Regional Anesthesia and Pain Medicine最新文献

{"title":"Transnasal spread of bupivacaine into the pterygopalatine fossa following endoscopically assisted cotton swab placement: a cadaveric study.","authors":"Simon Istenič, Anže Jerman, Luka Pušnik, Tatjana Stopar Pintarič, Nejc Umek","doi":"10.1136/rapm-2025-106553","DOIUrl":"https://doi.org/10.1136/rapm-2025-106553","url":null,"abstract":"<p><strong>Background: </strong>There are conflicting data on the efficacy of transnasal topical anesthetic approaches intended to achieve a pterygopalatine ganglion block, specifically regarding the extent to which local anesthetics reach the pterygopalatine fossa. This cadaveric study aims to determine whether bupivacaine can reach the pterygopalatine fossa following topical administration near the sphenopalatine foramen using endoscopically assisted cotton ball placement.</p><p><strong>Methods: </strong>Nine fresh cadavers underwent topical nasal administration of a solution containing bupivacaine, methylene blue, and iodine contrast. Under direct endoscopic visualization, an absorbent cotton ball was positioned intranasally adjacent to the sphenopalatine foramen. CT was used to confirm correct placement and measured relevant anatomical distances. Tissue biopsies from the pterygopalatine fossa were collected via a transmaxillary surgical approach and analyzed using high-performance liquid chromatography-mass spectrometry.</p><p><strong>Results: </strong>Bupivacaine was detected in all pterygopalatine fossa biopsy samples except one, which was the farthest (17.5 mm) from the sphenopalatine foramen. Concentrations exceeded 1.00 µg/g in 29% and 0.10 µg/g in 71% of samples. The concentration decreased exponentially with distance from the application site, following a one-phase decay model (R²=0.74).</p><p><strong>Conclusions: </strong>These findings demonstrate that bupivacaine can reach the pterygopalatine fossa from the nasal cavity when topically applied near the sphenopalatine foramen under endoscopic assistance, supporting the feasibility of such an approach. They also suggest the main mean of transport is simple diffusion, meaning that optimizing bupivacaine concentration, duration of application, and precise placement of the absorbent cotton ball are crucial for maximizing the block's clinical efficacy.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute compartment syndrome in pediatric patients with peripheral nerve blocks.","authors":"Tricia Vecchione, Vipin Bansal, Benjamin Joel Shore, Giorgio Veneziano, Rani A Sunder, Harshad Gurnaney, Karen Boretsky","doi":"10.1136/rapm-2025-106423","DOIUrl":"https://doi.org/10.1136/rapm-2025-106423","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What you measure matters: the importance of outcome measures in evaluating the prevalence of painful chemotherapy-induced peripheral neuropathy.","authors":"Tiffany Li, David Goldstein, Susanna B Park","doi":"10.1136/rapm-2025-106586","DOIUrl":"https://doi.org/10.1136/rapm-2025-106586","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of fascial plane blocks for traumatic rib fractures: a scoping review.","authors":"Ahtsham U Niazi, Max Solish, Aneurin Moorthy, Faizan Niazi, Antonio Hermes Abate, Catherine Devion, Stephen Choi","doi":"10.1136/rapm-2024-106366","DOIUrl":"https://doi.org/10.1136/rapm-2024-106366","url":null,"abstract":"<p><strong>Background: </strong>The primary cause of morbidity and mortality in traumatic rib fractures is respiratory complications due to compromised respiratory mechanics secondary to pain and opioid-related respiratory depression. Thoracic epidural analgesia (TEA) provides effective analgesia but may not be possible in patients due to spinal cord injuries, thoracic vertebral fractures, and coagulopathy. New thoracic fascial plane blocks provide new options for patients with multiple rib fractures (MRFs).</p><p><strong>Objective: </strong>Our primary objective was to assess the effectiveness of thoracic fascial plane blocks for patients with MRFs by looking at pain control, opioid consumption, and respiratory function postblock compared with preblock.