Nephrologie & Therapeutique最新文献

{"title":"Améliorer l’accès à la transplantation rénale des sujets hyperimmunisés : quelle place pour un blocage de la voie de l’IL-6 dans les protocoles de désimmunisation ?","authors":"Jules Weinhard ,&nbsp;Johan Noble ,&nbsp;Thomas Jouve ,&nbsp;Paolo Malvezzi ,&nbsp;Lionel Rostaing","doi":"10.1016/j.nephro.2022.07.402","DOIUrl":"10.1016/j.nephro.2022.07.402","url":null,"abstract":"<div><h3>Background</h3><p>Desensitization allows kidney transplantation for HLA highly sensitized subjects. Due to the central role of IL-6 in immunological response, tocilizumab (monoclonal antibody directed against IL-6 receptor) could probably improve desensitization efficacy.</p></div><div><h3>Methods</h3><p>Pubmed systematic review by using <em>MeSH</em> terms: tocilizumab, clazakizumab, interleukin-6 blockade, kidney transplantation, kidney graft and desensitization.</p></div><div><h3>Studies</h3><p>IL-6 plays a role in humoral response (plasmocyte differentiation induced by lymphocyte T, IL-21 secretion) as well as in cellular response (differentiation of LT Th17 rather than T reg). In desensitization field, tocilizumab was first studied as second-line treatment after failing of standard-of-care (apheresis, rituximab ± IgIV). Recent study showed that tocilizumab as a monotherapy attenuated anti-HLA antibodies rates but was not sufficient to allow transplantation. However, lymphocyte immunophenotyping showed that tocilizumab hindered B cells maturation. Thereby, tocilizumab could improve long-term efficacy of desensitization, by limiting the anti-HLA rebound and so avoiding antibody-mediated rejection. This hypothesis is supported by a recent study which used clazakizumab (monoclonal antibody directed against IL-6) in association with standard-of-care. In that study, clazakizumab was continued after kidney transplantation. Results were encouraging because 9/10 patients were transplanted and there was no donor-specific antibody at 6 months post-transplantation.</p></div><div><h3>Conclusion</h3><p>IL-6 pathway blockade as a monotherapy fails to desensitize HLA highly sensitized kidney transplant candidates. In association with standard-of-care, it does not seem to significatively improve kidney allograft access (short-term efficacy) vs. standard-of-care only. However, it could improve long-term prognosis of HLA incompatible transplantation by orienting the response towards a tolerogenic profile, by hindering B-cell maturation and, thereby, avoiding DSA rebounds after transplantation. This hypothesis needs to be proven by further studies.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 577-583"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10700724","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":"Association entre l’inscription sur liste d’attente de donneur à cœur arrêté contrôlé Maastricht III et le temps d’attente avant la transplantation rénale dans un centre français","authors":"Vivien Petit ,&nbsp;Remi Lenain ,&nbsp;Florence Debillon ,&nbsp;Marc Hazzan ,&nbsp;François Provot","doi":"10.1016/j.nephro.2022.09.002","DOIUrl":"10.1016/j.nephro.2022.09.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Transplantation from controlled donation after circulatory determination of death (cDCD) is a new practice in France. An additional specific consent is required for registration on the cDCD waiting list. The aim of this study is to evaluate the impact of cDCD acceptance on the waiting time for the registered patients on the transplant list.</p></div><div><h3>Methods</h3><p>Patients registered on the kidney transplant waiting list for a Death Brain Donor (DBD) kidney transplant between 2018 and 2019 in our center were included. Patients who were candidates for a second kidney transplant or who had already received an organ transplant were not included. The cDCD waiting list registration was authorized by a signed consent of the patient on the day of DBD registration. The primary endpoint was time to renal transplantation.</p></div><div><h3>Results</h3><p>Of the 315 patients eligible for a cDCD graft at transplant list registration, 152 were registered on the cDCD waiting list. Time to transplantation for these patients was multiplied by 1.42 (95%CI 1.07–1.87) compared with patients not registered for a cDCD graft. The time to transplantation was 2.59 months (95%CI 0.49–4.69) shorter for a 2-year follow-up for cDCD-listed patients. This represents one additional transplant at 6 months for every seven registered patients.</p></div><div><h3>Conclusion</h3><p>cDCD waiting list registration reduced the time to kidney transplantation in France.