Journal of Voice最新文献

{"title":"Salient Voice Symptoms in Primary Muscle Tension Dysphonia.","authors":"Avery Moore, Adrianna C Shembel","doi":"10.1016/j.jvoice.2024.12.020","DOIUrl":"https://doi.org/10.1016/j.jvoice.2024.12.020","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with primary muscle tension dysphonia (pMTD) commonly report symptoms of vocal effort, fatigue, discomfort, odynophonia, and aberrant vocal quality (eg, vocal strain, hoarseness). However, voice symptoms most salient to pMTD have not been identified. Furthermore, how standard vocal fatigue and vocal tract discomfort indices that capture persistent symptoms-like the Vocal Fatigue Index (VFI) and Vocal Tract Discomfort Scale (VTDS)-relate to acute symptoms experienced at the time of the voice evaluation is unclear. Finally, correlations between voice symptoms and acoustic vocal quality are poorly understood. As such, the objectives of this study were to: (1) identify the most salient pMTD symptoms, (2) correlate the VFI and VTDS with acute voice symptom severity, and (3) better understand relationships between voice symptom experiences and vocal acoustics.</p><p><strong>Methods: </strong>Thirty subjects (15 pMTD, 15 controls) rated their vocal effort, vocal fatigue, vocal tract discomfort, odynophonia, and vocal quality on separate 100 mm visual analog scales (VAS) and completed the VFI-Part1 and VTDS. Cepstral peak prominences (CPP) were obtained from voice recordings of sustained /i/ and the all-voiced consensus of auditory-perceptual evaluation of voice (CAPE-V) sentence.</p><p><strong>Results: </strong>Patients with pMTD reported significantly higher severities of vocal effort (P < 0.0001), fatigue (P = 0.001), and discomfort (P = 0.0008) and scored significantly higher on both vocal indices (VFI-Part1: P < 0.0001; VTDS: P = 0.0056) compared to vocally healthy controls. Both indices had medium-to-high correlations with acute symptom severities in both groups. However, there were no significant differences between groups on odynophonia severity (P = 0.349), acoustic vocal quality (/i/: P = 1.00, CAPE-V: P = 0.228) or self-perceptual vocal quality (P = 0.141). There were also no significant relationships between vocal acoustics and patient symptoms or between vocal acoustics and standard vocal fatigue and vocal tract discomfort indices (P's > 0.05).</p><p><strong>Conclusion: </strong>Somatosensory symptoms of vocal effort, vocal fatigue, and vocal tract discomfort are the most salient clinical features in patients with pMTD. Standard voice indices that capture more chronic symptoms can also reliably capture symptoms experienced at the time of the voice evaluation in patients with pMTD. Although odynophonia and aberrant acoustic vocal quality may be present in some patients with pMTD, they do not appear to be symptoms central to the condition. Because somatosensory experiences are more salient than vocal quality and vocal acoustics in pMTD, somatosensory symptoms of vocal effort, fatigue, and discomfort should hold more weight during the voice evaluation when pMTD is suspected.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928501","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":"Machine Learning-Based Estimation of Hoarseness Severity Using Acoustic Signals Recorded During High-Speed Videoendoscopy.","authors":"Tobias Schraut, Michael Döllinger, Melda Kunduk, Matthias Echternach, Stephan Dürr, Julia Werz, Anne Schützenberger","doi":"10.1016/j.jvoice.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.jvoice.2024.12.008","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the use of sustained phonations recorded during high-speed videoendoscopy (HSV) for machine learning-based assessment of hoarseness severity (H). The performance of this approach is compared with conventional recordings obtained during voice therapy to evaluate key differences and limitations of HSV-derived acoustic recordings.</p><p><strong>Methods: </strong>A database of 617 voice recordings with a duration of 250 ms was gathered during HSV examination (HS). Two databases comprising 809 vowels recorded during voice therapy were used for comparison, examining recording durations of 1 second (VT-1) and 250 ms (VT-2). A total of 490 features were extracted, including perturbation and noise characteristics, spectral and cepstral coefficients, as well as features based on modulation spectrum, nonlinear dynamic analysis, entropy, and empirical mode decomposition. Model development focused on selecting a minimal-optimal feature subset and suitable classification algorithms. Recordings were classified into two groups of hoarseness based on auditory-perceptual ratings by experts, yielding a continuous hoarseness score yˆ. Model performance was evaluated based on classification accuracy, correlation between predicted scores yˆ∈[0,1] and subjective ratings H∈{0,1,2,3}, and correlation between the relative change in quantitative and subjective ratings.