in Pregnant Women Diagnosed with Isolated Fetal Growth Restriction in the Third Trimester.","authors":"Fatma İsmail Ali Ramadan, İbrahim Kale, Berna Buse Kobal, Aysegul Ozel, Murat Muhcu","doi":"10.1055/a-2140-7110","DOIUrl":"10.1055/a-2140-7110","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate serum amphiregulin (AREG) concentrations in pregnant women with isolated fetal growth restriction (FGR) in the third trimester.</p><p><strong>Materials and methods: </strong>This cross-sectional study was conducted with 90 pregnant women who applied to the Umraniye Training and Research Hospital Gynecology and Obstetrics Clinic between January 2022 and May 2022. The FGR group consisted of 45 pregnant women diagnosed with FGR in the third trimester, and the control group consisted of 45 healthy pregnant women matched with the FGR group in terms of age and body mass index (BMI). Demographic characteristics, ultrasound findings, and neonatal outcomes were noted. As a primary outcome, the two groups were compared for maternal serum AREG concentrations.</p><p><strong>Results: </strong>Both groups were similar in terms of demographic characteristics (p>0.05). While fetal BPD, AC, and FL measurements in the group diagnosed with FGR were significantly lower than in the control group, umbilical artery Doppler PI and S/D were higher (p=0.000, for all). Gestational age at birth, newborn birth weight, birth height, and 1-minute Apgar score were significantly lower and the NICU admission rate was higher in the FGR group (p=0.000, p=0.000, p=0.000, p=0.027, p=0.011 respectively). Gestational age at blood sampling for AREG was similar in both groups (p=0.869). While maternal serum AREG concentration was 969.39 ng/L in the FGR group, it was 795.20 ng/L in the control group (p=0.018). AUC analysis of AREG for estimation of FGR in ROC analysis was 0.57 (p<0.247, 95% CI=0.44-0.69). The optimal threshold value for FGR estimation of maternal serum AREG concentration was determined as 874.03 ng/L with 55% sensitivity and 55% specificity.</p><p><strong>Conclusion: </strong>High maternal serum AREG concentrations appear to be associated with isolated FGR in the third trimester. The pathways through which AREG modulates fetal growth remain to be investigated.</p>","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"161-165"},"PeriodicalIF":0.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10427973","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":"Full trisomy 14 in one of bichorionic biamniotic twins.","authors":"Dubravko Habek, Anis Cerovac","doi":"10.1055/a-2215-6984","DOIUrl":"10.1055/a-2215-6984","url":null,"abstract":"<p><p>We describe the case of the lethal full trisomy (T) 14 in a fetus from bichorionic biamniotic (BCBA) twin pregnancy. This is a case of a 28-year-old primigravida, with an unremarkable personal and family history, who just like her 30-year-old husband, was without consanguinity between spouses. She conceived spontaneously, without a burdened gynecological-obstetric history. By the 12th week of pregnancy, she had hyperemesis gravidarum and one episode of bleeding due to which progesterone supplementation was prescribed. Due to asymptomatic bacteriuria, she took cefuroxime axetil in the 13th week of pregnancy and azithromycin in the 15th week due to cervicitis with ureaplasma urealyticum.</p>","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"196-197"},"PeriodicalIF":0.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404614","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":"[Characteristics and Outcome of Neonates With Postnatally Diagnosed Congenital Diaphragmatic Hernia].","authors":"Bartolomeo B L Bo, Lotte Lemloh, Lennart Hale, Andreas Heydweiller, Brigitte Strizek, Charlotte Bendixen, Lukas Schroeder, Andreas Mueller, Florian Kipfmueller","doi":"10.1055/a-2198-8950","DOIUrl":"10.1055/a-2198-8950","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital diaphragmatic hernia (CDH) is one of the most severe neonatal malformations with a mortality of 20-35%. Currently, the rate of prenatally recognized CDHs is 60-80%. This study investigated the characteristics and outcome data of children with prenatally unrecognized CDH.</p><p><strong>Methods: </strong>Postnatally diagnosed CDH newborns treated at the University Hospital Bonn between 2012 and 2021 were included. Treatment and outcome data were compared according to type of maternity hospital, Apgar values, and between prenatally and postnatally diagnosed CDH.</p><p><strong>Results: </strong>Of 244 CDH newborns, 22 were included. Comparison for birth in a facility with vs. without pediatric care showed for mortality: 9% vs. 27%, p=0.478; ECMO rate: 9% vs. 36%, p=0.300; age at diagnosis: 84 vs. 129 min, p=0.049; time between intubation and diagnosis: 20 vs. 86 min, p=0.019. Newborns in the second group showed significantly worse values for pH and pCO2. Furthermore, there was a tendency for higher mortality and ECMO rates in children with an Apgar score<7 vs.≥7. Children diagnosed postnatally were significantly more likely to have moderate or severe PH and tended to have cardiac dysfunction more often than those diagnosed prenatally.</p><p><strong>Discussion: </strong>In our cohort, ca. one in 10 newborns received a postnatal CDH diagnosis. Birth in a facility without pediatric care is associated with later diagnosis, which may favor hypercapnia/acidosis and more severe pulm.</p><p><strong>Hypertension: </strong></p>","PeriodicalId":23854,"journal":{"name":"Zeitschrift fur Geburtshilfe und Neonatologie","volume":" ","pages":"181-187"},"PeriodicalIF":0.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138803911","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}