Revista Do Instituto De Medicina Tropical De Sao Paulo最新文献

{"title":"Evaluation of the public health laboratory network for tegumentary leishmaniasis in an endemic area of Brazil.","authors":"Fernanda Alvarenga Cardoso Medeiros, Job Alves Souza Filho, Maria Inês Fernandes Pimentel, Ilka Afonso Reis, Daniel Menezes-Souza, Aline Fagundes da Silva, Andreza Pain Marcelino","doi":"10.1590/S1678-9946202466070","DOIUrl":"10.1590/S1678-9946202466070","url":null,"abstract":"<p><p>Diagnostic networks ensure efficiency in disease diagnosis. A descriptive study evaluated the network of public health laboratories (NPHL) in Minas Gerais State, Brazil, using diagnostic results for tegumentary leishmaniasis (TL) from the laboratory management system in 2017-2020. Out of 1,369 individuals analyzed, 704 (51.4%) cases of TL were confirmed, with 610 (86.7%) by direct parasitological examination (DPE) and 94 (13.4%) by polymerase chain reaction (PCR). Notably, 25.3% of cases with DPE-negative results were PCR-positive. Consecutive diagnostic tests enhanced diagnosis of TL. NPHL-MG is a promising model for expanding similar networks and improving disease control.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e70"},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856844","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":"Long-term chronic infection of a young immunocompromised patient by the SARS-CoV-2 P.2 VOI.","authors":"Camila Malta Romano, Vitor Gabriel Lopes da Silva, Luciane Sussuchi da Silva, Carolina Sanchez Aranda, Cristina Mendes de Oliveira, Marilda Mendonça Teixeira Siqueira, Elisa Cavalcante Pereira, Paola Cristina Resende, Nancy Cristina Junqueira Bellei, José Eduardo Levi, Maria Isabel de Moraes-Pinto","doi":"10.1590/S1678-9946202466069","DOIUrl":"10.1590/S1678-9946202466069","url":null,"abstract":"<p><p>An immunocompromised patient was infected by the SARS-CoV-2 variant of interest named Zeta (P.2) in February 2021. More than one year later, he suffered from symptomatic COVID-19 and sequencing revealed the same variant, which accumulated 23 substitutions. This case illustrates intra-host evolution of a particular SARS-CoV-2 variant, highlighting the importance of genomic surveillance of immunocompromised patients.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e69"},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856847","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":"Scrotal abscess caused by Candida glabrata in a patient with uncontrolled diabetes mellitus and chronic renal failure.","authors":"Mehmet Ali Tüz, Derya Tuna Ecer, Tuğba Kula Atik, Oktay Yapıcı","doi":"10.1590/S1678-9946202466071","DOIUrl":"10.1590/S1678-9946202466071","url":null,"abstract":"<p><p>Candida glabrata is a yeast which incidence has increased in recent years and usually causes urogenital and bloodstream infections. Its resistance to fluconazole hinders C. glabrata infections treatment. This case report presents a case of candidemia and scrotal abscess caused by C. glabrata, which was successfully treated with liposomal amphotericin B. The primary treatment options for C. glabrata candidemia are echinocandins and amphotericin B formulations. However, echinocandins and lipid-based amphotericin B formulations do not properly pass through the urinary system. Amphotericin B deoxycholate has a high risk of side effects and is difficult to obtain. The treatment option for candidemia caused by fluconazole-resistant C. glabrata secondary to urinary tract infection is unclear and there are no sufficient studies. For treatment, liposomal amphotericin B may be considered, especially for scrotal and prostatic fluconazole-resistant fungal abscesses. More studies comparing the penetration of antifungals into scrotal and prostatic tissue and the success of antifungal treatment in these tissue infections are needed.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e71"},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855860","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":"Seroconversion and seroreversion rates of anti-Strongyloides IgG in rural areas of the Amazon: a population-based panel study.","authors":"Fabiana Martins de Paula, Bruna Barroso Gomes, Dirce Mary Correia Lima Meisel, William Henry Roldan, Mônica da Silva Nunes, Marcelo Urbano Ferreira, Ronaldo Cesar Borges Gryschek","doi":"10.1590/S1678-9946202466072","DOIUrl":"10.1590/S1678-9946202466072","url":null,"abstract":"<p><p>Using a panel study design, we aimed to estimate the seroconversion and seroreversion rates of anti-Strongyloides IgG antibodies from surveys carried out 11 months apart in a rural community in the Amazon