American journal of obstetrics and gynecology最新文献

{"title":"Considerations for Gestational Age, Delivery Indication, and Therapies in Preeclampsia Prediction.","authors":"Catarina R Palma Dos Reis,Manu Vatish,Ana Sofia Cerdeira","doi":"10.1016/j.ajog.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.05.010","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"17 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subserosal pregnancy: a rare and underestimated ectopic pregnancy useful to be included in the classification.","authors":"Guglielmo Stabile,Francesco Cracco,Stefania Carlucci,Luigi Nappi,Giulia Zinicola","doi":"10.1016/j.ajog.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.05.008","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"121 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI Anatomy of the Anal Sphincters for the Obstetrician Gynecologist.","authors":"Anne G Sammarco,Christopher X Hong,Rene Genadry,Abby Stork,Danielle Herman,Deslyn Hobson,Carolyn Swenson,John O L DeLancey","doi":"10.1016/j.ajog.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.05.005","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"9 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Cell-Free DNA for the Determination of Fetal Red Blood Cell Antigen Genotype: A Systematic Review and Meta-Analysis.","authors":"Hiba J Mustafa,Parisa Najjariasl,Faezeh Aghajani,Enaja V Sambatur,Asma Khalil,Kenneth J Moise,Alireza A Shamshirsaz","doi":"10.1016/j.ajog.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.05.004","url":null,"abstract":"OBJECTIVETo evaluate the diagnostic accuracy of cfDNA in identifying fetal RBC antigen genotypes.DATA SOURCESA comprehensive systematic search was conducted across three databases between 2000 and 2024.STUDY ELIGIBILITY CRITERIAWe included cohort studies utilizing cfDNA for fetal RBC antigen detection in pregnancies at risk of or with red cell alloimmunization. Two reviewers independently assessed the studies for inclusion, resolving any disagreements through discussion.STUDY APPRAISAL AND SYNTHESIS METHODSReporting followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two authors independently extracted data and assessed the risk of bias using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Pooled sensitivity and specificity were determined using a hierarchical summary receiver operating characteristic (HSROC) approach. The analysis was conducted for all studies and then per each laboratory technique, including polymerase chain reaction (PCR), next-generation sequencing (NGS), and Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF). Subgroup analyses were performed for each antigen type, including RhD, RhC, Rhc, RhE, Kell, and Duffy (Fya) antigens.RESULTSA total of 84 studies encompassing 77,187 antigen samples with neonatal genotype concordance were included. Seventy-six studies used PCR (75,692 antigen samples), five used NGS (328 antigen samples), and three used MALDI-TOF (1,167 antigen samples). Combining all lab techniques, the sensitivity and specificity of cfDNA in identifying fetal RBC antigen were 99% (95% CI 99-100). The diagnostic accuracy using i)PCR technique for the following antigens in order RhD (74,786 samples), RhC (189 samples), Rhc (232 samples), RhE (276 samples), and Kell (209 samples) were, the pooled sensitivity is 99% (95% CI 99,100), 100% (95% CI 98-100), 99% (95% CI 96-100), 100% (95% CI 97-100), and 99% (95% CI 96-100), respectively and the pooled specificity is 99% (95% CI 99-100), 100% (95% CI 98-100), 100% (95% CI 94-100), 100% (95% CI 99-100), 100% (95% CI 98-100), respectively, ii) NGS technique for the following antigens in order RhD (68 samples), RhC (42 samples), Rhc (52 samples), RhE (88 samples), and Kell (108 samples) were, the pooled sensitivity is 100% (95% CI 96-100), 100% (95% CI 92-100), 100% (95% CI 95-100), 100% (95% CI 95-100), and 100% (95% CI 90-100), respectively and the pooled specificity is 100% (95% CI 91-100), 100% (95% CI 93-100), 100% (895% CI 83-100), 100% (95% CI 97-100), and 100% (95% CI 98-100), respectively, and iii) MALDI-TOF technique studies only investigated RhD (1,167 samples) with sensitivity of 99% and specificity of 98%. Fya antigen (19 samples) was only available in the NGS technique (sensitivity and specificity of 100%).CONCLUSIONCfDNA can accurately detect six fetal blood group antigens involved in red cell allo","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"54 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the clinical utility and strategy of whole exome sequencing testing for fetuses with increased nuchal translucency.","authors":"Fan Zhou,Mei Yang,Zhu Zhang,Hongmei Zhu,Jiamin Wang,Lingping Li,Bocheng Xu,Qinqin Xiang,Ting Hu,Shanling Liu","doi":"10.1016/j.ajog.