Anaesthesia最新文献

{"title":"Efficacy and safety of intrathecal diamorphine: replies","authors":"Eric Albrecht,&nbsp;Sina Grape,&nbsp;Kariem El-Boghdadly","doi":"10.1111/anae.16623","DOIUrl":"10.1111/anae.16623","url":null,"abstract":"<p>We thank Drs Xu and Rong [<span>1</span>] and Drs Leslie and Stranix [<span>2</span>] for their comments regarding our systematic review and meta-analysis exploring the efficacy and safety of intrathecal diamorphine [<span>3</span>].</p><p>Drs Xu and Rong correctly highlighted that the figure we initially presented regarding the risk of bias assessment of the included trials was not derived from the Cochrane Collaboration's Risk of Bias tool 2 (RoB2) [<span>1</span>], but rather RoB1. Whilst this was an oversight, and represents an educational opportunity for many readers, we fully agree with their observation and are pleased to now present the appropriate figure (Fig. 1) for included studies (online Supporting Information Appendix S1).</p><p>Drs. Leslie and Stranix share their experience with intrathecal diamorphine, reporting doses ranging from 0.4 to 1.0 mg with good efficacy and a 10% incidence of postoperative nausea and vomiting [<span>2</span>]. While they acknowledge the need for further trials, they also note the challenge of convincing colleagues to adjust their practices, even in the context of prospective trial results. However, clinical practice should be guided by robust evidence rather than personal experience. We, therefore, encourage Drs. Leslie and Stranix to collect prospective data and publish their results for the benefit of patients across the UK where diamorphine is used commonly. Indeed, as a drug that is used commonly in the UK, it is disappointing that only 12 trials have been published over the past 35 years. We encourage clinicians and researchers to conduct dose–response studies urgently to better define the efficacy and safety profiles of intrathecal diamorphine.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"724-725"},"PeriodicalIF":7.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescuing the stylet: how technique can close the gap in hyperangulated videolaryngoscopy","authors":"Chiung-Fang Hsu, Shu-Yueh Cheng, Ming-Hui Hung","doi":"10.1111/anae.16626","DOIUrl":"https://doi.org/10.1111/anae.16626","url":null,"abstract":"&lt;p&gt;The trial by Taboada et al. [&lt;span&gt;1&lt;/span&gt;] showed superior first-attempt tracheal intubation success with a flexible-tip bougie compared with a stylet when using a hyperangulated videolaryngoscope in patients who were critically ill. While the manoeuvrability of the bougie offers advantages, we believe that the results also highlight how adjustments in technique could improve stylet performance substantially, rescuing it from perceived inferiority.&lt;/p&gt;\u0000&lt;p&gt;Taboada et al. shaped the stylet with a 30–40° angulation in the distal 5 cm of the tracheal tube (‘hockey stick’ shape) [&lt;span&gt;2&lt;/span&gt;]. This shape is used commonly for direct laryngoscopy or Macintosh videolaryngoscopy but may not replicate the curvature of hyperangulated blades such as the C-MAC® D-Blade (Karl Storz Endoscopy-America, Inc., El Segundo, CA, USA) used in the study. In contrast, Köhl et al. used the same videolaryngoscope with the manufacturer-designed hyperangulated stylet (C-MAC Guide™), achieving a 99% first-attempt success rate in patients with anticipated difficult airways [&lt;span&gt;3&lt;/span&gt;]. This suggests that mismatched blade-stylet geometry, rather than intrinsic limitations of the stylet, may have contributed to the lower success observed in the stylet group in the study by Taboada et al.&lt;/p&gt;\u0000&lt;p&gt;Notably, both groups achieved excellent glottic visualisation (modified Cormack and Lehane grade 1 view in 96% of the bougie group and 90% in the stylet group). Despite this, the stylet group had a lower first-attempt tracheal intubation success rate (83% vs. 99%) and a higher rate of laryngeal manipulation (31% vs. 10%). These findings support previous observations that overexposure of the glottis may hinder tube delivery by increasing the angle between the tracheal tube and tracheal inlet [&lt;span&gt;2, 4&lt;/span&gt;]. A full glottic view is not always favourable; deliberate limitation of blade insertion to achieve a grade 2a or 2b view may, paradoxically, make tracheal intubation easier, especially when using a stylet. Gu et al. showed that limiting glottic exposure improved tracheal intubation speed and ease, despite similar overall success rates [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;While flexible-tip bougies are useful adjuncts, they are not available in many clinical environments. In such settings, technique becomes paramount. A practical alternative involves shaping a standard malleable stylet to match the blade's curvature, limiting blade insertion depth to avoid excessive angulation and withdrawing the stylet as the tracheal tube passes the vocal cords. These pragmatic, evidence-based refinements [&lt;span&gt;2-4&lt;/span&gt;] may help close the performance gap between bougie and stylet, particularly in environments where specialised equipment is unavailable.