Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Commentary: Acute type A dissection with malperfusion syndrome: Start your stopwatch?","authors":"Gardner Yost MD, MS , David Williams MD , Bo Yang MD, PhD","doi":"10.1016/j.jtcvs.2024.02.019","DOIUrl":"10.1016/j.jtcvs.2024.02.019","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 574-575"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can we safely expand the donation after circulatory death donor heart pool by extending the donor age limit?","authors":"Yeahwa Hong MD, PhD,&nbsp;Nicholas R. Hess MD,&nbsp;Luke A. Ziegler BA,&nbsp;Danny Chu MD,&nbsp;Pyongsoo D. Yoon MD,&nbsp;Johannes O. Bonatti MD,&nbsp;Derek R. Serna-Gallegos MD,&nbsp;Ibrahim Sultan MD,&nbsp;David J. Kaczorowski MD","doi":"10.1016/j.jtcvs.2024.04.008","DOIUrl":"10.1016/j.jtcvs.2024.04.008","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluates the impact of donor age on outcomes following donation after circulatory death heart transplantation.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing registry was queried to analyze adult recipients who underwent isolated donation after circulatory heart transplantation from January 1, 2019, to September 30, 2023. The cohort was stratified into 2 groups according to donor age, where advanced donor age was defined as 40 years or more. Outcomes were 90-day and 1-year post-transplant survival. Propensity score matching was performed. Subgroup analysis was performed to evaluate the effects of recipient age on 90-day survival among the recipients with advanced-age donors.</div></div><div><h3>Results</h3><div>A total of 994 recipients were included in the study period, and 161 patients (17.1%) received allografts from advanced-age donors. During the study period, the annual incidence of donation after circulatory heart transplantation with advanced-age donors substantially increased. The recipients with advanced-age donors had similar 90-day and 1-year post-transplant survivals compared with the recipients with younger donors. The comparable 90-day survival persisted in a propensity score–matched comparison. In the subgroup analysis among the recipients with advanced-age donors, the recipients aged 60 years or more had significantly reduced 90-day survival compared with the recipients aged less than 60 years.</div></div><div><h3>Conclusions</h3><div>The use of appropriately selected donation after circulatory donors aged 40 years or more has similar survival compared with that of younger donors. With careful candidate risk stratification and selection, consideration of using donation after circulatory donors aged more than 40 years may further ameliorate ongoing organ shortage with comparable early post-transplant outcomes.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 658-666.e3"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140832603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-risk features associated with recurrence in stage I lung adenocarcinoma","authors":"Cameron N. Fick MD ,&nbsp;Elizabeth G. Dunne MD ,&nbsp;Stijn Vanstraelen MD ,&nbsp;Nicolas Toumbacaris MSPH ,&nbsp;Kay See Tan PhD ,&nbsp;Gaetano Rocco MD ,&nbsp;Daniela Molena MD ,&nbsp;James Huang MD ,&nbsp;Bernard J. Park MD ,&nbsp;Natasha Rekhtman MD, PhD ,&nbsp;William D. Travis MD ,&nbsp;Jamie E. Chaft MD ,&nbsp;Matthew J. Bott MD ,&nbsp;Valerie W. Rusch MD ,&nbsp;Prasad S. Adusumilli MD ,&nbsp;Smita Sihag MD ,&nbsp;James M. Isbell MD ,&nbsp;David R. Jones MD","doi":"10.1016/j.jtcvs.2024.05.009","DOIUrl":"10.1016/j.jtcvs.2024.05.009","url":null,"abstract":"<div><h3>Objective</h3><div>There is a lack of knowledge regarding the use of prognostic features in stage I lung adenocarcinoma (LUAD). Thus, we investigated clinicopathologic features associated with recurrence after complete resection for stage I LUAD.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of patients with pathologic stage I LUAD who underwent R0 resection from 2010 to 2020. Exclusion criteria included history of lung cancer, induction or adjuvant therapy, noninvasive or mucinous LUAD, and death within 90 days of surgery. Fine and Gray competing-risk regression assessed associations between clinicopathologic features and disease recurrence.