</p><p><strong>Evidence review: </strong>Literature was searched using keywords and controlled terms, based on the two concepts \"rib fractures\" and \"fascial plane blocks\". Terms were searched in PubMed, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Web of Science, Scopus, Google Scholar and ClinicalTrials.gov from inception to October 11, 2023, using medical subject headings (MeSH) and free-text terms without date or language restrictions. The terms included rib fractures, thoracic trauma, chest injuries, fascial plane blocks, PEC 1, PEC 2, PEC 3, pectoralis plane, serratus anterior plane (SAPB) and erector spinae plane block.</p><p><strong>Findings: </strong>The available evidence shows that erector spinae plane block and SAPB are effective blocks to provide analgesia and reduce opioid requirements in patients with unilateral or bilateral rib fractures.</p><p><strong>Conclusions: </strong>More randomized control studies are needed to compare these blocks with paravertebral block or TEA to see if they provide analgesia, improve respiratory function, and reduce opioid requirements.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of epinephrine on ropivacaine pharmacokinetics in TAP blocks: a randomized controlled trial.","authors":"Romain Rozier, Yann Le Guennec, Xavier Capdevila, Eric Le Louarn, Juliette Balbo, Thibaud Lavrut, Patrick Baque, Olivier Perus, Alexandre Destere, Axel Maurice-Szamburski","doi":"10.1136/rapm-2025-106500","DOIUrl":"https://doi.org/10.1136/rapm-2025-106500","url":null,"abstract":"<p><strong>Background: </strong>Ropivacaine is commonly used in abdominal wall blocks due to its safety profile, and the addition of epinephrine is hypothesized to prolong analgesic duration and reduce systemic absorption. However, previous studies have been limited by non-weight-adjusted dosing and potential pharmacokinetic interactions, and inadequate investigation of the free form of ropivacaine.</p><p><strong>Objective: </strong>To characterize and compare the pharmacokinetics of total and free ropivacaine administered at a weight-adjusted dose of 1 mg/kg in Transversus Abdominis Plane (TAP) blocks, with and without epinephrine (1:200 000; 5 µg/mL).</p><p><strong>Methods: </strong>In this randomized controlled trial, 40 patients undergoing laparoscopic colectomy received bilateral TAP blocks with ropivacaine alone (TAP/E-) or ropivacaine with epinephrine (TAP/E+). Pharmacokinetic parameters, including maximum plasma concentration (Cmax), time to Cmax (Tmax), and area under the concentration-time curve, were assessed over 240 min. Secondary outcomes included α₁-acid glycoprotein (AGP), analgesia, safety, and mean plasma concentration (Cmean).</p><p><strong>Results: </strong>The mean Cmax in the TAP/E+ group (0.531±0.245 µg/mL) was not significantly different from that in the TAP/E- group (0.746±0.428 µg/mL). Epinephrine significantly prolonged Tmax (165 vs 55.9 min in TAP/E-, p<0.001) and reduced Cmean (p=0.005). No serious adverse events occurred, though QT interval prolongation was observed in both groups.</p><p><strong>Conclusion: </strong>This study demonstrates that adding epinephrine did not alter the Cmax of ropivacaine in TAP blocks, but did prolong the time to reach Cmax. These findings support the routine inclusion of epinephrine in TAP blocks and provide a basis for multimodal analgesia strategies.</p><p><strong>Trial registration number: </strong>NCT04959123.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of patient-reported opioid use to verified prescription fills before and after surgery.","authors":"Siddartha Simha, Ralph Lamonge, Jennifer F Waljee, Yen-Ling Lai, Vidhya Gunaseelan, Michael J Englesbe, Chad M Brummett, Mark C Bicket","doi":"10.1136/rapm-2024-106090","DOIUrl":"https://doi.org/10.1136/rapm-2024-106090","url":null,"abstract":"<p><strong>Objective: </strong>To determine the correlation of patient-reported opioid use as compared to fills verified in a prescription drug monitoring program (PDMP) before and after surgery.