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 604-610"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10343829","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":"Piège diagnostique : neurotoxicité au lithium avec lithémie normale","authors":"Hugo Tiv ,&nbsp;Antoine Vandelaer ,&nbsp;Pierre Delanaye ,&nbsp;Florence Forte ,&nbsp;Antoine Bouquegneau","doi":"10.1016/j.nephro.2022.07.398","DOIUrl":"10.1016/j.nephro.2022.07.398","url":null,"abstract":"<div><p>We describe here the case of a 54-year-old bipolar woman, followed in psychiatry and treated with lithium and a selective serotonin reuptake inhibitor (escitalopram) and lamotrigine, presenting a lithium poisoning with an altered state of consciousness caused by a supposed mismanagement of her treatment. Lithium poisoning was suggested based on neurological clinical features, but the blood test brought out a lithium concentration within the therapeutic values at 1,2 mmol/L (N: 0,6–1,2 mmol/L). The classic biological complications related to lithium poisoning (hypercalcemia, diabetes insipidus) confirmed the diagnosis. The patient has been transferred to our nephrology department where she got two hemodialysis sessions conducting to clinical and biological improvement, confirming the diagnosis of lithium poisoning despite the normal blood levels. Later, she was transferred to the psychiatry department for follow-up and for treatment adjustment.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 650-654"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10348118","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":"Innovations thérapeutiques dans la prise en charge de l’anémie de la maladie rénale chronique Therapeutic innovations in the management of chronic kidney disease-associated anemia","authors":"Julien Aniort ,&nbsp;Clarisse Greze ,&nbsp;George Kosmadakis","doi":"10.1016/S1769-7255(22)00650-2","DOIUrl":"10.1016/S1769-7255(22)00650-2","url":null,"abstract":"<div><p>L’anémie est une complication fréquente de la maladie rénale chronique (MRC). Le défaut de production d’érythropoïétine (EPO) par les reins et la carence martiale en sont les principales causes. De fait, la supplémentation en fer et l’administration d’EPO recombinante représentent les bases de sa prise en charge. De nouvelles formulations de fer administrables par voie orale, intraveineuse ou directement <em>via</em> le dialysat ont été développées récemment pour en améliorer l’efficacité et la tolérance. Le citrate ferrique administré par voie orale permet de corriger efficacement l’anémie en cas de carence martiale tout en exerçant un effet de chélation du phosphate. Le carboxymaltose ferrique permet l’administration intraveineuse de doses plus importantes de fer moins fréquemment. Le citrate de pyrophosphate ferrique administré directement <em>via</em> le dialysat autorise la compensation des pertes en fer en cours de séance d’hémodialyse (HD). Les inhibiteurs des HIF-prolyl-hydroxylase représentent une nouvelle classe thérapeutique d’agents stimulant l’érythropoïèse. Administrés par voie orale, ils agissent en stabilisant le facteur de transcription HIF impliqué dans l’initiation de la production d’érythropoïétine en situation d’hypoxie. Plusieurs études cliniques ont évalué ces nouvelles molécules en comparaison à un placebo ou aux EPO recombinantes. Chez les patients avec MRC non dialysés ou dialysés, ils ont montré leur non-infériorité par rapport aux érythropoïétines recombinantes pour corriger l’anémie. La diminution de l’hepcidine qu’ils induisent apparaît plus importante que celle induite par les EPO recombinantes injectables. Les premières données sur leur sécurité d’utilisation sont plutôt rassurantes mais devront être confirmées par des études à plus long terme et à plus larges effectifs.</p><p>© 2022 Publié par Elsevier Masson SAS au nom de Société francophone de néphrologie, dialyse et transplantation.</p></div><div><p>Anemia is a common complication of chronic kidney disease (CKD). The insufficient erythropoietin (EPO) production by the kidneys and iron deficiency are the main causes. Iron supplementation and the administration of recombinant EPO are the main treatment modalities. New iron formulations that can be administered orally, intravenously or directly via the dialysate have recently been developed to improve efficacy and tolerance. Ferric citrate administered orally can effectively corrects anemia in case of iron deficiency and in addition chelate phosphate in the gut lumen. Ferric carboxymaltose allows intravenous administration of larger doses given less frequently. Ferric pyrophosphate citrate administered directly via the dialysate allows the compensation of iron losses during the hemodialysis session. HIF-prolyl-hydroxylase inhibitors are a new therapeutic class of erythropoiesis-stimulating agents. Orally administered, they act by stabilizing the HIF transcription factor involved in the initiation of erythr","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 6","pages":"Pages 6S25-6S32"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10667545","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":"Avantages cliniques de l’hémodialyse à domicile et les obstacles à son développement","authors":"Hafedh FESSI","doi":"10.1016/S1769-7255(23)00006-8","DOIUrl":"10.1016/S1769-7255(23)00006-8","url":null,"abstract":"<div><p>En 2023, l’hémodialyse à domicile (HDD) est une modalité de dialyse utilisée en toute sécurité et réalisée de manière autonome à domicile par des patients insuffisants rénaux chroniques. L’HDD