&lt;/p&gt;\u0000&lt;p&gt;In summary, the work of Taboada et al. provides valuable insight into how performance differences between adjuncts may reflect not only device characteristics but also how those devices are used. Emphasising these pragmatic refinements c","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"8 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884995","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":"Culture of excellence or culture of control?","authors":"Reginald Edward","doi":"10.1111/anae.16629","DOIUrl":"https://doi.org/10.1111/anae.16629","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"11 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884703","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":"Improving tracheal intubation outcomes requires deeper analysis of the three axes of tracheal tube orientation","authors":"Erich B. Schulz","doi":"10.1111/anae.16625","DOIUrl":"https://doi.org/10.1111/anae.16625","url":null,"abstract":"&lt;p&gt;I read with interest the network meta-analysis examining the relative performance of modern videolaryngoscopes by de Carvalho et al. [&lt;span&gt;1&lt;/span&gt;]. The authors' call to action includes identifying strategies to translate better glottic visualisation into improved tracheal intubation efficacy. This call is most compelling in emergency tracheal intubations by relatively inexperienced non-anaesthetists in out-of-hospital or emergency department contexts [&lt;span&gt;2&lt;/span&gt;]. Maximising the value of limited opportunities for first responders to practise tracheal intubation in controlled environments is crucial for improving field outcomes.&lt;/p&gt;\u0000&lt;p&gt;Peyton's teaching approach has been shown to speed learning and aid retention, particularly in small group or individual teaching environments [&lt;span&gt;3&lt;/span&gt;]. This requires deconstructing and describing each step in a procedure precisely, followed by allowing the trainee to test their understanding by describing back the steps before completing the task themselves. We need to deconstruct the step of positioning and orienting the tracheal tube in order to pass it through the glottis, as a startling number of tracheal intubation attempts fail despite a full view of the cords. The complexity of this step appears to have gone unrecognised. Positioning and orienting an object in a three-dimensional space requires a total of six different numbers, each with a specific zero reference. While clinical language covers the three dimensions of position (left/right; anterior/posterior; and superior/inferior) the three axes of rotation of a free-floating object like a tracheal tube are not. The terms pitch, roll and yaw, originally from sailing but popularised by aviation, describe the three distinct rotations.&lt;/p&gt;\u0000&lt;p&gt;Some studies have investigated the rotation of hands during tracheal intubation [&lt;span&gt;4&lt;/span&gt;], but there is limited research on the orientation of the tracheal tube itself. There is no published analysis of the interactions between each of the three rotations of a curved tracheal tube with a curved laryngoscope blade and maxillary dental arch during tracheal intubation. The orientation of the tracheal tube and the pressure at the tube-blade contact point significantly influence the anteroposterior position of the tracheal tube tip at the level of the glottis [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Overall, there seems to be an underlying assumption that correct tracheal tube three-dimensional orientation either develops with experience, as an unteachable competence, or can be circumvented by equipment modifications. Numerous studies show that relying on trainees to gain proficiency after 50–100 tracheal intubations leaves non-anaesthetists under-prepared for emergency tracheal intubations.&lt;/p&gt;\u0000&lt;p&gt;In my experience, the most common observable orientation error with a standard Macintosh blade is bending the proximal tracheal tube cephalad over the upper teeth. Despite this leading to a predictable posterior deflection ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"39 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885077","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":"Postoperative intravenous iron: haemoglobin gains are clear, but do they translate to clinical benefit?","authors":"Reginald Edward","doi":"10.1111/anae.16628","DOIUrl":"https://doi.org/10.1111/anae.16628","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"18 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884700","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":"Assessing healthcare simulation facilitation using a competency-based tool derived from practice in low-resource settings","authors":"Adam I. Mossenson, Janie A. Brown, Eugene Tuyishime, Rodrigo Rubio Martinez, Karima Khalid, Patricia Livingston","doi":"10.1111/anae.16621","DOIUrl":"https://doi.org/10.1111/anae.16621","url":null,"abstract":"The worldwide expansion in healthcare simulation training includes accelerated uptake in low-resource settings. Until recently, no framework has specifically delineated the competencies underpinning effective facilitation practice in low-resource settings. We describe the development of the Facilitation Behavioural Assessment Tool for simulation facilitation training and report reliability in scoring facilitation performance. This tool was informed by healthcare simulation facilitation practice in low-resource settings.