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.05.003","url":null,"abstract":"OBJECTIVEThe routine recommendation for detecting monogenic disease in fetuses with increased nuchal translucency (NT) remains controversial. This study aimed to evaluate the clinical significance and optimal strategy of whole exome sequencing (WES) in fetuses with increased NT.STUDY DESIGNThis retrospective study included pregnancies that underwent amniocentesis due to advanced maternal age, positive screening results, or abnormal ultrasound findings between January 2018 and December 2019. Chromosomal abnormalities were diagnosed using chromosome microarray analysis (CMA). WES testing was sequentially performed in fetuses with NT ≥ 3.5 mm. Newborns were followed up regularly until they reached 48-60 months of age.RESULTSOf 11,774 pregnancies undergoing amniocentesis, 607 fetuses (5.16%) had NT ≥ 3 mm. Chromosomal abnormalities were detected in 23.56% (143/607), including aneuploidy (13.18%, 80/607) and chromosome deletion/duplication or regions of homozygosity (10.38%, 63/607). The diagnostic yield of CMA for aneuploidies and pathogenic/likely pathogenic (P/LP) chromosome abnormalities was 17.63% (107/607), after excluding 36 cases with variants of uncertain significance (VUS). Among 464 fetuses with NT ≥ 3 mm and negative CMA results, 240 cases had fetal NT ≥ 3.5 mm, of which 96 cases underwent WES testing. WES identified diagnostic variants in genes associated with an increased NT phenotype in 10.42% (10/96) of cases. These variants involved genes of DDX3X, RIT1, NIPBL, ANKRD11, PIEZO2, NF1, ASXL1, CCDC22, and TUBB3, which are inherited in either an X-linked (XL) or autosomal dominant (AD) pattern. Adverse outcomes were observed in 80% (8/10) of these cases, including four induced abortions, three cases of developmental delay, and one neonatal death. A total of 86 fetuses (14.17%, 86/607) had additional ultrasound findings. Fetuses with NT ≥ 3.5 mm and additional ultrasound findings identified during the second trimester exhibited a significantly higher rate of chromosomal abnormalities compared to those without additional findings (44.62% vs. 19.00%, P = 0.00). Among fetuses with NT ≥ 3 mm and negative CMA and/or WES testing results, 90.39% (395/437, after excluding 27 pregnancies lost to follow-up) were healthy during follow-up. The remaining approximately 10% (42 cases) experienced miscarriage, induced abortion, intrauterine fetal death, or developmental delay.CONCLUSIONCMA identified chromosomal abnormalities in 17.63% of fetuses with NT ≥ 3 mm. Fetuses with increased NT and additional ultrasound findings exhibited a significantly higher rate of chromosomal abnormalities. WES provided an additional diagnostic yield of 10.42% for monogenic disorders in fetuses with NT ≥ 3.5 mm. WES testing, combined with data reanalysis based on subsequent prenatal/postnatal phenotypes, offers an optimal strategy for diagnosing monogenic diseases in fetuses with increased NT.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"31 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoxic-ischemic encephalopathy following intrapartum asphyxia: is it avoidable?","authors":"Mikko Tarvonen,Riina Jernman,Vedran Stefanovic,Ville Tuppurainen,Riitta Karikoski,Leena Haataja,Sture Andersson","doi":"10.1016/j.ajog.2025.04.073","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.04.073","url":null,"abstract":"BACKGROUNDThe proportion of term hypoxic-ischemic encephalopathy arising during intrapartum fetal surveillance remains unclear. Moreover, recent Cochrane review and other studies emphasized the need for research on the impact of admission cardiotocography, and highlighted the necessity for a definition of 'avoidable perinatal brain injury'.OBJECTIVETo assess the impact of intrapartum asphyxia on neonatal hypoxic-ischemic encephalopathy occurrence and identify the proportion of cases that benefit from preventive measures.STUDY DESIGNThis retrospective 20-year birth cohort study included admission and intrapartum cardiotocography recordings from spontaneous term (≥37 weeks of gestation) singleton deliveries at seven maternity hospitals within the Helsinki University Hospital area, Finland, between 2005 and 2024. In newborns diagnosed with hypoxic-ischemic encephalopathy, cases following intrapartum asphyxia were identified by a normal cardiotocogram at admission, whereas antepartum exposure was indicated by an abnormal admission cardiotocogram. Cord blood gases, erythropoietin, and serum S100β concentrations were analyzed, and placentas underwent histopathological examination. Primary outcome was