requiert une formation adéquate et une installation adaptée prenant en compte également la gestion des dispositifs médicaux et des consommables dans le cadre de vie de chaque patient. L’HDD peut être pratiquée selon la convenance du patient quotidiennement, tous les deux jours ou toute la nuit (nocturne). Les durées des séances varient de quelques heures (moins de trois heures) en journée à plusieurs heures (six à dix heures) pendant la nuit. Au cours des dix dernières années, nous avons participé à un nouveau départ de l’HDD avec la mise à disposition de petites machines mieux adaptées au domicile et aux patients. Quelques études interventionnelles contrôlées et de nombreuses données de registres supportent l’hypothèse selon laquelle l’augmentation de la fréquence et de la durée de la dialyse s’associent à une amélioration de la survie des patients, du profil de risque cardiovasculaire et de la qualité de vie. Outre les avantages physiologiques de l’HDD, il existe des avantages clairs en termes de qualité de vie, sociaux et économiques. Il existe cependant certains inconvénients de l’HDD, notamment l’application et le temps requis pour la formation, le risque d’épuisement professionnel et la réticence à « hospitaliser » à la maison. Dans l’ensemble, ces limites peuvent être anticipées et surmontées par une formation adaptée, un suivi pluridisciplinaire et une organisation dédiée. Cette revue rappelle les principaux avantages cliniques de l’HDD liés à la fois à la physiologie et au style de vie ainsi que les principaux obstacles et propose des perspectives pour en garantir son développement.</p><p>© 2022 Société francophone de néphrologie, dialyse et transplantation. Publié par Elsevier Masson SAS. Tous droits réservés.</p></div><div><p>In 2023, home hemodialysis (HHD) is a dialysis modality used safely and performed independently at home by patients with chronic kidney disease (CKD). HHD requires adequate training and appropriate installation which includes the management of medical devices and consumables in the environment of each patient. According to each patient, HHD can be performed daily, every other day or overnight (nocturnal). The duration of the session varies from a few hours (less than three) during the day to several hours (six to ten) during the night. Over the past 10 years, we have been part of a revival in HHD with the availability of small machines better suited to homes and patients. Few controlled interventional studies and extensive registry data support the hypothesis that increase of frequency and duration of dialysis is associated with improved patient survival, cardiovascular risk profile, and quality of life. In addition to the physiological benefits of HDD, there are clear quality of life, social and economic benefits. T","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 5","pages":"Pages 5S18-5S22"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10684296","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":"Amylose AA vésicale : une localisation rare. À propos d’un cas","authors":"Nisrine Hikki ,&nbsp;Samia Sassi ,&nbsp;Naji Reguieg ,&nbsp;Kaoutar Znati ,&nbsp;Tarik Bouattar ,&nbsp;Loubna Benamar ,&nbsp;Rabia Bayahia ,&nbsp;Naima Ouzeddoun","doi":"10.1016/j.nephro.2022.10.004","DOIUrl":"10.1016/j.nephro.2022.10.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Bladder localization of AA amyloidosis is rare. It can be responsible for massive and recurrent hematuria. We report a case of bladder AA amyloidosis secondary to Crohn's disease in a renal transplant patient.</p></div><div><h3>Clinical observation</h3><p>A 62-year-old man, suffering from Crohn's disease since 1991 complicated by renal AA amyloidosis. He received a kidney transplant since 20 years from an HLA identical donor. After an 18-year period of clinical remission, the patient was admitted for a flare-up of his Crohn's disease in the form of intermittent diarrhoea. Treatment with corticosteroids allowed a good evolution. A year later, he was rehospitalized for massive macroscopic haematuria. Histological examination of the bladder biopsy revealed AA amyloidosis. The patient fully recovered but died 6 weeks later from septic shock of urinary origin.</p></div><div><h3>Conclusion</h3><p>The treatment of bladder localization of AA amyloidosis is based on treating the cause. Hematuria is sometimes massive, exceptionally requiring emergency cystectomy for haemostasis.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 655-657"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10351265","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":"Automated complete blood counter, urine analyzer and urine dipstick test results are correlated with thoma cell counting chamber counts in the diagnosis of dialysis related peritonitis in children","authors":"Şükran Keskin Gözmen ,&nbsp;Erkin Serdaroğlu ,&nbsp;Nida Dinçel ,&nbsp;Pınar Erturgut ,&nbsp;Cemaliye Başaran ,&nbsp;Fatma Devrim ,&nbsp;Betül Pehlivan Zorlu ,&nbsp;Özlem Dur ,&nbsp;Orhan Deniz Kara ,&nbsp;Ebru Bekiroğlu Yilmaz","doi":"10.1016/j.nephro.2022.10.001","DOIUrl":"10.1016/j.nephro.2022.10.