</p><p><strong>Results: </strong>Logistic regression combined with five acoustic features achieved a classification accuracy of 0.863 (VT-1), 0.847 (VT-2), and 0.742 (HS) on the test sets. A correlation of 0.797 (VT-1), 0.763 (VT-2), and 0.637 (HS) was obtained between yˆ and H, respectively. For 21 test subjects with two recordings, the model yielded a correlation of 0.592 (VT-1), 0.486 (VT-2), and 0.088 (HS) between ∆yˆ and ∆H.</p><p><strong>Conclusion: </strong>While acoustic signals recorded during HSV show potential for quantitative hoarseness assessment, they are less reliable than voice therapy recordings due to practical challenges associated with oral laryngeal examination. Addressing these limitations, for example, through the use of flexible nasal endoscopy, could improve the quality of HSV-derived acoustic recordings and voice assessments.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928488","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":"Potential Biophysiological Mechanisms Underlying Vocal Demands and Vocal Fatigue.","authors":"Adrianna C Shembel, Chaya Nanjundeswaran","doi":"10.1016/j.jvoice.2022.07.017","DOIUrl":"10.1016/j.jvoice.2022.07.017","url":null,"abstract":"<p><p>Patients with complaint of vocal fatigue have perceptual, acoustic, and aerodynamic outcomes that are heterogeneous in nature. One reason may be due to different underlying biophysiological mechanisms that lead to these heterogeneous clinical presentations. Five potential mechanisms are proposed: neuromuscular, metabolic, vocal tissue, afferent, and central neural. Analytical frameworks and study designs to study these mechanisms are also addressed. A better understanding of biophysiological mechanisms of vocal fatigue can improve precision of therapeutic approaches. It can also help shift management from symptom-based to etiology-focused approaches for vocal fatigue.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":"281.e1-281.e10"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9943805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10742880","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":"Factors Influencing Teachers' Experience of Vocal Fatigue and Classroom Voice Amplification.","authors":"Russell E Banks, Lady C Cantor-Cutiva, Eric Hunter","doi":"10.1016/j.jvoice.2022.06.026","DOIUrl":"10.1016/j.jvoice.2022.06.026","url":null,"abstract":"<p><strong>Background: </strong>Voice disorders among teachers are widespread. Teachers' voice problems have been shown to influence the teaching-learning process, thereby impeding students' academic performance. Voice amplification has been used as a preventative strategy to avoid voice problems and as a means of augmenting student reception of a teacher's voice. However, the relationship between perceived vocal fatigue and amplification use has not been established, nor have factors been identified which may be associated with the use of voice amplification in the classroom.</p><p><strong>Purpose: </strong>This research has two aims: (1) determine the relationship between self-reported vocal fatigue and self-reported teachers' use of sound field amplification in the classroom; and (2) identify which factors are related with the use of amplification systems among the participating teachers.</p><p><strong>Methods: </strong>Paper and online surveys were provided to teachers throughout the United States. These surveys contained the 19-question Vocal Fatigue Index (VFI), in addition to other questions regarding health-related conditions and lifestyle habits of respondents. Access to and use of amplification systems, as well as other work-related factors that might influence the use of such systems were detailed by the respondents.</p><p><strong>Results: </strong>Regardless of grades levels or measured factors, teachers who reported using amplification systems were more likely to report higher levels of vocal fatigue. Teachers who taught in lower grade levels or in larger capacity classrooms not only reported a greater likelihood of using the systems more frequently, but also reported a greater access to amplification systems. Overall, less than 40% of teachers had access to an amplification system. Teachers of lower grades reported having the least access.</p><p><strong>Conclusions: </strong>Our results suggest an association between teachers' use of voice amplification systems and vocal fatigue. In addition, some work-related factors (eg, grade level, classroom capacity) were associated with the use of amplification systems. The results can be beneficial to teachers, school administrators, lawmakers and health professionals to more efficiently use diminishing educational resources in a targeted fashion to better train and potentially reduce the occurrence of voice problems among teachers.