</p><p><strong>Background: </strong>Correctly determining prescription opioid use before and after surgery is critical to develop effective policies and care pathways for opioid stewardship perioperatively. While many surgical teams, health systems, and patient registries rely on patients to report their use of prescription opioids, the accuracy of this reporting is unclear.</p><p><strong>Methods: </strong>Patient-reported data on opioid use from 12 225 adult patients who underwent surgical procedures between 1 January 2018 and 31 October 2019 across 70 participating hospitals in Michigan Surgical Quality Collaborative were compared to the reference standard of the state PDMP. The primary outcome was patient-reported opioid fill in the 30 days after surgery compared to PDMP-verified prescription fill, and the secondary outcomes were patient-reported use in the 30-day and 1-year period prior to surgery compared to PDMP data. Accuracy, sensitivity, specificity, and other predictive values were calculated.</p><p><strong>Results: </strong>Among 12 225 patients (58% women, 19.2% non-white, mean (SD) age 15.6 (16.3)), the patient report had acceptable accuracy (83.2%, 95% CI 82.5% to 83.9%) and sensitivity (91.2%, 95% CI 90.6% to 91.8%) compared to 30-day postoperative opioid fills in the PDMP, while less than half of patients without PDMP-verified fills accurately reported not filling an opioid prescription (specificity 43.1%, 95% CI 40.9% to 45.3%). For 30-day and 1-year periods before surgery, patient-reported opioid use had acceptable accuracy (86.8% (95% CI 86.1% to 87.4%) and 77.9% (95% CI 77.2% to 78.7%), respectively) and specificity (90.0% (95% CI 89.4% to 90.5%) and 90.8% (95% CI 90.2% to 91.4%), respectively), while only slightly above half of patients with PDMP-verified opioid fills reported opioid use before surgery (sensitivity 58.9% (95% CI 56.2% to 61.7%) and 47.3% (95% CI 45.7% to 49.0%), respectively).</p><p><strong>Conclusions: </strong>For perioperative opioid fills and use, the patient report appears to align with PDMP data. The patient report may also complement PDMP data by identifying persons who may report opioid prescription fills or use without corresponding data in the PDMP, especially in the postoperative period.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cooled radiofrequency ablation provides extended clinical utility in the management of chronic sacroiliac joint pain: 12-month follow-up results from the observational phase of a randomized, multicenter, comparative-effectiveness crossover study.","authors":"Steven Paul Cohen, Leonardo Kapural, Lynn Kohan, Sean Li, Robert Hurley, Richard Vallejo, Yashar Eshraghi, Pradeep Dinakar, Shravani Durbhakula, Douglas P Beall, Mehul J Desai, David Reece, Sandy Christiansen, Min Ho Chang, Adam J Carinci, Michael DePalma","doi":"10.1136/rapm-2024-106315","DOIUrl":"https://doi.org/10.1136/rapm-2024-106315","url":null,"abstract":"<p><strong>Introduction: </strong>Sacroiliac joint (SIJ) pain comprises up to 30% of cases of mechanical low back pain (LBP), the leading cause of disability worldwide. Despite sacral lateral branch cooled radiofrequency ablation (CRFA) showing efficacy in clinical trials, there is a lack of comparative-effectiveness long-term follow-up.</p><p><strong>Methods: </strong>In this randomized, multicenter, comparative-effectiveness study, 210 patients with injection-confirmed SIJ pain who responded to prognostic lateral branch blocks were randomly assigned to receive CRFA of the L5 dorsal ramus and S1-S3/4 lateral branches or standard medical management (SMM) consisting of pharmacotherapy, physical therapy, injections, and integrative therapies. Patients were followed up at 1, 3, 6, 9, and 12 months, with participants reporting unsatisfactory SMM outcomes being allowed to crossover (XO) and receive CRFA at 3 months. The primary outcome measure was the mean change in average LBP score on a 0-10 Numeric Rating Scale (NRS), with secondary outcomes including measures of quality of life (QoL) and function. A responder was defined as a participant who experienced a ≥30% or ≥2-point decrease in average daily NRS pain score coupled with a score ≥5 out of 7 (moderately better) on the Patient Global Impression of Change scale.