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"36 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885079","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":"Temporal characteristics of remimazolam-induced sedation in paediatric anaesthesia: a reply","authors":"Yu-Bo Fang,&nbsp;Hua-Cheng Liu","doi":"10.1111/anae.16615","DOIUrl":"10.1111/anae.16615","url":null,"abstract":"<p>We appreciate the insightful commentary from Li et al. [<span>1</span>]. In our multicentre trial, the median time to loss of consciousness during induction of anaesthesia was 45 s and 25 s, for children aged 3–6 y receiving 0.3 mg.kg^-1 remimazolam vs. 2.5 mg.kg^-1 propofol, respectively [<span>2</span>]. Although the pharmacokinetic simulation from Li et al. suggests increased drug efficacy, our findings regarding time to loss of consciousness were consistent with previous paediatric research [<span>3</span>]. The use of remimazolam monotherapy for anaesthetic induction did indeed necessitate higher doses [<span>4</span>]. Notably, opioid co-administration can reduce the dose of sedative drugs, and our protocol for anaesthesia induction included intravenous administration of 3 μg.kg^-1 fentanyl 3 min before injection of the study drugs. Consequently, we observed a Modified Observer's Assessment of Alertness/Sedation score of 3 or 2 in some patients before injection of the study drugs. This sequential approach was designed specifically to synchronise tracheal intubation with the peak opioid analgesic effect, accounting for known pharmacokinetic variability in paediatric populations.</p><p>Regarding the methods, our protocol mandated randomised administration of initial bolus doses; an injection duration &lt; 60 s; and a standardised assessment of loss of consciousness with no response to gentle shoulder shaking. Consequently, establishing robust temporal pharmacokinetic-pharmacodynamic models between sedative drug administration and loss of consciousness through covariate-adjusted analyses (e.g. age, sex and BMI) using both linear and logistic regression approaches is crucial in optimising safe and effective anaesthetic induction in paediatric anaesthesia.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"732"},"PeriodicalIF":7.5,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16615","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating ventilator settings as related to mechanical power: tidal volume vs. respiratory rate dynamics","authors":"Mohamad F. El-Khatib, Robert L. Chatburn","doi":"10.1111/anae.16616","DOIUrl":"https://doi.org/10.1111/anae.16616","url":null,"abstract":"&lt;p&gt;We read with great interest the article by Buiteman-Kruizinga et al. [&lt;span&gt;1&lt;/span&gt;] which investigated the effect of individual components of mechanical ventilation on mechanical power and provided evidence that the respiratory rate may be the most attractive ventilator setting to adjust when targeting a lower mechanical power. The authors utilised data from three randomised clinical trials that involved patients receiving invasive mechanical ventilation in the form of either volume- or pressure-controlled ventilation for reasons other than acute respiratory distress syndrome (ARDS). In addition, the authors grouped the patients by an upper quartile cut-point of 17 J.min&lt;sup&gt;-1&lt;/sup&gt; for mechanical power but did not segregate patients based on the mode of mechanical ventilation utilised.&lt;/p&gt;\u0000&lt;p&gt;This exploration aligns well with our study in which we modelled the effects of individual ventilator settings such as tidal volume, respiration rate and positive end-expiratory pressure on mechanical power across various ventilation modes and ARDS severity using a mathematical simulator [&lt;span&gt;2&lt;/span&gt;]. Some of our findings align well with those of Buiteman-Kruizinga et al. However, our data showed that tidal volume reduction may be the most effective and consistent strategy for reducing mechanical power to ≤ 17 J.min&lt;sup&gt;-1&lt;/sup&gt;, especially under volume-controlled ventilation with constant flow, which yielded the lowest mechanical power compared with pressure-controlled ventilation and descending ramp volume-controlled ventilation.