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":"113-122"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9939560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10744640","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":"Stress Effects on Pharyngeal Air Pressure and Upper Esophageal Sphincter Pressure During Phonation: The Influence of Vocal Tract Semi-Occlusion.","authors":"Jesse D Hoffmeister, Christopher L Ulmschneider, Michelle R Ciucci, Timothy M McCulloch","doi":"10.1016/j.jvoice.2022.07.020","DOIUrl":"10.1016/j.jvoice.2022.07.020","url":null,"abstract":"<p><strong>Objectives/hypothesis: </strong>The objective of this study was to determine whether vocal tract semi-occlusion (SOVT) influenced stress effects on pharyngeal air pressure and upper esophageal sphincter (UES) pressure during phonation. Relationships between dysphonia and stress are well recognized but poorly understood. Stress effects act globally on the body, and may be observed beyond intrinsic laryngeal muscles to include pharyngeal muscles and the UES, which contribute to voice modulation. Phonation with SOVT may provide resistance to stress effects on the vocal tract. We hypothesized that stress effects on pharyngeal air pressure and UES pressure would be measurable with a high-resolution, 360° pressure catheter, and that stress effects would be impacted differently by occlusal and non-occlusal phonatory tasks.</p><p><strong>Methods: </strong>Ten healthy adults performed sustained vowel tasks (comfortable /a/, and loud /a/), and SOVT tasks (bilabial fricative and straw phonation). Each task was performed during a baseline condition, and during stress induced through a cold pressor task. Pharyngeal air pressure and UES pressure were measured via high-resolution manometry. Changes in pressure between baseline and stress were compared among phonatory tasks.</p><p><strong>Results: </strong>Stress-induced changes to UES pressure differed by phonatory task (P < 0.01). Stress increased UES pressures during vowels, but had no effect during bilabial fricative, and decreased UES pressures during straw phonation. Change in UES pressure with stress was greater for comfortable /a/ and loud /a/ than straw phonation (P = 0.048 and P = 0.019, respectively), and was not significantly different between comfortable /a/ or loud /a/ and bilabial fricative. Stress-induced changes in pharyngeal air pressure were not significantly different among tasks.</p><p><strong>Conclusions: </strong>These findings help identify possible mechanisms underlying the relationship between stress and voice, and point to the utility of SOVT tasks for training vocal tract resistance to stress. This methodology provides a foundation for measuring changes to extra-laryngeal components of the vocal tract during phonation.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":"283.e27-283.e34"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9958265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10839581","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 Study on Voice Measures in Patients With Alzheimer's Disease.","authors":"Noé Xiu, Béatrice Vaxelaire, Lanlan Li, Zhenhua Ling, Xiaoya Xu, Linming Huang, Bo Sun, Lin Huang, Rudolph Sock","doi":"10.1016/j.jvoice.2022.08.010","DOIUrl":"10.1016/j.jvoice.2022.08.010","url":null,"abstract":"<p><strong>Objective: </strong>As Alzheimer's disease (AD) might provoke certain nerve disorders, patients with AD can acquire sensorimotor adaptation problems, and thus the acoustic characteristics of the speech they produce may differ from those of healthy subjects. This study aimed to (1) extract acoustic characteristics (relating to articulatory gestures) potentially useful for detecting AD and (2) examine whether these characteristics could help identify AD patients.</p><p><strong>Methods: </strong>A total of 50 individuals participated in the study, including the AD group (17 cases), the Neurologically Healthy (NH) group (13 cases), the Mild Cognitive Impairment (MCI) group (11 cases), and the Vascular Cognitive Impairment (VCI) group (9 cases). Voice samples involving three vowels (/i/, /a/, and /u/) and six consonants (/p/, /pʰ/, /t/, /tʰ/, /k/, and /kʰ/) were collected using a digital recorder (TASCAM DR40X). Microphone-to-mouth distance was maintained at 30 cm. Acoustic measures included F0, jitter, shimmer, HNR, F1, F2, F3, and VOT.</p><p><strong>Results: </strong>One-way ANOVA tests were carried out to compare the acoustic measures among the four groups. F3 of vowel /u/, F2 bandwidth of vowel /a/, VOT of consonant /t/, and male participants' F0 of three vowels (/a/, /i/, and /u/) were found significantly different, while no significant differences were found in the other measures.</p><p><strong>Conclusion: </strong>Some acoustic characteristics can indeed help detect AD patients.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":"286.e13-286.e24"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9180724","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":"Anxiety and Depression Features in Laryngopharyngeal Reflux Disease: A Systematic Review.","authors":"Jérôme R Lechien","doi":"10.1016/j.jvoice.2024.12.026","DOIUrl":"https://doi.org/10.1016/j.jvoice.2024.12.026","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the anxiety and depression features in laryngopharyngeal reflux disease (LPRD).</p><p><strong>Methods: </strong>A laryngologist and librarian conducted a PubMed, Scopus, and Cochrane Library systematic review related to anxiety, depression, and mental health in LPRD through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements.