Brazilian Journal of Anesthesiology最新文献

{"title":"Efficacy of erector spinae plane block in pain management for patients with herpes zoster: a systematic review and meta-analysis","authors":"Alexandre Yamada Fujimura Júnior ,&nbsp;Carolina Braga Moura ,&nbsp;Arnaldo Bastos dos Santos","doi":"10.1016/j.bjane.2025.844598","DOIUrl":"10.1016/j.bjane.2025.844598","url":null,"abstract":"<div><h3>Objectives</h3><div>Systematic review and meta-analysis to evaluate the efficacy of the Erector Spinae Plane Block (ESPB) in managing pain related to Herpes Zoster.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, Cochrane Library, and CNKI for randomized trials comparing ESPB plus standard clinical treatment with clinical treatment alone. The population included patients with acute infection and those with Postherpetic Neuralgia (PHN). The primary outcome was pain intensity, and secondary outcomes included analgesic consumption. Mean Difference (MD) was used for continuous outcomes, and Risk Ratio (RR) for binary outcomes.</div></div><div><h3>Results</h3><div>Seven trials with 362 patients were included. ESPB significantly reduced pain up to eight weeks (MD = -1.21; 95% CI -2.17 to -0.24; I² = 89%). In the subgroup analysis of patients in the acute stage, the benefit seemed to extend with pain reduction lasting up to 12-weeks (MD = -1.49; 95% CI -2.61 to -0.37; I² = 0%), and a reduction in the incidence of PHN (RR = 0.49; 95% CI 0.28 to 0.85; I²: 0%). In the PHN subgroup, pain reduction was notable only at four weeks (MD = -1.08; 95% CI -1.81 to -0.35; I² = 86%). ESPB also reduced acetaminophen (MD = -0.6 g.day^-1; 95% CI -1.05 to -0.14; I² = 49%) and pregabalin consumption (-68.58 mg.day^-1; 95% CI -127.18 to -9.97; I² = 41%) over 12 weeks.</div></div><div><h3>Conclusion</h3><div>ESPB seems to provide pain relief in Herpes Zoster patients, with a prolonged benefit in the acute stage. Also, ESPB reduced the need for analgesics over 12 weeks. More research is needed to corroborate this practice.</div></div><div><h3>Study Registration Number and Date</h3><div>This article was prospectively registered in PROSPERO (<span><span>www.crd.york.ac.uk/prospero</span><svg><path></path></svg></span>, CRD42024566674).</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844598"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460970","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":"Impact of anesthetic technique on troponin I levels in pediatric cardiac surgery: a randomized clinical trial","authors":"João Victor Galvão Barelli ,&nbsp;David D. Araujo ,&nbsp;Suely P. Zeferino ,&nbsp;Gustavo M. Dantas ,&nbsp;Filomena B. Galas","doi":"10.1016/j.bjane.2025.844603","DOIUrl":"10.1016/j.bjane.2025.844603","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the effects of the inhalational anesthetic sevoflurane on postoperative myocardial injury and renal function in children under 2 years old with congenital heart disease (RACHS 1, 2, and 3) undergoing cardiac surgery with extracorporeal circulation.</div></div><div><h3>Methods</h3><div>A randomized clinical trial was conducted with 66 patients divided into two groups: one receiving sevoflurane and the other Total Intravenous Anesthesia (TIVA). The primary outcome was the serum troponin I levels within the first 48 hours postoperatively. Secondary outcomes included urine output and serum urea levels.</div></div><div><h3>Results</h3><div>The median troponin I levels at 48 hours were 10.5 ng.mL−1 (IQR: 8.2–12.7) in the sevoflurane group and 11.0 ng.mL⁻¹ (IQR: 8.7–13.0) in the TIVA group (p = 0.336). The sevoflurane group showed higher urine output on the second postoperative day (median: 800 mL [IQR: 420–913] vs. 541 mL [IQR: 312–718], p = 0.034) and lower serum urea levels (median: 24 mg.dL⁻¹ [IQR: 16–35] vs. 36 mg.dL⁻¹ [IQR: 23–49], p = 0.030).</div></div><div><h3>Conclusions</h3><div>While sevoflurane did not significantly impact myocardial injury markers, it demonstrated potential renal protective effects in this patient population. Further research is necessary to confirm these findings across different pediatric age groups and surgical contexts.