</div></div><div><h3>Results</h3><div><span><span><span>In total, 1912 patients met inclusion criteria. Most patients (1565 [82%]) had stage IA LUAD, and 250 developed recurrence: 141 (56%) distant and 109 (44%) locoregional only. The 5-year cumulative incidence of recurrence was 12% (95% CI, 11%-14%). Higher maximum standardized uptake value of the </span>primary tumor (hazard ratio [HR], 1.04), sublobar resection (HR, 2.04), higher International Association for the Study of Lung Cancer grade (HR, 5.32 [grade 2]; HR, 7.93 [grade 3]), </span>lymphovascular invasion (HR, 1.70), visceral pleural invasion (HR, 1.54), and tumor size (HR, 1.30) were independently associated with a hazard of recurrence. Tumors with 3 to 4 high-risk features had a higher cumulative incidence of recurrence at 5 years than tumors without these features (30% vs 4%; </span><em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Recurrence after resection for stage I LUAD remains an issue for select patients. Commonly reported clinicopathologic features can be used to define patients at high risk of recurrence and should be considered when assessing the prognosis of patients with stage I disease.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 436-444.e6"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A measurement of eco-friendly, sustainable significance","authors":"Gaetano Rocco MD","doi":"10.1016/j.jtcvs.2024.06.003","DOIUrl":"10.1016/j.jtcvs.2024.06.003","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 466-468"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolut explant, Y annuloplasty, and surgical aortic valve replacement: Tips and tricks","authors":"Marvin D. Atkins MD,&nbsp;Yuncen A. He MD,&nbsp;Michael J. Reardon MD","doi":"10.1016/j.jtcvs.2024.01.001","DOIUrl":"10.1016/j.jtcvs.2024.01.001","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages e14-e16"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choice of revascularization strategy for ischemic cardiomyopathy due to multivessel coronary disease","authors":"Anas H. Alzahrani MD, MPH ,&nbsp;Shinobu Itagaki MD, MSc ,&nbsp;Natalia N. Egorova PhD, MPH ,&nbsp;Joanna Chikwe MD","doi":"10.1016/j.jtcvs.2024.03.007","DOIUrl":"10.1016/j.jtcvs.2024.03.007","url":null,"abstract":"<div><h3>Objective</h3><div>Limited comparative data guide the decision between coronary artery bypass grafting<span><span> and percutaneous coronary intervention for multivessel revascularization in </span>ischemic cardiomyopathy<span>. The study objective was to compare the long-term outcomes of coronary artery bypass grafting and percutaneous coronary intervention for ischemic cardiomyopathy.</span></span></div></div><div><h3>Methods</h3><div>Clinical registries from the New Jersey Department of Health linked to administrative databases were used to compare all-cause mortality, repeat revascularization, heart failure readmissions, myocardial infarction, and stroke using Cox proportional hazards and propensity matching with competing risk analysis in 5988 patients with ejection fraction<span> 35% or less who underwent coronary artery bypass grafting (3673, 61.3%) or percutaneous coronary intervention (2315, 38.6%) for multivessel coronary disease between 2007 and 2018. Median follow-up time was 5.2 years (range, 0-13 years); the last follow-up date was December 31, 2020.</span></div></div><div><h3>Results</h3><div>After controlling for completeness of revascularization, at 13 years, mortality was 57% (95% CI, 51-63) after percutaneous coronary intervention and 60% (95% CI, 53-66) after coronary artery bypass grafting (hazard ratio [HR], 1.10; 95% CI, 0.93-1.31; <em>P</em> = .28); risk of repeat revascularization was 18% for percutaneous coronary intervention versus 14% for coronary artery bypass grafting (HR, 1.62; 95% CI, 1.17-2.25; <em>P</em> = .003); risk of readmission for heart failure was 16% after percutaneous coronary intervention and coronary artery bypass grafting (HR, 1.13,95% CI, 0.84-1.51, weighted <em>P</em> = .10); risk of myocardial infarction was 10% versus 6%, respectively (HR, 1.91; 95% CI, 1.18-3.09; <em>P</em> = .007); and stroke risk was 3% versus 4%, respectively (HR, 0.79; 95% CI, 0.41-1.53; <em>P</em> = .52). Rate of complete revascularization was lower after percutaneous coronary intervention than after coronary artery bypass grafting and associated with higher mortality after percutaneous coronary intervention (HR, 1.35; 95% CI, 1.20-1.52; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Coronary bypass was associated with similar mortality, stroke, and heart failure readmissions, and reduced repeat revascularization compared with percutaneous coronary intervention in patients with ischemic cardiomyopathy if similar rates of complete revascularization were achieved. These findings support consensus recommendations for coronary artery bypass grafting and medical therapy in patients with multivessel coronary disease<span> and left ventricular dysfunction.