American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Comparison of Paired Immunofluorescent Antibody Serology and Real-Time Polymerase Chain Reaction Testing for the Detection of Acute Q Fever among Febrile Patients in Kilimanjaro, Tanzania, 2012-2014.","authors":"Robert J Rolfe, John A Crump, Venance P Maro, Blandina T Mmbaga, Wilbrod Saganda, Bingileki F Lwezaula, Marc Roger Couturier, Weston C Hymas, Jamie L Perniciaro, William L Nicholson, Gilbert J Kersh, Matthew P Rubach","doi":"10.4269/ajtmh.23-0860","DOIUrl":"10.4269/ajtmh.23-0860","url":null,"abstract":"<p><p>Acute Q fever diagnosis via paired serology is problematic because it requires follow-up for convalescent sample collection; as such, it cannot provide a diagnosis to inform a treatment decision at the time of acute presentation. Real-time polymerase chain reaction (PCR) may be a useful approach for the diagnosis of acute Q fever in endemic settings. Among febrile patients enrolled in a sentinel surveillance study for Q fever at two referral hospitals in Moshi, Tanzania, from 2012 to 2014, we analyzed those with paired sera for IgG to Coxiella burnetii (C. burnetii) phase II antigens using immunofluorescent antibody (IFA) testing, and acute serum was tested for C. burnetii with PCR. Acute Q fever was defined as a fourfold or greater rise from the acute to convalescent sample in IFA reciprocal titer or PCR detection that was confirmed through repeat testing. Test characteristics were tabulated. Among 496 participants tested using both paired IFA and PCR testing, 463 (93.3%) tested negative on both IFA and PCR, five (1.0%) tested positive for Q fever on both IFA and PCR, and 28 (5.6%) tested positive for Q fever on IFA alone. The sensitivity of PCR testing using paired IFA testing as an index was 0.15 (5/33), and the specificity was 1 (463/463). C. burnetii PCR testing provides a clinically specific method that may aid in timely diagnosis in settings in which acute Q fever is a common cause of febrile illness. However, we found a low clinical sensitivity of PCR testing on serum when compared with paired IFA serology.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"533-538"},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913735","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":"Investigating Environmental Determinants of Hookworm Transmission using GPS Tracking and Metagenomics Technologies.","authors":"Jeffrey Gabriel Sumboh, Kwasi Agyenkwa-Mawuli, Eyram Schwinger, Irene Owusu Donkor, Jewelna Akorli, Duah Dwomoh, Yvonne Ashong, Dickson Osabutey, Felix Owusu Ababio, Olivia Nusbaum, Debbie Humphries, Michael Cappello, Kwadwo Ansah Koram, Samuel K Kwofie, Michael D Wilson","doi":"10.4269/ajtmh.24-0384","DOIUrl":"10.4269/ajtmh.24-0384","url":null,"abstract":"<p><p>To identify potential sources of hookworm infections in a Ghanaian community of endemicity that could be targeted to interrupt transmission, we tracked the movements of infected and noninfected persons to their most frequented locations. Fifty-nine participants (29 hookworm positives and 30 negatives) wore GPS trackers for 10 consecutive days. Their movement data were captured in real time and overlaid on a community grid map. Soil samples were collected and divided into two parts: one for determining the physical and chemical properties and the other for culture of helminth larvae. Soil parameters were determined using standard methods, and the number of larvae recovered from Baermann cultures (expressed as larvae per gram of soil) was recorded. We found no significant difference in the larval counts between sites of infected and noninfected participants (P = 0.59). Sandy-loam soil, pH, and effective cation exchange capacity were associated with high larval recovery counts (P <0.001), whereas nitrogen and clay content were associated with low counts (P <0.001). Genomic DNA was extracted from helminth larvae, and species were identified using metagenomic analysis of DNA sequences. The dominant helminth species identified were Panagrolaimus superbus, Parastrongyloides trichosuri, Trichuris trichiura (human whipworm), and Ancylostoma caninum (dog hookworm). Despite Necator americanus being the predominant species in the community, no larvae of this species were identified. This study, however, demonstrates the feasibility of applying molecular tools for identifying environmental factors and places associated with exposure to human and zoonotic helminths, including areas that may be targeted to break transmission in communities where infection is endemic.