Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Acute Aortic Dissection: Observational Lessons Learned From 11 000 Patients.","authors":"Eduardo Bossone, Kim A Eagle, Christoph A Nienaber, Santi Trimarchi, Himanshu J Patel, Thomas G Gleason, Chih-Wen Pai, Daniel G Montgomery, Reed E Pyeritz, Arturo Evangelista, Alan C Braverman, Derek R Brinster, Dan Gilon, Marco Di Eusanio, Marek P Ehrlich, Kevin M Harris, Truls Myrmel, Eric M Isselbacher","doi":"10.1161/CIRCOUTCOMES.123.010673","DOIUrl":"10.1161/CIRCOUTCOMES.123.010673","url":null,"abstract":"<p><strong>Background: </strong>Over the past 25 years, diagnosis and therapy for acute aortic dissection (AAD) have evolved. We aimed to study the effects of these iterative changes in care.</p><p><strong>Methods: </strong>Patients with nontraumatic AAD enrolled in the International Registry of Acute Aortic Dissection (61 centers; 15 countries) were divided into time-based tertiles (groups) from 1996 to 2022. The impact of changes in diagnostics, therapeutic care, and in-hospital and 3-year mortality was assessed. Cochran-Armitage trend and Jonckheere-Terpstra tests were conducted to test for any temporal trend.</p><p><strong>Results: </strong>Each group consisted of 3785 patients (mean age, ≈62 years old; ≈65.5% males); nearly two-thirds had type A AAD. Over time, the rates of hypertension increased from 77.8% to 80.4% (<i>P</i>=0.002), while smoking (34.1% to 30.6%, <i>P</i>=0.033) and atherosclerosis decreased (25.6%-16.6%; <i>P</i><0.001). Across groups, the percentage of surgical repair of type A AAD increased from 89.1% to 92.5% (<i>P</i><0.001) and was associated with decreased hospital mortality (from 24.1% in group 1 to 16.7% in group 3; <i>P</i><0.001). There was no difference in 3-year survival (<i>P</i>=0.296). For type B AAD, stent graft therapy (thoracic endovascular aortic repair) was used more frequently (22.3%-35.9%; <i>P</i><0.001), with a corresponding decrease in open surgery. Endovascular in-hospital mortality decreased from 9.9% to 6.2% (<i>P</i>=0.003). As seen with the type A AAD cohort, overall 3-year mortality for patients with type B AAD was consistent over time (<i>P</i>=0.084).</p><p><strong>Conclusions: </strong>Over 25 years, substantial improvements in-hospital survival were associated with a more aggressive surgical approach for patients with type A AAD. Open surgery has been partially supplanted by thoracic endovascular aortic repair for complicated type B AAD, and in-hospital mortality has decreased over the time period studied. Postdischarge survival for up to 3 years was similar over time.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010673"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 Update to the 2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures.","authors":"Michelle M Kittleson, Khadijah Breathett, Boback Ziaeian, David Aguilar, Vanessa Blumer, Biykem Bozkurt, Rebecca L Diekemper, Michael P Dorsch, Paul A Heidenreich, Corrine Y Jurgens, Prateeti Khazanie, George Augustine Koromia, Harriette G C Van Spall","doi":"10.1161/HCQ.0000000000000132","DOIUrl":"10.1161/HCQ.0000000000000132","url":null,"abstract":"<p><p>This document describes performance measures for heart failure that are appropriate for public reporting or pay-for-performance programs and is meant to serve as a focused update of the \"2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.\" The new performance measures are taken from the \"2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines\" and are selected from the strongest recommendations (Class 1 or Class 3). In contrast, quality measures may not have as much evidence base and generally comprise metrics that might be useful for clinicians and health care organizations for quality improvement but are not yet appropriate for public reporting or pay-for-performance programs. New performance measures include optimal blood pressure control in patients with heart failure with preserved ejection fraction, the use of sodium-glucose cotransporter-2 inhibitors for patients with heart failure with reduced ejection fraction, and the use of guideline-directed medical therapy in hospitalized patients. New quality measures include the use of sodium-glucose cotransporter-2 inhibitors in patients with heart failure with mildly reduced and preserved ejection fraction, the optimization of guideline-directed medical therapy prior to intervention for chronic secondary severe mitral regurgitation, continuation of guideline-directed medical therapy for patients with heart failure with improved ejection fraction, identifying both known risks for cardiovascular disease and social determinants of health, patient-centered counseling regarding contraception and pregnancy risks for individuals with cardiomyopathy, and the need for a monoclonal protein screen to exclude light chain amyloidosis when interpreting a bone scintigraphy scan assessing for transthyretin cardiac amyloidosis.