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844603"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538015","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":"Single-agent versus combination regimens containing propofol: a retrospective cohort study of recovery metrics and complication rates in a hospital-based endoscopy suite","authors":"Guozhen Xie ,&nbsp;Maria Estevez ,&nbsp;Kiyan Heybati ,&nbsp;Matthew Vogt ,&nbsp;Michael Smith ,&nbsp;Christine Moshe ,&nbsp;Johanna Chan ,&nbsp;Vivek Kumbhari ,&nbsp;Ryan Chadha","doi":"10.1016/j.bjane.2025.844602","DOIUrl":"10.1016/j.bjane.2025.844602","url":null,"abstract":"<div><h3>Background</h3><div>Anesthesiologists are often tasked with overseeing sedation in non-surgical settings. We aim to determine whether adding adjuvant sedatives to propofol affects the recovery times and complication rates after endoscopy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adults (≥18) who received propofol while undergoing esophagogastroduodenoscopy (EGD) and/or colonoscopy (COL) at a large academic institution over a four-year period. Patients receiving propofol alone were compared against patients receiving propofol in combination with midazolam, fentanyl, ketamine, or dexmedetomidine. The primary outcome was PACU length of stay, adjusted for age, sex, and ASA Score. Secondary outcomes included incidence of PACU postoperative nausea and vomiting, hypoxemia (SpO₂ &lt; 90%), bradycardia (HR &lt; 60 bpm), and escalation of care (hospital admission), reported in adjusted odds ratios and their 95% confidence intervals.</div></div><div><h3>Results</h3><div>Across the study period, 28,532 cases were included. Colonoscopies performed under propofol+fentanyl sedation were associated with significantly longer PACU LOS compared to propofol alone. Adjusted mean PACU LOS was significantly longer in patients receiving adjuvant fentanyl, compared to propofol alone (p &lt; 0.01) and propofol + dexmedetomidine (p &lt; 0.01). Patients receiving propofol alone exhibited a 9.4% incidence of bradycardia, 16.0% hypoxia, 0.89% PONV, and 0.40% hospitalization. Adjuvant fentanyl use was associated with higher odds of hypoxia across all procedure types (p &lt; 0.05). Adjuvant dexmedetomidine was associated with higher rates of bradycardia, but lower rates of hypoxia, PONV, and hospitalization (p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>With the exception of fentanyl, combining propofol with other sedatives was not associated with longer recovery times. The incidence of complications differed significantly with the use of adjuvant fentanyl or dexmedetomidine.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844602"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538098","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":"Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis","authors":"Gustavo R.M. Wegner ,&nbsp;Bruno F.M. Wegner ,&nbsp;Henrik G. Oliveira ,&nbsp;Luis A. Costa ,&nbsp;Luigi W. Spagnol ,&nbsp;Valentine W. Spagnol ,&nbsp;Jorge R.M. Carlotto ,&nbsp;Eugénio Pagnussatt Neto","doi":"10.1016/j.bjane.2025.844604","DOIUrl":"10.1016/j.bjane.2025.844604","url":null,"abstract":"<div><h3>Background</h3><div>The impact of choosing between inhalational anesthetics and propofol for maintenance anesthesia in liver transplantation or liver resections remains uncertain.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on PubMed, Scopus, Embase, Web of Science, and the Cochrane Library on September 5, 2023, adhering to the Cochrane Handbook and PRISMA guidelines.</div></div><div><h3>Results</h3><div>Fifteen randomized controlled trials and five observational studies, comprising 1,602 patients, were included. The statistical analysis was categorized into three groups: liver transplantation (four studies), living donor hepatectomy (four studies), and liver mass hepatectomy (twelve studies). The liver mass hepatectomy group was further subdivided based on the performance of the Pringle maneuver and the use of pharmacological preconditioning. Statistically significant results are described below. In liver transplant recipients, propofol anesthesia was associated with lower AST levels on the first postoperative day. Hepatic donors anesthetized with propofol had higher total infusion volumes and intraoperative urine output. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher peak AST and ALT levels compared to those who received pharmacological preconditioning. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher AST and ALT levels on both the first and third postoperative days, increased total infusion volumes, and shorter hospital stays, when compared to pharmacological conditioning.</div></div><div><h3>Conclusions</h3><div>Our findings do not offer sufficient evidence to inform clinical practice. The choice between propofol-based and inhalational anesthesia should be tailored to the individual patient's condition and the nature of the procedure being performed.</div></div><div><h3>Registration</h3><div>PROSPERO ID: CRD42023460715.