</span></div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 639-647.e21"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140141035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of extracardiac Fontan operation: A single institution experience with 398 patients","authors":"Shuta Ishigami MD, PhD ,&nbsp;Gregory King MD, PhD ,&nbsp;Edward Buratto MBBS, PhD, FRACS ,&nbsp;Tyson A. Fricke MBBS, PhD, FRACS ,&nbsp;Robert G. Weintraub MBBS, FRACP, FACC, FCSANZ ,&nbsp;Christian P. Brizard MD, MS ,&nbsp;Igor E. Konstantinov MD, PhD, FRACS","doi":"10.1016/j.jtcvs.2024.05.030","DOIUrl":"10.1016/j.jtcvs.2024.05.030","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to evaluate the outcomes of the extracardiac Fontan operation at a single institution.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of 398 patients from a single institution who underwent their initial extracardiac Fontan operation between 1997 and 2020. We determined the incidence of and risk factors for failure of the Fontan circulation, which includes death, Fontan takedown, heart transplantation<span>, protein-losing enteropathy, plastic bronchitis<span>, and functional status at the last follow-up.</span></span></div></div><div><h3>Results</h3><div><span>The median follow-up time was 10.3 years (interquartile range, 6.4-14.6). The overall survival was 96% and 86% at 10 and 20 years after extracardiac Fontan operation, respectively. There were 6 early deaths (6/398, 1.5%) and 15 late deaths (15/398, 3.8%). Forty-nine patients (12.5%) developed failure of the Fontan circulation. Freedom from the failure of Fontan circulation was 88% at 10 years and 76% at 20 years. Risk factors for failure of the Fontan circulation were right ventricular dominance (hazard ratio, 4.7; </span><em>P</em><span> &lt; .001; 95% CI, 2.1-10.5), aortic atresia (hazard ratio, 5.5; </span><em>P</em><span> &lt; .001; 95% CI, 2.3-12.8), and elevated mean pulmonary artery pressure (hazard ratio, 2.3; </span><em>P</em> = .002; 95% CI, 1.2-6.7).</div></div><div><h3>Conclusions</h3><div>Rates of failure of the Fontan circulation are low after the contemporary extracardiac Fontan operation. Risk factors for failure of the extracardiac Fontan circulation include right ventricular dominance, aortic atresia, and elevated pulmonary artery pressures.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 400-410.e7"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative exercise training decreases complications of minimally invasive lung cancer surgery: A randomized controlled trial","authors":"Nanjiang Zhou MD ,&nbsp;Jeffrey W. Ripley-Gonzalez MSc ,&nbsp;Wenliang Zhang MD, PhD ,&nbsp;Kangling Xie MD, PhD ,&nbsp;Baiyang You MD, PhD ,&nbsp;Yanan Shen MMed ,&nbsp;Zeng Cao MPT ,&nbsp;Ling Qiu MD ,&nbsp;Cui Li MD ,&nbsp;Siqian Fu MD ,&nbsp;Chunfang Zhang MD, PhD ,&nbsp;Yaoshan Dun MMed, PhD ,&nbsp;Yang Gao MD, PhD ,&nbsp;Suixin Liu MD, PhD","doi":"10.1016/j.jtcvs.2024.04.009","DOIUrl":"10.1016/j.jtcvs.2024.04.009","url":null,"abstract":"<div><h3>Objective</h3><div>Limited evidence exists regarding the efficacy of preoperative exercise in reducing short-term complications after minimally invasive surgery<span> in patients with non–small cell lung cancer. This study aims to investigate the impact of preoperative exercise on short-term complications after minimally invasive lung resection.</span></div></div><div><h3>Methods</h3><div>In this prospective, open-label, randomized (1:1) controlled trial at Xiangya Hospital, China (September 2020 to February 2022), patients were randomly assigned to a preoperative exercise group with 16-day alternate supervised exercise or a control group. The primary outcome assessed was short-term postoperative complications, with a follow-up period of 30 days postsurgery.