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e000132"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering Research With the American Heart Association Get With The Guidelines Registries Through Integration of a Database and Research Tools.","authors":"Chandler Beon, Lanjing Wang, Vihaan Manchanda, Pratheek Mallya, Haoyun Hong, Holly Picotte, Kathie Thomas, Jennifer L Hall, Juan Zhao, Xue Feng","doi":"10.1161/CIRCOUTCOMES.124.010967","DOIUrl":"10.1161/CIRCOUTCOMES.124.010967","url":null,"abstract":"<p><strong>Background: </strong>The American Heart Association's Get With The Guidelines (GWTG) has emerged as a vital resource in advancing the standards and practices of inpatient care across stroke, heart failure, coronary artery disease, atrial fibrillation, and resuscitation focus areas. The GWTG registry data have also created new opportunities for secondary use of real-world clinical data in biomedical research. Our goal was to implement a scalable database with an integrated user interface (UI) to improve GWTG data management and accessibility.</p><p><strong>Methods: </strong>The curation of registry data begins by going through a data processing and quality control pipeline programmed in Python. This pipeline includes data cleaning and record exclusion, variable derivation and unit harmonization, limited data set preparation, and documentation generation of the registry data. The database was built using PostgreSQL, and integrations between the database and the UI were built using the Django Web Framework in Python. Smaller subsets of data were created using SQLite database files for distribution purposes. Use cases of these tools are provided in the article.</p><p><strong>Results: </strong>We implemented an automated data curation pipeline, centralized database, and UI application for the American Heart Association GWTG registry data. The database and the UI are accessible through a Precision Medicine Platform workspace. As of March 2024, the database contains over 13.2 million cleaned GWTG patient records. The SQLite subsets benefit researchers by optimizing data extraction and manipulation using Structured Query Language. The UI improves accessibility for nontechnical researchers by presenting data in a user-friendly tabular format with intuitive filtering options.</p><p><strong>Conclusions: </strong>With the implementation of the GWTG database and UI application, we addressed data management and accessibility concerns despite its growing scale. We have launched tools to provide streamlined access and accessibility of GWTG registry data to all researchers, regardless of familiarity or experience in coding.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010967"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Socioeconomic and Mental Health Changes After Out-of-Hospital Cardiac Arrest in Women and Men.","authors":"Robin L A Smits, Fleur Heuvelman, Karen Nieuwenhuijsen, Patrick Schober, Hanno L Tan, Irene G M van Valkengoed","doi":"10.1161/CIRCOUTCOMES.124.011072","DOIUrl":"10.1161/CIRCOUTCOMES.124.011072","url":null,"abstract":"<p><strong>Background: </strong>Long-term effects of out-of-hospital cardiac arrest (OHCA) may affect the ability to work and mental health. Our aim was to analyze 5-year changes in socioeconomic and mental health outcomes after OHCA in women and men.</p><p><strong>Methods: </strong>We included 259 women and 996 men from North Holland, the Netherlands, who survived 30 days after OHCA occurred between 2009 and 2015. We assessed changes in employment, income, primary earner status, and anxiety/depression (using medication proxies) from the year before the OHCA to 5 years after with generalized linear mixed models, stratified by sex. We tested differences in changes by sex with interaction terms. Additionally, we explored yearly changes. The 5-year changes after OHCA were compared with changes in a sex- and age-matched sample of people without OHCA. Differences were tested using an interaction term of time and OHCA status.</p><p><strong>Results: </strong>In both women and men (median age [Q1, Q3]: 51 [45, 55] and 54 [48, 57] years, respectively), decreases from before OHCA to 5 years thereafter were observed in the proportion employed (from 72.8% to 53.4% [women] and 80.9% to 63.7% [men]) and the median income. No change in primary earner status was observed in either sex. Dispensing of anxiety/depression medication increased only in women, especially after 1 year (odds ratio, 5.68 [95% CI, 2.05-15.74]) and 5 years (odds ratio, 5.73 [95% CI, 1.88-17.53]). Notable differences between women and men were observed for changes in primary earner status and anxiety/depression medication (eg, at year 1, odds ratio for women, 6.71 [95% CI, 1.96-23.01]; and for men, 0.69 [95% CI, 0.33-1.45]). However, except for anxiety/depression medication in women, similar changes were also observed in the general population.