Journal of Clinical Sleep Medicine最新文献

{"title":"Cutting the weight, restoring the breath: bariatric surgery in obesity hypoventilation syndrome.","authors":"Nathan C Nowalk, Maria Paola Arellano-Maric, Babak Mokhlesi","doi":"10.5664/jcsm.11830","DOIUrl":"10.5664/jcsm.11830","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1651-1653"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nocturnal cerebral oxygenation in patients with COPD at altitude: data from a randomized clinical trial of acetazolamide.","authors":"Yaël A Schmuziger, Maamed Mademilov, Aline Buergin, Philipp M Scheiwiller, Laura Mayer, Simon R Schneider, Mona Lichtblau, Konstantinos Bitos, Lara Muralt, Julian Müller, Azamat Akylbekov, Gulzada Mirzalieva, Talant M Sooronbaev, Silvia Ulrich, Konrad E Bloch, Michael Furian","doi":"10.5664/jcsm.11868","DOIUrl":"https://doi.org/10.5664/jcsm.11868","url":null,"abstract":"<p><strong>Study objectives: </strong>Patients with chronic obstructive pulmonary disease (COPD) may experience cerebral tissue deoxygenation during altitude travel, especially during sleep. We quantified nocturnal cerebral (CTO) and arterial oxygenation (SpO₂) in patients with COPD during a stay at 3100 meters and evaluated the effects of preventive acetazolamide therapy.</p><p><strong>Methods: </strong>Patients with moderate to severe COPD, living < 800 meters, underwent nocturnal pulse oximetry and cerebral tissue oximetry by near-infrared spectroscopy at 760 meters and during the first night at 3100 meters. Patients were randomized to 375 mg/day acetazolamide or placebo starting 24 hours before ascent and while staying at 3100 meters. Altitude and acetazolamide effects on CTO and other outcomes were evaluated by mixed linear regression analysis.</p><p><strong>Results: </strong>Forty-three patients, 9 female, mean±SD age 55.4±8.9 years, FEV₁ 60±13% predicted, were included in the analysis. When ascending from 760 to 3100 meters taking placebo (N=17), CTO and SpO₂ decreased from 66.5±1.0% to 63.4±1.0% (P<0.05) and from 90.8±0.4% to 83.7±0.4% (P<0.05), respectively; cerebral (cODI) and arterial (aODI) oxygen desaturation indices (≥4% dips in CTO or SpO₂, respectively) increased by a mean(95%CI) of 6.2/h (4.0 to 8.5) and 19.5/h (13.2 to 25.9); (P<0.05). Compared to placebo, the mean CTO (+2.3% [2.2 to 2.5]) and SpO₂ (+2.1% [2.1 to 2.2]) were higher and the mean cODI (-4.4/h [-7.3 to -1.5]) and aODI (-15.0/h [-23.1 to -6.9]) were lower in the acetazolamide group, P<0.05 all effects.</p><p><strong>Conclusions: </strong>Patients with COPD travelling to 3100 meters experienced sustained and intermittent nocturnal cerebral deoxygenation related to hypoxemia. Acetazolamide mitigated these altitude-related deoxygenations, albeit not to lowland values.</p><p><strong>Clinical trial registration: </strong>Registry: ClinicalTrials.gov; Identifier: NCT03156231.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbid insomnia and sleep apnea (COMISA) is associated with worse verbal episodic memory in older women.","authors":"Breanna M Holloway, Christian D Harding, Pamela DeYoung, Crystal G Kwan, Lanna Avetisyan, Kitty K Lui, Sonia Ancoli-Israel, Sarah J Banks, Ina Djonlagic, Atul Malhotra","doi":"10.5664/jcsm.11902","DOIUrl":"https://doi.org/10.5664/jcsm.11902","url":null,"abstract":"<p><strong>Study objectives: </strong>To investigate whether comorbid insomnia and sleep apnea (COMISA) is associated with poor verbal memory in older adults, and whether this relationship is moderated by sex.</p><p><strong>Methods: </strong>110 older adults aged (65-83), all diagnosed with OSA, completed overnight polysomnography and cognitive testing. COMISA was defined as OSA plus an Insomnia Severity Index score ≥ 11. Verbal memory was assessed via the delayed recall component of the ADCS-PACC. Moderation analysis examined the interaction between COMISA and sex on verbal memory performance, adjusting for age, body mass index, <i>APOE</i>4 status, and education. Post hoc sleep architecture differences between men and women with COMISA and women with COMISA compared to OSA only were analyzed using MANCOVA.</p><p><strong>Results: </strong>COMISA was associated with significantly worse verbal memory performance, with this effect driven by women (<i>b</i>=-2.82, SE=0.94, <i>t</i>=-3.01, <i>p</i>=0.003) and absent in men (<i>b</i>=0.62, SE=0.97, <i>t</i>=0.63, <i>p</i>=0.528). Post hoc analyses revealed that women with COMISA showed reduced REM sleep and increased SWS compared to men with COMISA.