&lt;/p&gt;\u0000&lt;p&gt;Notably, Buiteman-Kruizinga et al. emphasised respiratory rate as a prime target to lower mechanical power in patients without ARDS, whereas our modelling data suggest tidal volume reduction is more efficient in simulated ARDS scenarios. An obvious reason for this divergence is the fact that the patients in the study by Buiteman-Kruizinga et al. did not have ARDS while our study included simulated patients with mild, moderate and severe ARDS. However, we believe another important reason may be the fact that Buiteman-Kruizinga et al. did not segregate patients based on the mode of mechanical ventilation but mixed mechanical power values obtained under volume- and pressure-controlled ventilation despite mechanical power being expressed differently under these two widely used modes of mechanical ventilation [&lt;span&gt;3&lt;/span&gt;]. While respiration rate is reflected as directly proportional to mechanical power in both expressions under volume- and pressure-controlled ventilation, tidal volume is not only reflected as directly proportional to mechanical power but also may be reflected through its indirect effect on driving pressure and peak airway pressure that are included in mechanical power expressions. For the same simulated lung mechanics, our data showed that volume-controlled ventilation results in lower generated mechanical power compared with pressure control given the same tidal volume and breathing frequency. Al","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"91 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853636","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":"Stress, strain and mechanical power: a reply","authors":"Laura A. Buiteman-Kruizinga","doi":"10.1111/anae.16617","DOIUrl":"https://doi.org/10.1111/anae.16617","url":null,"abstract":"&lt;p&gt;We thank Fajardo-Campoverdi et al. for their letter [&lt;span&gt;1&lt;/span&gt;] and appreciate the insightful comments regarding our study about the effect of rate reduction on the amount of mechanical power [&lt;span&gt;2&lt;/span&gt;]. The authors raise an interesting point about the potential influence of the way of flow delivery, whether constant or decelerated, on mechanical power.&lt;/p&gt;\u0000&lt;p&gt;We acknowledge that the method of inspiratory flow delivery can be a relevant factor in energy transfer within the respiratory system. The viscoelastic properties of lung tissue suggest that cyclic deformation, influenced by flow patterns, might contribute to mechanical power and tissue strain. Importantly, energy transfer is not solely determined by peak pressures but also by other parameters and the duration of the respiratory cycle [&lt;span&gt;3&lt;/span&gt;]. Although our analysis did not examine the effects of inspiratory flow delivery explicitly, these are, to some extent, captured in the mechanical power equation through peak pressure, which is influenced by flow patterns and resistive pressure components.&lt;/p&gt;\u0000&lt;p&gt;We divided our analysed cohort into patients who received volume-controlled ventilation (n = 920) and those who received pressure-controlled ventilation (n = 812). We then repeated the analysis by creating four subgroups, each for tidal volume and respiratory rate and for peak pressure and respiratory rate. Mechanical power levels were visualised using cumulative distribution graphs for each subgroup. We observed no differences between the two ventilation modes, both in terms of the absolute mechanical power levels and differences in the four subgroups (Fig. 1).&lt;/p&gt;\u0000&lt;figure&gt;&lt;picture&gt;\u0000&lt;source media=\"(min-width: 1650px)\" srcset=\"/cms/asset/5b647d2c-613f-47e6-af22-3502d9e1743b/anae16617-fig-0001-m.jpg\"/&gt;&lt;img alt=\"Details are in the caption following the image\" data-lg-src=\"/cms/asset/5b647d2c-613f-47e6-af22-3502d9e1743b/anae16617-fig-0001-m.jpg\" loading=\"lazy\" src=\"/cms/asset/f653d79e-aa47-433f-be14-7fdaae225cac/anae16617-fig-0001-m.png\" title=\"Details are in the caption following the image\"/&gt;&lt;/picture&gt;&lt;figcaption&gt;\u0000&lt;div&gt;&lt;strong&gt;Figure 1&lt;span style=\"font-weight:normal\"&gt;&lt;/span&gt;&lt;/strong&gt;&lt;div&gt;Open in figure viewer&lt;i aria-hidden=\"true\"&gt;&lt;/i&gt;&lt;span&gt;PowerPoint&lt;/span&gt;&lt;/div&gt;\u0000&lt;/div&gt;\u0000&lt;div&gt;Cumulative distribution plots of mechanical power in four groups, divided into two ventilation modes. (a) Dark blue, low tidal volume (V&lt;sub&gt;T&lt;/sub&gt;) and low respiratory rate; green, high V&lt;sub&gt;T&lt;/sub&gt; and low respiratory rate; red, low V&lt;sub&gt;T&lt;/sub&gt; and high respiratory rate; light blue, high V&lt;sub&gt;T&lt;/sub&gt; and high respiratory rate, in patients who received volume-controlled ventilation. (b) Dark blue, low peak pressure (Ppeak) and low respiratory rate; red, low Ppeak and high respiratory rate; green, high Ppeak and low respiratory rate; light blue, high Ppeak and high respiratory rate, in patients who received volume-controlled ventilation. (c) Dark blue, low tidal volume (V&lt;sub&gt;T&lt;/sub&gt;) and low respi","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"72 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853637","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":"Separating the signal from the noise: how mortality rate associated with hip fracture changes over time after accounting for population level mortality rates","authors":"James R. G. Womersley","doi":"10.1111/anae.16622","DOIUrl":"10.1111/anae.16622","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"720-721"},"PeriodicalIF":7.5,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853649","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}