</p><p><strong>Conclusions: </strong>OHCA survivors experience changes in employment, income, and primary earner status similar to the general population. However, women who survived OHCA more often received anxiety/depression medication in the years following OHCA.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011072"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Medication Adherence and Health Status in Heart Failure With Reduced Ejection Fraction: Insights From the CHAMP-HF Registry.","authors":"Rayan S El-Zein, Moghniuddin Mohammed, Daniel D Nguyen, C Larry Hill, Laine Thomas, Michael Nassif, Adam D DeVore, Nancy M Albert, Javed Butler, J Herbert Patterson, Fredonia B Williams, Adrian Hernandez, Gregg C Fonarow, John A Spertus","doi":"10.1161/CIRCOUTCOMES.123.010211","DOIUrl":"10.1161/CIRCOUTCOMES.123.010211","url":null,"abstract":"<p><strong>Background: </strong>The foundation for managing heart failure with reduced ejection fraction (HFrEF) is adherence to guideline-directed medical therapy. Finding an association between medication adherence and patients' health status (their symptoms, function, and quality of life) can be used to underscore its importance to patients.</p><p><strong>Methods: </strong>The association of self-reported medication adherence in US outpatients with HFrEF enrolled in the Change the Management of Patients with Heart Failure registry from 2015 to 2017 was compared with their health status at baseline and 12 months later. A secondary analysis of changes in adherence between baseline and 6 months with 6-month health status was also performed. Medication adherence was assessed with the self-reported 4-item Morisky-Green-Levine Medication Adherence Scale, with scores ≥1 classified as nonadherent. The primary health status outcome was the disease-specific 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OS; range, 0-100; higher is better). Robust linear regression models adjusted for confounders were used.</p><p><strong>Results: </strong>After excluding those who died (n=316) or did not provide 12-month KCCQ (n=1285), 3495 outpatients with HFrEF were included, of whom 1108 (31.7%) reported being nonadherent. Nonadherent participants were younger, had significantly worse baseline health status (-5.83-point difference; <i>P</i><0.001), and showed less improvement at 12 months (-1.7-point difference in mean change; <i>P</i>=0.017) than adherent participants. Among nonadherent patients at baseline, those whose adherence improved trended toward greater 6-month health status improvements than those remaining nonadherent (fully adjusted difference of 2.52 points; <i>P</i>=0.054).</p><p><strong>Conclusions: </strong>In HFrEF, medication nonadherence was associated with worse health status and less improvement over the following year. Improvements in adherence were associated with better health status than remaining nonadherent, underscoring the importance of supporting adherence with guideline-directed medical therapy in patients with HFrEF.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010211"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11408112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritizing Patient Perspectives: Cardiovascular Health of Transgender and Nonbinary People.","authors":"Carl G Streed, Asa E Radix","doi":"10.1161/CIRCOUTCOMES.124.011319","DOIUrl":"10.1161/CIRCOUTCOMES.124.011319","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011319"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ABCs of Leveraging APCD for Research in Congenital Cardiology.","authors":"Michael L O'Byrne","doi":"10.1161/CIRCOUTCOMES.124.011359","DOIUrl":"10.1161/CIRCOUTCOMES.124.011359","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011359"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cautionary Note on Data Sharing.","authors":"Daniel B Kramer, Brahmajee K Nallamothu","doi":"10.1161/CIRCOUTCOMES.124.010257","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.010257","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 9","pages":"e010257"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the Impact of Hospital-Level Variation on the Use of Inpatient Rehabilitation Facilities Versus Skilled Nursing Facilities on Individual Patients With Stroke.","authors":"Kent P Simmonds, James Burke, Alan Kozlowski, Michael Andary, Zhehui Luo, Mathew J Reeves","doi":"10.1161/CIRCOUTCOMES.123.010636","DOIUrl":"10.1161/CIRCOUTCOMES.123.010636","url":null,"abstract":"<p><strong>Background: </strong>There is substantial hospital-level variation in the use of Inpatient Rehabilitation Facilities (IRFs) versus Skilled Nursing Facilities (SNFs) among patients with stroke, which is poorly understood. Our objective was to quantify the net effect of the admitting hospital on the probability of receiving IRF or SNF care for individual patients with stroke.