</p><p><strong>Results: </strong>Of the 96 identified studies, 22 publications met the inclusion criteria, accounting for 2162 patients with suspected LPRD (n = 1607), gastroesophageal reflux disease (GERD; n = 423), both LPRD and GERD (n = 132), and 926 healthy/asymptomatic individuals. The LPRD diagnosis was mainly based on symptoms and findings. Twenty-six different mental health instruments were used across the studies. Anxiety was found in 28.8%-39.3% of patients with suspected LPRD. Depression was documented in 6.3%-45.6% of suspected LPRD. Most studies reported a significantly higher prevalence/incidence of anxiety and depression in suspected LPRD compared to controls. The LPRD symptom severity was associated with the severity of anxiety and depression in all studies exploring association findings. The anxiety and depression symptoms were reported as higher in LPRD compared to GERD populations. The bias analysis highlighted an important heterogeneity between studies, especially for the LPRD diagnosis and the mental health instruments used.</p><p><strong>Conclusion: </strong>The prevalence of depression and anxiety is commonly higher in suspected LPRD compared to asymptomatic individuals. Future studies are needed to understand the association between the development of LPRD and mental health disorders.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911115","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":"Treating Presbyphonia in 2024: A Scoping Review.","authors":"Ralph Haddad, Estelle Bogdanski, Alexia Mattei, Justin Michel, Antoine Giovanni","doi":"10.1016/j.jvoice.2024.12.025","DOIUrl":"https://doi.org/10.1016/j.jvoice.2024.12.025","url":null,"abstract":"<p><p>Presbyphonia is a multi-dimensional pathology. Therefore, its treatment should address its different affecting factors, including a global health management to fight geriatric frailty, improve overall physical strength, and limit medication side-effects. The specific therapies should address glottal gap closure and vocal folds' pliability. Based on a literature scoping review, we propose to start with voice therapy, combining different exercises and techniques that can improve voice quality. For patients with high vocal demands or larger glottal gaps, a medialization should be performed with an office-based medialization with hyaluronic acid injection as a first line. This can be associated with office-based injection of platelet rich plasma to improve mucosal vibration.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911118","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":"Translation, Cultural Adaptation, and Validation of the Vietnamese Version of the Vocal Fatigue Index.","authors":"Chau Thi Minh Nguyen, Debra Jean Phyland, Ha Mai Khanh Huynh, Minh Le Thi Binh Nguyen, Truc Thanh Thai","doi":"10.1016/j.jvoice.2024.12.019","DOIUrl":"https://doi.org/10.1016/j.jvoice.2024.12.019","url":null,"abstract":"<p><strong>Objectives: </strong>The Vocal Fatigue Index (VFI) is widely used to identify vocal fatigue, but no Vietnamese version exists. This study aimed to translate the VFI into Vietnamese and evaluate its reliability and validity among primary school teachers in Vietnam.</p><p><strong>Methods: </strong>The VFI was translated using a forward-backward method. A cross-sectional study was conducted with 339 primary school teachers. Internal consistency was assessed using Cronbach's alpha, and test-retest reliability was measured with intra-class correlation coefficients (ICC). Construct validity was evaluated using confirmatory factor analysis (CFA), and criterion validity was assessed using receiver operating characteristic (ROC) analysis, with self-reported voice problems as the reference.</p><p><strong>Results: </strong>The mean age of participants was 39.9 years [standard deviation (SD) = 10.4], and 84.7% were female. Internal consistency was high (Cronbach's alpha = 0.93). Test-retest reliability was also good (ICC = 0.77, P < 0.001). CFA indicated that the three-factor model fit well with the data (Tucker-Lewis Index (TLI) = 0.91, comparative fit index (CFI) = 0.93, root mean squared error of approximation = 0.07, standardized root mean squared residual = 0.05). ROC analysis showed good criterion validity (area under ROC curve (AUC) = 0.80), with a cut-off score of 33 (out of 76) yielding sensitivity of 77.7% and specificity of 69.1%.</p><p><strong>Conclusions: </strong>The Vietnamese version of the VFI demonstrates strong reliability and validity, making it a valuable tool for screening and research in Vietnam. Future studies should extend its use to other populations, including professional voice users.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903992","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":"Letter to the Editor: \"Correlation Between Detection Results of Pepsin in Vocal Fold Polyp Tissues and the Postoperative Efficacy\".","authors":"Sanjeev Yadav","doi":"10.1016/j.jvoice.2024.11.030","DOIUrl":"https://doi.org/10.1016/j.jvoice.2024.11.030","url":null,"abstract":"","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899712","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}