</p><p><strong>Results: </strong>At 12 months, the mean NRS pain score declined from a baseline of 6.4±1.4 to 3.5±2.6, with 57.4% (35/61) of participants in the randomized CRFA cohort experiencing a ≥2-point or 30% decrease in average LBP from baseline. In the crossover cohort, 35/63 (55.6%) subjects had the same experience 12 months following the XO procedure; in the XO group, the mean LBP decreased from 6.1±1.5 to 3.4±2.5. Patients also experienced clinically meaningful improvements in QoL via EuroQoL-5D-5L at 12 months (mean change of +0.22±0.27 in the originally-treated CRFA group and +0.21±0.33 in the XO group). Oswestry Disability Index (ODI) scores also improved by 12.4%±14.7 (CRFA) and 13.7%±17.1 (XO) from baseline at study-end. No serious adverse events related to the CRFA procedure were reported.</p><p><strong>Conclusion: </strong>CRFA in patients with SIJ pain provided clinically significant and sustained improvements for 12 months following a single CRFA treatment, regardless of previous SMM treatment.</p><p><strong>Trial registration number: </strong>NCT03601949.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining needle placement and pressure monitoring in regional anesthesia: insights from advanced imaging and innovative technologies.","authors":"Graeme A McLeod, Xavier Sala-Blanch, Dihan van Niekerk, Miguel Angel Reina","doi":"10.1136/rapm-2024-106356","DOIUrl":"https://doi.org/10.1136/rapm-2024-106356","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can a single-shot abdominal wall nerve block for unexpected open surgery be done without specific consent?","authors":"Lana Joudeh, Alexander B Stone, Philipp Gerner","doi":"10.1136/rapm-2025-106496","DOIUrl":"https://doi.org/10.1136/rapm-2025-106496","url":null,"abstract":"<p><p>Abdominal wall blocks are simple and safe opioid-sparing adjuncts for abdominal procedures that are generally well tolerated. These blocks have been shown to be effective for open abdominal surgeries, though their utility in laparoscopic or robotic surgery has been questioned. The unanticipated conversion from laparoscopic to open surgery may pose a challenge for the anesthesiologist, if regional anesthesia was not discussed before the start of the case as part of the pain-control regimen. Inability to offer an abdominal wall block leads to increased use of opioid medications and less-than-ideal analgesia during emergence and the immediate postoperative period, often until consent can be obtained and a nerve block offered. In this discourse, we discuss if a single-shot abdominal wall block is within the scope of a typical general anesthetic or if specific consent is needed prior to performance.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Pain and Spine Intervention Society.","authors":"Honorio T Benzon, Dalia Elmofty, Hariharan Shankar, Maunak Rana, Andrea L Chadwick, Shalini Shah, Dmitri Souza, Ameet S Nagpal, Salahadin Abdi, Christian Rafla, Alaa Abd-Elsayed, Tina L Doshi, Maxim S Eckmann, Thanh D Hoang, Christine Hunt, Carlos A Pino, Jessica Rivera, Byron J Schneider, Alison Stout, Angela Stengel, Maged Mina, John D FitzGerald, Joshua A Hirsch, Ajay D Wasan, Laxmaiah Manchikanti, David Anthony Provenzano, Samer Narouze, Steven P Cohen, Timothy P Maus, Ariana M Nelson, Harsha Shanthanna","doi":"10.1136/rapm-2024-105593","DOIUrl":"10.1136/rapm-2024-105593","url":null,"abstract":"<p><strong>Background: </strong>There is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit.</p><p><strong>Methods: </strong>Development of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed.</p><p><strong>Results: </strong>This guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections.</p><p><strong>Conclusions: </strong>In this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}