</p><p><strong>Conclusions: </strong>COMISA is linked to sex-specific cognitive vulnerability, with older women showing worse verbal memory than men. Post hoc analyses revealed differences in sleep architecture by sex within COMISA, warranting further investigation into stage-specific sleep contributions to cognitive risk. These findings highlight the importance of sex-informed approaches to assessing and managing cognitive risk in aging populations.</p><p><strong>Clinical trial registration: </strong>Registry: ClinicalTrials.gov; Name: Is Obstructive Sleep Apnea Important in the Development of Alzheimer's Disease?; Identifier: NCT05094271; URL: https://clinicaltrials.gov/study/NCT05094271.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classifying hypopneas as obstructive or central can enhance transvenous phrenic nerve stimulation therapy patient selection and outcomes.","authors":"Kara Dupuy-McCauley, Alan R Schwartz, Shahrokh Javaheri, Robin Germany, Scott McKane, Timothy I Morgenthaler","doi":"10.5664/jcsm.11904","DOIUrl":"https://doi.org/10.5664/jcsm.11904","url":null,"abstract":"<p><strong>Study objectives: </strong>While not all sleep laboratories distinguish between obstructive and central hypopneas, recent research suggests that patients may receive an incorrect primary diagnosis without this effort. The remedē System Pivotal Trial studied transvenous phrenic nerve stimulation in patients with moderate-to-severe central sleep apnea (CSA). Entry criteria required apnea-hypopnea index (AHI) ≥ 20 with central apnea index greater than obstructive apnea index and obstructive apneas < 20% of AHI but did not classify hypopneas. This analysis re-examined sleep studies from the trial to assess hypopnea classification impact on candidacy and treatment outcomes.</p><p><strong>Methods: </strong>Hypopneas were classified as central versus obstructive by a sleep core laboratory following a modified version of AASM recommended criteria. AHI composition was assessed pre/post treatment.</p><p><strong>Results: </strong>At baseline, 91% (138/151) of patients had ≥ 50% of events classified as central accounting for hypopnea classification. If all hypopneas were assumed obstructive, only 63% (95/151) would have had ≥ 50% central events. The likelihood of achieving ≥ 50% AHI reduction increased with the percentage of baseline events that were central: responder rates were 37.5% for patients with < 50% central events, incrementally increasing to 76.5% for those with ≥ 90% central events. At 6 months, residual AHI predominantly consisted of obstructive hypopneas. Central events decreased by 89% with treatment (baseline median 32 events/h). Obstructive apneas and hypopneas increased by 2 events/h and 3 events/h, respectively.</p><p><strong>Conclusions: </strong>Distinguishing central from obstructive hypopneas is required to accurately determine the proportion of central and obstructive breathing events, and is crucial for appropriate therapy selection and managing patient expectations about treatment outcomes.</p><p><strong>Clinical trial registration: </strong>Registry: ClinicalTrials.gov; Identifier: NCT01816776.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of V̇-Com on chinstrap usage and study completion rates during CPAP titration.","authors":"Ludovico Messineo, Carmen Keasling, Bryan Hughes, Bernard Hete, Gabriel Tallent, Robert J Farney, William H Noah","doi":"10.5664/jcsm.11900","DOIUrl":"https://doi.org/10.5664/jcsm.11900","url":null,"abstract":"<p><strong>Study objectives: </strong>Mouth leak during continuous positive airway pressure (CPAP) therapy is a common barrier to tolerability and adherence and is often managed with chinstraps. Here we investigated whether V̇-Com, a device that reduces inspiratory pressure by adding non-compensated resistance into the CPAP circuit, could lower the <i>chinstrap usage rate</i> during in-laboratory titration. Additionally, we tested the effect of V̇-Com on <i>study abortion rate</i> due to CPAP intolerance.</p><p><strong>Methods: </strong>We conducted a retrospective study of in-laboratory CPAP titrations performed at a multi-site sleep center. Mouth leak was identified based on ventilator-reported leak (>30 L/min), visual observation of mouth opening, or characteristic alterations in the flow signal. V̇-Com was added as a first-line intervention when mouth leak was detected. If V̇-Com proved ineffective, it was removed, and a chinstrap was utilized. Similarly, V̇-Com was used in the attempt to salvage studies that were otherwise going to be aborted due to PAP intolerance.