hypoxic-ischemic encephalopathy. Secondary outcome was fetal asphyxia, defined as the presence of severe or moderate acidemia.RESULTSAmong 317 126 term newborns, 314 cases of hypoxic-ischemic encephalopathy were identified. Admission cardiotocogram was normal in 141 (44.9%) and abnormal in 173 (55.1%). Of those with a normal admission cardiotocogram, severe acidemia (umbilical artery pH <7.00 and/or base excess ≤-12.0 mmol/L) evolved in 127/141 (90.1%) and moderate acidemia (umbilical artery pH 7.09-7.00 and base excess -10.0 to -11.9 mmol/L) in 11/141 (7.8%). Excluding cases with a perinatal sentinel event and timely deliveries, 70 cases (49.6%) remained in which hypoxic-ischemic encephalopathy presumably developed during labor and was considered potentially avoidable. These findings suggest that in 22.3% (70/314), preventive measures should have been implemented. Newborns with abnormal cardiotocograms had higher median umbilical blood erythropoietin concentrations than those with normal admission cardiotocograms (112 U/L; interquartile range 22-1130 vs. 29 U/L; interquartile range 7-680, P<.001), indicating more chronic hypoxia.CONCLUSIONSOf term newborns with hypoxic-ischemic encephalopathy and normal admission cardiotocogram, 98% were attributable to intrapartum asphyxia. Our findings indicate that half of cases of intrapartum hypoxic-ischemic encephalopathy with a normal admission cardiotocogram were potentially avoidable, suggesting that one-fifth of all cases could have benefited from preventive measures. The findings underscore the role of optimal intrapartum care in preventing hypoxic-ischemic encephalopathy.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"28 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Reproductive Access Restrictions and Out-of-State Abortion Care in Colorado, an Interrupted Time Series Analysis for 2018-2024.","authors":"Kelly A DeBie,Kayleigh P Keller,Jennifer L Peel,Margaret J Gutilla,Andreas M Neophytou","doi":"10.1016/j.ajog.2025.04.071","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.04.071","url":null,"abstract":"OBJECTIVEAccess to abortion has changed dramatically in the United States in recent years, both at the federal and state level. For nearly fifty years, the right to abortion was considered federally protected right under the Roe v. Wade (1973) recognition of privacy rights under the 14th Amendment. In September 2021, Texas passed SB8 which implemented a 6-week restriction on access to abortion. The following year, in 2022, the Supreme Court issued the Dobbs v. Jackson Women's Health Organization decision. Dobbs reversed Roe v. Wade and shifted determinations about legal access to the states, several of which already had trigger bans awaiting the potential removal of this Constitutional right. To explore how these legal alterations to access are associated with changes in travel into abortion-rights protective states for abortions by residents of abortion-restrictive states, we sought to measure monthly abortion trends. Specifically, our goal is to compare monthly abortion utilization in Colorado by resident status before and after introduction of abortion access restrictions, while adjusting for overall temporal trends.STUDY DESIGNUtilizing monthly count data for induced abortions from the Colorado Department of Health and Environment (CDPHE) from 2018-2024, an interrupted time series analysis was used to assess the association between changes in federal and state law and the number of out-of-state patients traveling to Colorado for abortions. Secondary analysis focused specifically on Texas residents. Quasi-Poisson time series regression models adjusted for time in two ways: first, we used a linear time adjustment to account for any long term trends, and second, we used harmonic terms to account for any seasonal variation present in the data.RESULTSOut-of-state residents were over twice as likely to travel to Colorado after Dobbs compared to before: Rate Ratio (RR): 2.14 (95% confidence interval (CI): 1.54, 2.99, p<0.001). Texas residents were over 7 times more likely to travel to Colorado for abortions after the enactment of SB8. RR: 7.86, (95 % CI: 3.30, 20.09, p<0.001). Although initial spikes in travel to Colorado, particularly by Texas residents, have shown a gradual reduction over time, these patterns have not returned to baseline. This may indicate a long-term shift in how abortion care is provided and obtained in the United States in the wake of changes in the law.COMMENTThere has been a significant increase in the number of patients traveling to Colorado for abortions associated with changes to both federal and state laws, carrying implications for clinicians and patients alike. While some of the initial demand for abortions from out-of-state residents appears to have reduced in Colorado, it has not returned to baseline and may reflect a permanent shift in how and where abortion care is provided.