Basin in Brazil. We used enzyme immunoassays to measure anti-Strongyloides IgG antibodies in 325 baseline plasma samples and 224 others that were collected 11 months later from residents in the agricultural settlement of Granada, Acre State. We observed anti-Strongyloides IgG antibodies in 21.8% of the baseline samples (which showed that 3.4% of participants had larvae in their stool) and in 23.7% of the follow-up samples. The seroconversion rate estimated at 9.7 episodes/100 person-years at risk agrees with ongoing transmission. Specific antibodies were relatively short-lived and nine (25.0%) of 36 seropositive participants at baseline were seronegative when retested 11 months later. Fecal surveys can severely underestimate the prevalence of S. stercoralis infection in rural Amazonians. Serology provides a field-deployable diagnostic tool to find high-prevalence populations, identify associated risk factors, and monitor intervention programs.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e72"},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855863","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":"Neutrophil/lymphocyte and platelet/lymphocyte ratio in seropositive women for human immunodeficiency virus (HIV) and human papillomavirus (HPV) coinfection.","authors":"Karina Donato Fook, Maria José Abigail Mendes Araújo, Alessandra Costa de Sales Muniz, Mônika Machado de Carvalho, Ana Cléa Cutrim Diniz de Morais, Deborah Rocha de Araújo, Sulayne Janayna Araújo Guimarães, Camila Penha Abreu Souza, Carla Déa Trindade Barbosa, Maria Fernanda Lima Bertolaccini, Ilka Kassandra Pereira Belfort, Fernanda Ferreira Lopes, Sally Cristina Moutinho Monteiro","doi":"10.1590/S1678-9946202466067","DOIUrl":"10.1590/S1678-9946202466067","url":null,"abstract":"<p><p>This study aims to investigate the possible association between neutrophil/lymphocyte and platelet/lymphocyte ratio in women with HIV, undergoing antiretroviral treatment, with HPV coinfection. This is a cross-sectional study with HIV positive women; their biological samples were collected for laboratory tests (complete blood count) and oncotic cytology for detection of HPV DNA, by PCR-Nested (PGMY and GP primers). Viral load and CD4 and CD8 T-cells counts were obtained from medical records. The data were analyzed, comparing the two groups: those with coinfection and those without it. From 82 HIV seropositive women, 50% exhibited HPV coinfection and 12.2% of coinfected patients had cervical cell alterations. Quantification of viral load, CD4 and CD8 T-cells count, CD4 / CD8 ratio and neutrophil/lymphocyte (NLR) and platelet/lymphocyte (PLR) ratio presented significant differences between groups (p<0.05). The predicting power of NLR and PLR in differentiating HIV/HPV coinfection which demonstrated differences between groups (AUC of 0.882 and 0.776 for NLR and PLR, respectively). There is a relation between the neutrophil/lymphocyte and platelet/lymphocyte ratio with HIV/HPV coinfection in women undergoing antiretroviral treatment, suggesting a state of greater and persistent systemic inflammation, reflecting as a biomarker for screening and monitoring these patients.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e67"},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856896","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":"Trends in antimicrobial susceptibility patterns in Salmonella from human and nonhuman sources in Sao Paulo State, Brazil, 2016-2023.","authors":"Monique Ribeiro Tiba-Casas, Elisabete Aparecida Almeida, Gisele Lozano Costa, Amanda Maria de Jesus Bertani, Thais Vieira, Carlos Henrique Camargo","doi":"10.1590/S1678-9946202466064","DOIUrl":"10.1590/S1678-9946202466064","url":null,"abstract":"<p><p>Antimicrobial resistance constitutes a significant global challenge to public health and development, in which non-typhoidal Salmonella emerges as a critical concern. This study investigates the prevalence and antimicrobial resistance profiles of Salmonella isolates from both human and nonhuman sources. A total of 2,511 Salmonella isolates that had been collected from 2016 to 2023 were analyzed, of which 1,724 underwent antimicrobial susceptibility testing. The main focus lied on the 10 most prevalent serotypes, totaling 957 isolates. Serotyping showed the diverse distribution of serotypes, with Heidelberg, Typhimurium, Enteritidis, and the monophasic Salmonella Typhimurium occurring most often. Antimicrobial resistance was common since 512 strains resisted at least one drug and 319 several drugs. Notably, the Heidelberg and Mbandaka serotypes, predominantly occurring in nonhuman samples, showed multidrug resistance. Salmonella Typhi remained susceptible to antimicrobials. Resistance to nalidixic acid, tetracycline, sulfonamides, and ampicillin was prevalent, whereas all isolates remained susceptible to imipenem. A reduction in susceptibility rates for aminoglycosides was observed over the study period. Extended-spectrum β-lactamase production occurred in 4.4% of the isolates, of which Heidelberg configured the most prevalent extended-spectrum β-lactamase-positive serotype. These findings underscore the importance of surveillance and effective monitoring to control this pathogen, highlighting the necessity of prioritizing public health efforts.