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"561-570"},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998740","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":"A Rapid On-Site Detection Method for Plasmodium falciparum Carried by Mosquitoes Using Disc Microfluidic Isothermal Amplification.","authors":"Ning Jiang, Jie Bai, Wenqi Shan, Qiuming Zhou, Haowei Dong, Hao Yuan, Wenbing Zhong, Xiangyu Li, Yajun Ma, Ping Li, Heng Peng","doi":"10.4269/ajtmh.24-0599","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0599","url":null,"abstract":"<p><p>Rapidly identifying Anopheles-carrying malaria parasites is crucial for imported malaria prevention. However, suitable methods still lack quick detection in limited-resource situations. In this study, disc microfluidic isothermal amplification integrating loop-mediated isothermal amplification (LAMP) and microfluidic chip technology were applied to develop rapid and precise detection with low resource requirements. Primer set EMP1G2, which is specific to Plasmodium falciparum (P. falciparum) erythrocyte membrane protein 1, and primer set 18sG2, which is specific to ribosomal 18s subunit RNA, were screened for optimal LAMP-specific primer sets. The minimum detection limits were 125 copies/µL for the EMP1G2 and 6,562 copies/µL for the 18sG2. Subsequently, optimal primer sets were evaluated for specificity with nucleic acid from other mosquito-borne pathogens and arthropod vectors. No nonspecific amplification was observed in optimal amplification-specific primer sets with the DNA of Anopheles mosquitoes and morphologically similar arthropods or with the copy DNA of Zika virus, yellow fever virus, or dengue virus 1. The detection method was evaluated in a simulated scenario and demonstrated a robust capacity for rapid on-site detection. Additionally, polymerase chain reaction (PCR) and quantitative real-time PCR methods were compared using this method. In this study, a rapid detection method based on disc microfluidic isothermal amplification was developed that could be used to detect P. falciparum carried by mosquitoes in a field setting under limited resource conditions.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mpox Recrudescence after SARS-CoV-2 Coinfection in a Patient with AIDS.","authors":"Yaqing Liu, Shi Zou, Shihui Song, Yingcai Wan, Jianbo Wu, Mingqi Luo, Wei Guo, Ke Liang","doi":"10.4269/ajtmh.24-0304","DOIUrl":"10.4269/ajtmh.24-0304","url":null,"abstract":"<p><p>People living with HIV (PLWH) are known to exhibit more severe or prolonged symptoms of mpox (formerly monkeypox). However, the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on PLWH with mpox has not been adequately described. We report a case of mpox in an AIDS patient who had recurrent symptoms due to SARS-CoV-2 infection. The patient presented with a low CD4+ lymphocyte count (CD4 count) without antiretroviral therapy (ART) and suffered from severe mpox. The ART was initiated 17 days after the diagnosis of mpox, and the patient's skin lesions began crusting after 1 week of ART. However, after a SARS-CoV-2 infection, the mpox flared up again. The patient presented with more severe symptoms than those during the initial bout and with rectal involvement. We speculate that SARS-CoV-2 infection might cause a recrudescence of mpox in AIDS patients, which requires further investigation.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"677-681"},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913739","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":"Successful Treatment of Chromoblastomycosis caused by Cladophialophora carrionii with Itraconazole: Clinicopathology, Susceptibility, and Molecular Identification of a Case in Northern China.","authors":"Yalong Li, Yinggai Song, Aiping Wang","doi":"10.4269/ajtmh.24-0651","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0651","url":null,"abstract":"<p><p>Chromoblastomycosis (CBM), a prevalent subcutaneous mycosis in tropical and subtropical regions caused by dematiaceous fungi, often presents as refractory lesions. This case report details a 63-year-old woman from Tianjin, China, with CBM caused by Cladophialophora carrionii after plant trauma. Successful treatment with itraconazole was performed. After 3 months, the lesions improved significantly. The case highlights the importance of accurate diagnosis and tailored antifungal therapy, as well as the need for long-term follow-up because of the chronic nature of the disease.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Magnetic Resonance Imaging Findings in Hepatic Fascioliasis and Serological and Radiological Response After Triclabendazole Treatment.","authors":"Eun Jeong Won, Kyung-Won Kim, Eui-Jin Chang, Seongman Bae, Jiwon Jung, Yong Pil Chong, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Sung-Han Kim, Min Jae Kim","doi":"10.4269/ajtmh.24-0162","DOIUrl":"10.4269/ajtmh.24-0162","url":null,"abstract":"<p><p>Fascioliasis, a food-borne trematodiasis, is a disease primarily identified in livestock, such as sheep and cattle. Human fascioliasis has been reported sporadically in Korea, but a recent increase in patients has been associated with a green vegetable juice delivery service. We aimed to investigate the serological and radiological findings of the patients treated for fascioliasis. Patients with peripheral eosinophilia, which is a positive antibody for Fasciola hepatica (F. hepatica) and liver abscess, were considered to have fascioliasis and were treated with triclabendazole at a dose of 10 mg/kg, administered twice. A