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"50 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic diseases underlying a spectrum of fetal effusions.","authors":"Natalie B Gulrajani,Billie R Lianoglou,Katie Tick,Nuriye N Sahin-Hodoglugil,Ugur Hodoglugil,Patrick Devine,Jessica Van Ziffle,Mary E Norton,Teresa N Sparks","doi":"10.1016/j.ajog.2025.04.072","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.04.072","url":null,"abstract":"INTRODUCTIONNon-immune hydrops fetalis (NIHF) is well understood to be heterogenous and the common endpoint of many genetic diseases. However, less is known about the prevalence and presenting features of genetic diseases that underlie other types of fetal effusions such as single effusions, leaving uncertainty in clinical practice about optimal approaches to testing and counseling for these pregnancies. We aimed to determine the diagnostic yield of exome sequencing (ES) by type of fetal effusion and presence of concurrent structural abnormalities, as well as to identify the unique presenting features of underlying genetic diseases.METHODSWe conducted a prospective cohort study of pregnancies with NIHF and other fetal effusions, with participants enrolled from across the United States. Inclusion criteria were non-diagnostic results of chromosomal microarray and/or karyotype and the presence of at least one fetal effusion, including NT ≥3.5 mm, cystic hygroma, pleural effusion, pericardial effusion, ascites, and/or skin edema. ES was performed by our institution's CLIA-approved laboratory and results were returned to participants and their providers. Detailed fetal phenotypic data were ascertained and used to inform genetic variant interpretation, including fetal imaging findings (ultrasound, MRI, echocardiogram), pathology reports, and laboratory reports. Pregnancies with a variant or variants classified as pathogenic or likely pathogenic were considered diagnostic or positive. The primary outcome was the diagnostic yield of ES by type of fetal effusion, with and without concurrent structural abnormalities. Secondary outcomes were the types of fetal effusions observed by category of genetic disease.RESULTSIn all, 118 pregnancies with NIHF and other effusions underwent ES and 23% (27/118) had positive (diagnostic) findings. Pregnancies with NIHF with and without concurrent structural abnormalities had diagnostic yields of 21% (9/42) and 40% (6/15), respectively (p=0.15). Single effusions such as pleural effusion with and without concurrent structural abnormalities had diagnostic yields of 23% (6/26) and 17% (1/6), respectively (p=0.61). The diagnostic yield for increased NT or cystic hygroma was significantly greater for pregnancies with concurrent structural abnormalities (42%, 5/12) compared to those without (0%, 0/17, p&lt;0.01). We further observed numerous patterns in terms of how genetic diseases present in utero, such as RASopathies and musculoskeletal disorders demonstrating all types of effusions, while other disorders marked by neurodevelopmental delays after birth demonstrated all types of effusions except for NIHF.CONCLUSIONSThe diagnostic yield of ES was high across all types of effusions including single effusions with and without concurrent structural abnormalities, with the exception of isolated increased nuchal translucency or cystic hygroma. Further, we observed numerous patterns in terms of how genetic diseases present in utero wit","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"96 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143933007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Neonatal Survival in Pregnancies undergoing Serial Amnioinfusions for in utero Renal Failure.","authors":"Braxton Forde,Stefanie Riddle,Foong-Yen Lim,David N McKinney,Kara Markham,Mallory Hoffman,Jose L Peiro,Mel Minges,Meredith Schuh,Donna J Claes,Mounira Habli","doi":"10.1016/j.ajog.2025.04.057","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.04.057","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"8 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of Inclusion of Pregnant Individuals in Industry-Funded Clinical Trials : problems raised in oncology and detour solutions.","authors":"Estelle Heggarty,Hadia Moindjie,Paul Berveiller","doi":"10.1016/j.ajog.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.05.001","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"25 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}