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e64"},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632753","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":"Clinical epidemiological and laboratory investigation in co-infection with COVID-19 and tuberculosis.","authors":"Ana Carulina Guimarães Belchior, Antônio Martins de Freitas Neto, Grassyelly Silva Gusmao, Evelin Jaqueline Lima Dos Santos, Everton Ferreira Lemos, Mauricio Antonio Pompilio, Cláudia Elizabeth Volpe-Chaves, Eliana da Costa Alvarenga de Brito, Everton Falcão de Oliveira, Ana Caroline Blanco Carreiro, Anamaria Mello Miranda Paniago","doi":"10.1590/S1678-9946202466065","DOIUrl":"10.1590/S1678-9946202466065","url":null,"abstract":"<p><p>Currently, COVID-19 and tuberculosis (TB) are the deadliest infectious diseases worldwide. Their synergy, form of presentation, morbidity, and mortality are data that have been scarcely explored. Thus, this study aimed to characterize the clinical, epidemiological, and laboratory factors of this co-infection and to analyze the factors associated with the active TB among COVID-19 cases. A case-control study was conducted with a retrospective survey of 21 laboratory-confirmed COVID-19/TB co-infected patients (case group) and 21 COVID-19 patients (control group). The study included participants from eight hospitals in Campo Grande city, capital of Mato Grosso do Sul State, Brazil, from March 2020 to March 2022. Association analysis and binomial logistic regression were employed with statistical significance set at p≤0.05. From the 21 identified cases of COVID-19/TB co-infection, we found a more frequent association with HIV infection than the control-group, without worsening the outcome. COVID-19/TB patients had less dyspnea and less need for mechanical ventilation compared to the cases with COVID-19 only. On the other hand, COVID-19/TB patients had higher levels of C-reactive protein and lower hemoglobin levels, the latter variable was independently associated with COVID-19/TB. Among the clinical differences presented among COVID-19/TB co-infected patients, despite the association with HIV and lower clinical repercussions, only lower hemoglobin levels were associated with COVID-19/TB.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e65"},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632749","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":"Mutations in the voltage-gated sodium channel associated with pyrethroid resistance in Aedes albopictus in Yucatan, Mexico.","authors":"Wilbert Antonio Chi-Chim, Julian Everardo Garcia-Rejon, Julio Cesar Tzuc-Dzul, Lourdes Talavera-Aguilar, Rosa Cetina-Trejo, Nohemi Cigarroa-Toledo, Viviana Caamal-Villanueva, Diana Guadalupe Argaez-Sierra, Carlos Marcial Baak-Baak","doi":"10.1590/S1678-9946202466062","DOIUrl":"10.1590/S1678-9946202466062","url":null,"abstract":"<p><p>Aedes albopictus (Skuse) is a competent vector of dengue and Zika viruses in Mexico. Monitoring the level of resistance of local population is essential due to its epidemiological significance. This study aimed to identify mutations in the voltage-gated sodium channel (VGSC) as one of the mechanisms responsible for pyrethroid insecticide resistance in Ae. albopictus. Immature samples were collected in a rural town in Yucatan, Mexico, from May to October 2021. The pyrethroid insecticide lambda-cyhalothrin was impregnated in CDC bottles and bioassays were conducted on Ae. albopictus populations 3-5 days after emergence. The mosquitoes were susceptible to the insecticide. Females were taken for total DNA extraction. Fragments of domains II, III, and IV of the voltage-gated sodium channel (VGSC) were amplified and sequenced. The presence of synonymous and non-synonymous mutations was found in positions 1532 and 1534 of domain III of the sodium channel gene (VGSC). No mutant alleles in domain IV were detected. A homozygous mutant (ACG) coding for the amino acid threonine (1008Thr) was identified in domain II. Domain III included three heterozygous alleles (P1528S, L1530S, and Ile1410Thr). This last heterozygous allele is reported for the first time in Mexico. Homozygous mutants encoding the amino acids serine/serine and serine/proline in domain III were observed. These have been reported in Aedes aegypti from Mexico, but not yet in Ae. albopictus. This represents new findings for the region, as Ae. albopictus has only been introduced there for approximately five years. In conclusion, non-synonymous mutations were found in Ae. albopictus in a rural area of Yucatan, emphasizing the importance of integrated vector control to prevent Asian tiger mosquitoes from spreading these resistant alleles.