</p><p><strong>Results: </strong>Among 1,632 titrations, 190 patients (12%) experienced mouth leak and 46 individuals requested to abort their titration due to PAP intolerance (3%). V̇-Com reduced the <i>chinstrap usage rate</i> by 68% and the <i>study abortion rate</i> by 91%. In sensitivity analysis modeling hypothetical placebo response rates, the number needed to treat to avoid chinstrap use in one additional participant remained as low as 5, even under conservative assumptions.</p><p><strong>Conclusions: </strong>V̇-Com was associated with reduced chinstrap use and fewer aborted studies during CPAP titration. This suggests that V̇-Com may serve as a useful tool to improve pressure tolerance and leak management.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underestimation of nocturnal sleep duration in central disorders of hypersomnolence: an underrecognized feature?","authors":"Samantha Mombelli, Anne-Sophie Deshaies-Rugama, Hélène Blais, Cynthia Thompson, MiaClaude Massicotte, Alex Desautels, Jacques Montplaisir, Milan Nigam, Christophe Moderie, Lucie Barateau, Yves Dauvilliers, Julie Carrier, Nadia Gosselin","doi":"10.5664/jcsm.11896","DOIUrl":"https://doi.org/10.5664/jcsm.11896","url":null,"abstract":"<p><strong>Study objectives: </strong>Sleep misperception is well-documented in insomnia but remains understudied in central disorders of hypersomnolence (CDH). This study aimed to examine 1) total sleep time (TST) misperception in CDH and healthy controls, 2) the prevalence of accurate estimators, underestimators, and overestimators, and 3) the relationship between misperception and polysomnography (PSG) fragmentation variables.</p><p><strong>Methods: </strong>We included 420 adults with CDH (38 narcolepsy type 1-NT1, 52 narcolepsy type 2-NT2, 192 idiopathic hypersomnia-IH, 138 non-specified hypersomnia-NSH) and 86 healthy controls te0sted in Montreal, Canada. A replication cohort from a National Reference Center in France (n = 182; 79 NT1, 13 NT2, 35 IH, 55 NSH) was also analyzed. Participants underwent full-night PSGs, multiple sleep latency tests, and clinical interviews. TST misperception was defined as the ratio between self-reported to objective TST. Group comparisons were performed using ANCOVA adjusting for age and sex, and chi-square tests. Partial correlations were conducted to explore relationships between sleep fragmentation and TST misperception.</p><p><strong>Results: </strong>In the Canadian cohort, all CDH subgroups underestimated their TST relative to controls (p < 0.001). The highest underestimation rates occurred in NT1 (44.7%) and IH (26.6%), while the lowest was observed in healthy controls (11.6%). The French cohort confirmed the absence of significant differences in TST misperception between CDH subgroups. No correlations were found between PSG fragmentation variables and TST misperception.</p><p><strong>Conclusions: </strong>Underestimation of nocturnal TST is common in adults with CDH and may complicate clinical assessment. These findings underscore the importance of integrating objective sleep measures when evaluating patients with hypersomnolence.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of mouth tape for CPAP use in mouth breathing patients with OSA.","authors":"Avika Meksukree, Sirincha Pitipanyakul, Wasin Laohavinij, Busarakam Chaitusaney, Naricha Chirakalwasan, Prakobkiat Hirunwiwatkul, Natamon Charakorn","doi":"10.5664/jcsm.11870","DOIUrl":"https://doi.org/10.5664/jcsm.11870","url":null,"abstract":"<p><strong>Study objectives: </strong>To assess the use of mouth tape in patients with mouth breathing during continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA), focusing on CPAP adherence. Additional outcomes included daytime sleepiness (Epworth Sleepiness Scale (ESS)), snoring (visual analog scale (VAS)), night awakenings, mouth/throat dryness, leakage, and adverse effects.</p><p><strong>Methods: </strong>This randomized crossover study compared CPAP adherence with and without silicone hypoallergenic mouth tape. Participants used each intervention for 30 days, separated by a one-week washout period. After each period, CPAP data (adherence, apnea-hypopnea index (AHI), leakage) and questionnaires were retrieved.</p><p><strong>Results: </strong>Sixty-two patients with OSA (36 males; AHI (mean ± standard deviation), 45.8 ± 22.2 events/h; age, 57.7 ± 17.6 years; BMI, 27.9 ± 7.1 kg/m²) were randomized. Participants using mouth tape, compared to those without, showed better CPAP adherence: average use increased by 51.8 minutes per day (95% CI, 33.1 to 70.4) and by 41.4 minutes per used day (95% CI, 27.9 to 55.0). Frequency of use increased by 14.2% (95% CI, 9.3 to 19.0), with 17.6% more days reaching ≥4 hours/night (95% CI, 12.7 to 22.6). Good adherence increased with an odds ratio of 4.5. Mouth tape statistically improved ESS, snoring VAS, mouth/throat dryness, and night awakenings. Adverse effects were reported.