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844604"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538012","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":"A pragmatic view on general anesthesia in mechanical thrombectomy for acute ischemic stroke","authors":"Alessandro Scudellari ,&nbsp;Federico Bilotta","doi":"10.1016/j.bjane.2025.844599","DOIUrl":"10.1016/j.bjane.2025.844599","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844599"},"PeriodicalIF":1.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469858","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":"Transforming perioperative care in Brazil: challenges and opportunities for improving outcomes","authors":"Luciana C. Stefani ,&nbsp;Liana M.T.A. Azi ,&nbsp;Andre P. Schmidt","doi":"10.1016/j.bjane.2025.844596","DOIUrl":"10.1016/j.bjane.2025.844596","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844596"},"PeriodicalIF":1.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375056","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":"Home mechanical ventilation: a narrative review and a proposal of practical approach","authors":"Simone Chaves Fagondes ,&nbsp;Carmem Lúcia Oliveira da Silva ,&nbsp;Anneliese Hoffmann ,&nbsp;Rita de Cássia Guedes de Azevedo Barbosa ,&nbsp;Daiane Falkembach ,&nbsp;Ângela Beatriz John","doi":"10.1016/j.bjane.2025.844595","DOIUrl":"10.1016/j.bjane.2025.844595","url":null,"abstract":"<div><div>Growing evidence of the benefits of home ventilatory support in patients with chronic respiratory failure along with technological advances in ventilators have enabled their use in overly complex situations, shaping a new scenario for physicians. This has further given rise to new challenges related to their incorporation into current medical practice. However, this evolution needs to be coupled with knowledge and skills of physicians who are willing to prescribe Home Mechanical Ventilation (HMV), in order to prevent them from making inappropriate choices or adjustments that may ultimately have ethical and legal implications. This article aims to provide guidance and information to support the indication for HMV and the ventilation modalities to be implemented, review basic ventilation concepts, including the ventilator modes most commonly used in patients outside the hospital setting, list the brands and models available in the Brazilian market, provide the means for obtaining equipment for HMV, and finally, describe the requirements for selection of equipment, taking into account the individual characteristics of the patient to ensure safe perioperative care and earlier dehospitalization.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844595"},"PeriodicalIF":1.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054410","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":"End-tidal carbon dioxide-guided extracorporeal cardiopulmonary resuscitation improves neurological prognosis in patients: a single-center retrospective cohort study","authors":"Xiaozu Liao,&nbsp;Chen Gu,&nbsp;Zhou Cheng,&nbsp;Kepeng Liu,&nbsp;Qing Yin,&nbsp;Binfei Li","doi":"10.1016/j.bjane.2025.844588","DOIUrl":"10.1016/j.bjane.2025.844588","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an effective intervention for restoring adequate circulatory perfusion after cardiac arrest. Ensuring high-quality Cardiopulmonary Resuscitation (CPR) before initiating Extracorporeal Membrane Oxygenation (ECMO) is critical to mitigate tissue hypoxia and ischemia. This study aimed to evaluate the effect of End-Tidal Carbon Dioxide (ETCO₂) Goal-Directed CPR (GDCPR) on neurological function before ECMO using a retrospective case-control analysis.</div></div><div><h3>Methods</h3><div>The medical records of all patients who received ECPR treated at Zhongshan City People's Hospital were collected between January 2020 and March 2023. In this retrospective cohort study, the patients were divided into Conventional CPR (CCPR) and ETCO₂-GDCPR groups based on whether ETCO₂ was used as a guide for CPR.</div></div><div><h3>Results</h3><div>A total of 71 patients were included, of whom 46 comprised the CCPR group and 25 comprised the GDCPR group. Approximately 37% of patients who received ECPR had good cerebral function at discharge, with a higher rate in the GDCPR group (52%) compared with the CCPR group (28%) (p = 0.047). Multivariate analysis showed that the Highest Interleukin-6 (H-IL6) levels after ECMO (Odds Ratio [OR = 1.001], 95% Confidence Interval [95% CI 1.000–1.003], p = 0.005) was a risk factor for neurological function at discharge. The other risk factors for poor prognosis in patients who received ECPR included pre-ECMO CPR protocols (OR = 10.74, 95% CI 1.90–60.48, p = 0.007) and IL6 levels after ECMO (OR = 1.002, 95% CI 1.001–1.003, p = 0.005). ECMO duration (OR = 0.83, 95% CI 0.74–0.94, p = 0.002) was identified as a protective factor. Patients with short ECMO duration have a poor prognosis. The area under the curve for ECMO duration was 0.86 (0.77–0.94, p &lt; 0.01), while that for H-IL6 was 0.19 (0.09–0.29, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>ETCO₂-guided ECPR is associated with improved neurological prognosis and patient outcomes. Therefore, monitoring ETCO₂ levels should be considered a crucial component of evaluating resuscitation efficacy during CPR.