</p><p><strong>Methods: </strong>Using Medicare claims data (2011-2013), a cohort of patients with acute stroke discharged to an IRF or SNF was identified. We generated 2 multivariable logistic regression models. Model 1 predicted IRF admission (versus SNF) using only patient-level factors, whereas model 2 added a hospital random effect term to quantify the hospital effect. The statistical significance and direction of the random effect terms were used to categorize hospitals as being either IRF-favoring, SNF-favoring, or neutral with respect to their discharge patterns. The hospital's impact on individual patient's probability of IRF discharge was estimated by taking the change in individual predicted probabilities (change in individual predicted probability) between the 2 models. Hospital-level effects were categorized as small (<10%), moderate (10%-19%), or large (≥20%) depending on change in individual predicted probability.</p><p><strong>Results: </strong>The cohort included 135 415 patients (average age, 81.5 [SD=8.0] years, 61% female, 91% ischemic stroke) who were discharged from 1816 acute care hospitals to IRFs (n=66 548) or SNFs (n=68 867). Half of hospitals were classified as being either IRF-favoring (n=461, 25.4%) or SNF-favoring (n=485, 26.7%) with the remainder (n=870, 47.9%) considered neutral. Overall, just over half (n=73 428) of patients were treated at hospitals that had moderate or large independent effects on discharge settings. Hospital effects for neutral hospitals were small (ie, change in individual predicted probability <10%) for most patients (72.5%). However, hospital effects were moderate or large for 78.8% and 84.6% of patients treated at IRF- or SNF-favoring hospitals, respectively.</p><p><strong>Conclusions: </strong>For most patients with stroke, the admitting hospital meaningfully changed the type of rehabilitation care that they received.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010636"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transgender and Nonbinary Individuals' Perceptions Regarding Gender-Affirming Hormone Therapy and Cardiovascular Health: A Qualitative Study.","authors":"Chantal L Rytz, Badal S B Pattar, Sara J Mizen, Parker Lieb, Jeanna Parsons Leigh, Nathalie Saad, Sandra M Dumanski, Lauren B Beach, Zack Marshall, Amelia M Newbert, Lindsay Peace, Sofia B Ahmed","doi":"10.1161/CIRCOUTCOMES.124.011024","DOIUrl":"10.1161/CIRCOUTCOMES.124.011024","url":null,"abstract":"<p><strong>Background: </strong>Transgender and nonbinary individuals face substantial cardiovascular health uncertainties. The use of gender-affirming hormone therapy can be used to achieve one's gender-affirming goals. As self-rated health is an important predictor of health outcomes, an understanding of how this association is perceived by transgender and nonbinary individuals using gender-affirming hormone therapy is required. The objective of this research was to explore transgender and nonbinary individuals' perceptions of cardiovascular health in the context of using gender-affirming hormone therapy.</p><p><strong>Methods: </strong>In this qualitative study, English-speaking transgender and nonbinary adults using gender-affirming hormone therapy for 3 months or more were recruited from across Canada using purposive and snowball sampling methods. Semistructured interviews were conducted through videoconference to explore transgender and nonbinary individuals' perceptions of the association between gender-affirming hormone therapy and cardiovascular health between May and August 2023. Data were transcribed verbatim, and transcripts were analyzed independently by 3 reviewers using thematic analysis.</p><p><strong>Results: </strong>Twenty-one participants were interviewed (8 transgender women, 9 transgender men, and 3 nonbinary individuals; median [range] age, 27 [20-69] years; 80% White participants). Three main themes were identified: cardiovascular health was not a primary concern in the decision-making process with regard to gender-affirming hormone therapy, the improved well-being associated with gender-affirming hormone therapy was felt to contribute to improved cardiovascular health, and health care provider knowledge and attitude facilitate the transition process.</p><p><strong>Conclusions: </strong>Gender-affirming hormone therapy in transgender and nonbinary individuals is perceived to improve cardiovascular health. Given the positive associations between care aligned with patient priorities, self-rated health, and health outcomes, these findings should be considered as part of shared decision-making and person-centered care.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011024"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}