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Peritoneal dialysis<span><span> is the treatment<span> of choice for end-stage renal disease. Peritoneal dialysis related peritonitis is of great importance for patient and technical survival. The aim of our study was to evaluate the accuracy and the correlation between the three methods (complete blood count, </span></span>urinalysis device, urine dipstick test) and with the reference manual method (Thoma Cell Counter Chamber).</span></p></div><div><h3>Materials and methods</h3><p>We retrospectively analyzed 167 peritoneal fluid samples taken from 25 patients receiving peritoneal dialysis treatment. Leukocyte counts were evaluated with Thoma Cell Counter Chamber, complete blood count, urinalysis device and urine dipstick test.</p></div><div><h3>Results</h3><p>There was a significant positive correlation between Thoma Cell Counter Chamber and complete blood count results (Spearman's rho<!--> <!-->=<!--> <!-->0.70), between Thoma Cell Counter Chamber and urinalysis device (Spearman's rho<!--> <!-->=<!--> <!-->0.73), and between Thoma Cell Counter Chamber and urine dipstick test (Spearman's rho<!--> <!-->=<!--> <!-->0.71). Area under curve for complete blood count, urinalysis device and urine dipstick test were 0.93, 0.94 and 0.89 respectively, indicating good accuracy. Sensitivity and specificity were 89.7% and 86.7% in the complete blood count analysis (associated criterion: 130 cells/mm³). Sensitivity and specificity were 89.7% and 86.7% in the urinalysis device (associated criterion: 10 cells/HPF). Sensitivity and specificity were 79.6% and 91.4% when in the urine dipstick test analysis (associated criterion: +<!--> <!-->1 positivity). The Bland-Altman plot showed good agreement.</p></div><div><h3>Conclusion</h3><p>Automatic complete blood count and urinalysis devices have good correlation and agreement with manual method in the diagnosis of peritonitis in the pediatric age group. Urine dipstick test in the home setting can be useful for screening patients with suspected peritonitis.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 611-615"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10357221","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":"L’hémodialyse à domicile","authors":"Maxence Ficheux ,&nbsp;Guillaume Seret","doi":"10.1016/S1769-7255(23)00003-2","DOIUrl":"10.1016/S1769-7255(23)00003-2","url":null,"abstract":"","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 5","pages":"Page 5S1"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10674239","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":"Title Page","authors":"","doi":"10.1016/S1769-7255(23)00001-9","DOIUrl":"https://doi.org/10.1016/S1769-7255(23)00001-9","url":null,"abstract":"","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 5","pages":"Page i"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138214841","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":"Prise en charge de la carence martiale au cours de la maladie rénale chronique : mise au point et proposition d’un algorithme","authors":"Corinne Guibergia ,&nbsp;François Brazier ,&nbsp;Gabriel Choukroun","doi":"10.1016/j.nephro.2022.10.003","DOIUrl":"10.1016/j.nephro.2022.10.003","url":null,"abstract":"<div><p>Iron deficiency is very common in chronic kidney disease, even before the dialysis stage. It is an independent factor of morbidity and mortality in patients with non-dialysis chronic kidney disease. During chronic kidney disease, iron deficiency is defined by a transferrin saturation &lt;20% and/or a serum ferritin &lt;100 μg/L. In France, about half of non-dialysis chronic kidney disease patients have absolute iron deficiency (transferrin saturation &lt;20% and serum ferritin &lt;100 μg/L) and/or functional iron deficiency (transferrin saturation &lt;20% and serum ferritin &gt;100 μg/L). Despite this, iron deficiency is usually not investigated. In fact, more than 60% of nephrologists do not assess iron status at least once a year. In addition, iron deficiency is rarely treated: only 12% of patients are prescribed oral or intravenous iron. Early detection and treatment are fundamental and should be systematic. In order to help improve the management of iron deficiency among non-dialysis chronic kidney disease patients, we propose an algorithm that takes into account current recommendations and the most recent data from the literature. Initial blood test requires the measurement of hemoglobin concentration, transferrin saturation and serum ferritin. A transferrin saturation &lt;20% establishes the diagnosis of iron deficiency and the serum ferritin level points towards an absolute or functional deficiency. The combination of both values makes it possible to adapt the treatment, particularly in an inflammatory context where oral iron is not effective.</p></div>","PeriodicalId":51140,"journal":{"name":"Nephrologie & Therapeutique","volume":"18 7","pages":"Pages 658-665"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10357220","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}