</div></div><div><h3>Results</h3><div><span>A total of 124 patients were recruited (preoperative exercise group n = 62; control n = 62). Finally, 101 patients (preoperative exercise group; n = 51 and control; n = 50) with a median age of 56 years (interquartile range, 50-62 years) completed the study. Compared with the control group, the preoperative exercise group showed fewer postoperative complications (preoperative exercise 3/51 vs control 10/50; odds ratio, 0.17; 95% CI, 0.04-0.86; </span><em>P</em> = .03) and shorter hospital stays (mean difference, −2; 95% CI, −3 to −1; <em>P</em><span><span> = .01). Preoperative exercise significantly improved depression, stress, functional capacity, and </span>quality of life (all </span><em>P</em><span> &lt; .05) before surgery. Furthermore, preoperative exercise demonstrated a significantly lower minimum blood pressure during surgery and lower increases in body temperature on day 2 after surgery, neutrophil-to-lymphocyte ratio, and neutrophil count after surgery (all </span><em>P</em><span> &lt; .05). Exploratory research on lung tissue RNA sequencing<span> (5 in each group) showed downregulation of the tumor necrosis factor<span> signaling pathway in the preoperative exercise group compared with the control group.</span></span></span></div></div><div><h3>Conclusions</h3><div>Preoperative exercise training decreased short-term postoperative complications in patients with non–small cell lung cancer.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 516-528.e10"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Coarctation and hypertension dilemma unsolved","authors":"Mohamad Alaeddine MD","doi":"10.1016/j.jtcvs.2024.09.044","DOIUrl":"10.1016/j.jtcvs.2024.09.044","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Page 353"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age is superior to aortopathy phenotype as a predictor of aortic mechanics in patients with bicuspid valve","authors":"Matthew A. Thompson BS, BA ,&nbsp;Benjamin Kramer DO, MS ,&nbsp;Samar A. Tarraf PhD ,&nbsp;Emily Vianna MD ,&nbsp;Callan Gillespie MS ,&nbsp;Emidio Germano MD ,&nbsp;Brett Gentle DO ,&nbsp;Frank Cikach MD ,&nbsp;Ashley M. Lowry MS ,&nbsp;Amol Pande PhD ,&nbsp;Eugene Blackstone MD ,&nbsp;Jennifer Hargrave DO ,&nbsp;Robb Colbrunn PhD ,&nbsp;Chiara Bellini PhD ,&nbsp;Eric E. Roselli MD","doi":"10.1016/j.jtcvs.2023.12.018","DOIUrl":"10.1016/j.jtcvs.2023.12.018","url":null,"abstract":"<div><h3>Objectives</h3><div>Bicuspid aortic valve<span> (BAV) aortopathy is defined by 3 phenotypes—root, ascending, and diffuse—based on region of maximal aortic dilation. We sought to determine the association between aortic mechanical behavior and aortopathy phenotype versus other clinical variables.</span></div></div><div><h3>Methods</h3><div><span>From August 1, 2016, to March 1, 2023, 375 aortic specimens were collected from 105 patients undergoing elective ascending aortic aneurysm repair for BAV aortopathy. Planar biaxial data (191 specimens) informed constitutive descriptors of the arterial wall that were combined with in vivo geometry and </span>hemodynamics to predict stiffness, stress, and energy density under physiologic loads. Uniaxial testing (184 specimens) evaluated failure stretch and failure Cauchy stress. Boosting regression was implemented to model the association between clinical variables and mechanical metrics.</div></div><div><h3>Results</h3><div>There were no significant differences in mechanical metrics between the root phenotype (N = 33, 31%) and ascending/diffuse phenotypes (N = 72, 69%). Biaxial testing demonstrated older age was associated with increased circumferential stiffness, decreased stress, and decreased energy density. On uniaxial testing, longitudinally versus circumferentially oriented specimens failed at significantly lower Cauchy stress (50th [15th, 85th percentiles]: 1.0 [0.7, 1.6] MPa vs 1.9 [1.3, 3.1] MPa; <em>P</em><span> &lt; .001). Age was associated with decreased failure stretch and stress. Elongated ascending aortas were also associated with decreased failure stress.</span></div></div><div><h3>Conclusions</h3><div>Aortic mechanical function under physiologic and failure conditions in BAV aortopathy is robustly associated with age and poorly associated with aortopathy phenotype. Data suggesting that the root phenotype of BAV aortopathy portends worse outcomes are unlikely to be related to aberrant, phenotype-specific tissue mechanics.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 531-541.e4"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139054360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}