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844588"},"PeriodicalIF":1.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042757","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":"Evaluation of hypotension prediction index software in patients undergoing orthotopic liver transplantation: retrospective observational study","authors":"Jacek B. Cywinski ,&nbsp;Yufei Li ,&nbsp;Lusine Israelyan ,&nbsp;Roshni Sreedharan ,&nbsp;Silvia Perez-Protto ,&nbsp;Kamal Maheshwari","doi":"10.1016/j.bjane.2025.844589","DOIUrl":"10.1016/j.bjane.2025.844589","url":null,"abstract":"<div><h3>Background</h3><div>Extreme hemodynamic changes, especially intraoperative hypotension (IOH), are common and often prolonged during Liver Transplant (LT) surgery and during initial hours of recovery. Hypotension Prediction Index (HPI) software is one of the tools which can help in proactive hemodynamic management. The accuracy of the advanced hemodynamic parameters such as Cardiac Output (CO) and Systemic Vascular Resistance (SVR) obtained from HPI software and prediction performance of the HPI in LT surgery remains unknown.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study conducted in a tertiary academic center with a large liver transplant program. We enrolled 23 adult LT patients who received both Pulmonary Artery Catheter (PAC) and HPI software monitoring. Primarily, we evaluated agreement between PAC and HPI software measured CO and SVR. A priori, we defined a relative difference of less than 20% between measurements as an adequate agreement for a pair of measurements and estimated the Lin's Concordance Correlation Coefficient and Bland-Altman Limits of Agreement (LOA). Clinically acceptable LOA was defined as ± 1 L.min^-1 for CO and ± 200 dynes s.cm^-5 for SVR. Secondary outcome was the ability of the HPI to predict future hypotension, defined as Mean Arterial Pressure (MAP) less than 65 mmHg lasting at least one minute. We estimated sensitivity, positive predictive value, and time from alert to hypotensive events for HPI software.</div></div><div><h3>Results</h3><div>Overall, 125 pairs of CO and 122 pairs of SVR records were obtained from 23 patients. Based on our predefined criteria, only 42% (95% CI 30%, 55%) of CO records and 53% (95% CI 28%, 72%) of SVR records from HPI software were considered to agree with those from PAC. Across all patients, there were a total of 1860 HPI alerts (HPI ≥ 85) and 642 hypotensive events (MAP &lt; 65 mmHg). Out of the 642 hypotensive events, 618 events were predicted by HPI alert with sensitivity of 0.96 (95% CI: 0.95). Many times, the HPI value remained above alert level and was followed by multiple hypotensive events. Thus, to evaluate PPV and time to hypotension metric, we considered only the first HPI alert followed by a hypotensive event (“true alerts”). The “true alert” was the first alert when there were several alerts before a hypotension. There were 614 “true alerts” and the PPV for HPI was 0.33 (95% CI 0.31, 0.35). The median time from HPI alert to hypotension was 3.3 [Q1, Q3: 1, 9.3] mins.</div></div><div><h3>Conclusion</h3><div>There was poor agreement between the pulmonary artery catheter and HPI software calculated advanced hemodynamic parameters (CO and SVR), in the patients undergoing LT surgery. HPI software had high sensitivity but poor specificity for hypotension prediction, resulting in a high burden of false alarms.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844589"},"PeriodicalIF":1.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043236","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":"Challenges in surgical and perioperative care for Brazil's aging population","authors":"Andre P. Schmidt ,&nbsp;Federico Bilotta","doi":"10.1016/j.bjane.2025.844586","DOIUrl":"10.1016/j.bjane.2025.844586","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844586"},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017382","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}