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e62"},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632750","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":"Paracoccidioidomycosis presenting as a cecal lesion mimicking cholangiocarcinoma: a case report of unusual intestinal manifestation.","authors":"Eduarda Raunheitti Giesteira, Giovanna França Santore, Julia de Abreu Teixeira, Ezequias Batista Martins, Bianca Balzano de la Fuente Villar, Billy McBenedict, Karla Regina Oliveira de Moura Ronchini, Natalia Chilinque Zambão da Silva, Nilo Fernandes Leça Junior, Patrícia Yvonne Maciel Pinheiro, Remberto Maurício de La Cruz Vargas Vilte, Thais de Oliveira Vieira, Laura da Cunha Ferreira","doi":"10.1590/S1678-9946202466063","DOIUrl":"10.1590/S1678-9946202466063","url":null,"abstract":"<p><p>Paracoccidioidomycosis, the most important systemic mycosis in Latin America, is closely linked to rural activities. In Brazil, it is an endemic disease, with an estimated 4,000 to 6,000 annual cases, accounting for over 80% of the global diagnoses. We present an intriguing case of this disease with an intestinal manifestation in a 71-year-old woman. The involvement of the cecal appendix led to a complication of cholangitis that mimicked cholangiocarcinoma.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e63"},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632751","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":"Mitigating adverse outcomes in tuberculosis treatment: analyzing a non-compliance risk assessment strategy in a case report.","authors":"Carolina Rossoni de Melo, Cláudia Elizabeth Volpe-Chaves, Kássia Raquel da Silva, João Gabriel Cibolli Roso, Alexandre Albuquerque Bertucci, Eunice Atsuko Totumi Cunha, James Venturini, Ursulla Vilella Andrade, Michelle Mocellin Peruzzo, Wanessa da Silva Peres Bezerra, Sandra Maria do Valle Leone de Oliveira, Anamaria Mello Miranda Paniago","doi":"10.1590/S1678-9946202466059","DOIUrl":"10.1590/S1678-9946202466059","url":null,"abstract":"<p><p>Tuberculosis (TB) is a global public health concern and a leading cause of death. Its persistence occurs mainly because barriers in the care cascade are not being fully addressed. Healthcare professionals and scientists have been addressing treatment challenges such as abandonment and irregular drug intake via strategies such as directly observing treatment and singular therapeutic projects to improve adherence. However, while protocols and guidelines advocate these strategies, their implementation requires a broader approach from healthcare teams. This article examines the importance of such strategies in clinical TB management and analyzes an unfavorable outcome in an immunocompetent patient treated for pulmonary tuberculosis (PTB) from 2017 to 2022. After recurrence and treatment, the patient continued to have persistent acid-fast bacilli in the sputum, positive cultures for Mycobacterium tuberculosis, and progressive lung lesions, despite receiving the recommended treatment. Although categorized as having an intermediate risk of treatment abandonment, the patient faced challenges, such as the COVID-19 pandemic, pregnancy, and being diagnosed with COVID-19. After therapeutic failure and the loss of beneficial prospects, palliative care was initiated. This case illustrates the complexities of managing TB in patients with recurrent disease despite apparent adherence to treatment. After reassessing the risk of abandonment score, the patient was categorized as high-risk. This underscores the importance of singular therapeutic projects, such as psychological support for high-risk or intermediate patients, to prevent negative outcomes. This case reinforces the critical need for comprehensive patient-centered approaches to successfully treat and manage TB.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"66 ","pages":"e59"},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481031","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}