</p><p><strong>Conclusions: </strong>Using mouth tape in patients with mouth breathing during CPAP improved CPAP adherence in both duration and frequency. Unfavorable symptoms related to OSA, or CPAP were alleviated, leading to better sleep quality.</p><p><strong>Clinical trial registry: </strong>Registry: Thai Clinical Trials Registry; Title: The role of mouth tape for continuous positive airway pressure in obstructive sleep apnea; Identifier: TCTR20250425002; URL: www.thaiclinicaltrials.org/show/TCTR20250425002.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do we mitigate the challenges of pulse oximetry in the assessment of sleep-disordered breathing? Knowledge and innovation addressing skin tone variability.","authors":"Andrew M Namen, April Wright, Jocelyn Y Cheng, Sarah D Hashmi, Muhammad A Rishi","doi":"10.5664/jcsm.11884","DOIUrl":"https://doi.org/10.5664/jcsm.11884","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of socioeconomic disparities on CPAP adherence.","authors":"Samuel R Shing, Nicole Molin, Jefferson DeKloe, Natalie M Perlov, Erin W Creighton, Maurits S Boon, Colin T Huntley, Ritu G Grewal","doi":"10.5664/jcsm.11874","DOIUrl":"https://doi.org/10.5664/jcsm.11874","url":null,"abstract":"<p><strong>Study objectives: </strong>Socioeconomic disparities are known to have a significant impact on health outcomes including those related to obstructive sleep apnea (OSA). More recently, a metric known as area deprivation index (ADI), which combines 17 social determinants of health, has been used to better quantify this impact. We aim to examine the relationship between socioeconomic disparities and continuous positive airway pressure (CPAP) adherence among adults with OSA using ADI.</p><p><strong>Methods: </strong>A retrospective study of patients with diagnosis of OSA and prescribed CPAP from October-December 2022 was performed. Patients were divided into more- or less-socioeconomically disadvantaged groups based on ADI, as well as social vulnerability index (SVI), which captures high school diploma rates. 30-day, 6-month, and 12-month CPAP adherence and follow-up rates were collected and compared across ADI/SVI quartiles.</p><p><strong>Results: </strong>536 patients met inclusion criteria. Patients from the most deprived areas (highest ADI) had significantly lower CPAP adherence than those from least deprived areas at all timepoints (<i>P</i><0.05). Patients from areas with lower high school diploma rates had lower CPAP adherence (<i>P</i><0.05).</p><p><strong>Conclusions: </strong>Socioeconomic disparities appear to have a significant impact on CPAP adherence. People from areas that are more deprived and with lower high school diploma rates have lower therapy adherence rates. Patients within these groups may benefit from additional resources and/or closer follow up to improve adherence with treatment.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality measures for care of patients with restless legs syndrome: 2025 update after measure maintenance.","authors":"Robin M Lloyd, T'Auna Crawford, Ryan Donald, Diedra D Gray, William J Healy, Mithri R Junna, Daniel Lewin, Amee Revana, Sharon Schutte-Rodin","doi":"10.5664/jcsm.11894","DOIUrl":"https://doi.org/10.5664/jcsm.11894","url":null,"abstract":"<p><p>Restless legs syndrome (RLS), also called Willis-Ekbom disease, is a neurological disorder marked by a strong, uncontrollable urge to move the legs, often paired with unpleasant or uncomfortable sensations. To address gaps and variations in care in this patient population, the American Academy of Sleep Medicine (AASM) Quality Measures Task Force (Task Force) performed quality measure maintenance on the quality measures for the care of adult patients with restless legs syndrome (originally developed in 2015). The Task Force conducted a comprehensive review of current medical literature, including updated clinical practice guidelines, systematic literature reviews, existing quality measures for restless legs syndrome, and performance data to identify ongoing gaps and variations in care since the implementation of the original quality measure set and to inform potential revisions.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}