total of 21 patients diagnosed with fascioliasis were included. Patients were categorized into the early and late diagnosis groups according to the time gap between the presentation and diagnosis. A comparison of initial magnetic resonance imaging (MRI) between the two groups revealed a filling defect of the bile duct that was more commonly observed in the late diagnosis group (72.7% versus 0%; P = 0.003). Hepatic abscess lesions resolved slowly, with 14.3%, 50%, and 85.7% of patients showing complete resolution on computed tomography 6, 12, and 24 months after treatment, respectively. The mean levels of anti-F. hepatica antibodies decreased after a 6-month follow-up (mean levels, onset versus 6-month, 12-month, or 24-month follow-up; 4.36 versus 3.29, 3.17, or 2.31, respectively; all P <0.01). Eosinophil counts reduced significantly 1 month after treatment and remained normal thereafter in both groups. This study suggests that MRI could be useful for diagnosing fascioliasis in a subgroup of patients and that hepatic abscesses and positive antibody results could last for several months after treatment.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"577-580"},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913738","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":"Geospatial Analysis of Multilevel Socioenvironmental Factors Impacting the Campylobacter Burden among Infants in Rural Eastern Ethiopia: A One Health Perspective.","authors":"Xiaolong Li, Dehao Chen, Song Liang, Jemal Y Hassen, Sarah L McKune, Arie H Havelaar, Jason K Blackburn","doi":"10.4269/ajtmh.24-0401","DOIUrl":"10.4269/ajtmh.24-0401","url":null,"abstract":"<p><p>Increasing attention has focused on health outcomes of Campylobacter infections among children younger than 5 years in low-resource settings. Recent evidence suggests that colonization by Campylobacter species contributes to environmental enteric dysfunction, malnutrition, and growth faltering in young children. Campylobacter species are zoonotic, and factors from humans, animals, and the environment are involved in transmission. Few studies have assessed geospatial effects of environmental factors along with human and animal factors on Campylobacter infections. Here, we leveraged Campylobacter Genomics and Environmental Enteric Dysfunction project data to model multiple socioenvironmental factors on Campylobacter burden among infants in eastern Ethiopia. Stool samples from 106 infants were collected monthly from birth through the first year of life (December 2020-June 2022). Genus-specific TaqMan real-time polymerase chain reaction was performed to detect and quantify Campylobacter spp. and calculate cumulative Campylobacter burden for each child as the outcome variable. Thirteen regional environmental covariates describing topography, climate, vegetation, soil, and human population density were combined with household demographics, livelihoods/wealth, livestock ownership, and child-animal interactions as explanatory variables. We dichotomized continuous outcome and explanatory variables and built logistic regression models for the first and second halves of the infant's first year of life. Infants being female, living in households with cattle, reported to have physical contact with animals, or reported to have mouthed soil or animal feces had increased odds of higher cumulative Campylobacter burden. Future interventions should focus on infant-specific transmission pathways and create adequate separation of domestic animals from humans to prevent potential fecal exposures.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"506-517"},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913737","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":"Cross-Protection between West Nile Virus and Emerging Flaviviruses in Wild Birds.","authors":"Angela M Bosco-Lauth, Kris Kooi, Seth A Hawks, Nisha K Duggal","doi":"10.4269/ajtmh.24-0363","DOIUrl":"10.4269/ajtmh.24-0363","url":null,"abstract":"<p><p>West Nile virus (WNV), St. Louis encephalitis virus (SLEV), and Usutu virus (USUV) are zoonotic flaviviruses that cause neuroinvasive disease in humans and are maintained in overlapping avian-mosquito transmission cycles. West Nile virus and SLEV cocirculate in the United States, and WNV and USUV cocirculate in Europe. Cross-reactivity of immune responses against closely related flaviviruses is well documented. In birds, prior infection with WNV provides strong protection against SLEV genotype II and V infection, which may explain the decrease in SLEV circulation in the United States after WNV emergence in 1999. However, in 2015, a new SLEV genotype (III) emerged in the United States, suggesting that WNV immunity in birds may not provide cross-protection against this SLEV genotype. Here, we tested whether prior WNV infection protects birds against infection with SLEV genotype III, as well as USUV. First, we established a house sparrow (Passer domesticus) model of infection for SLEV genotype III. We then inoculated house sparrows with WNV and, 4 weeks later, challenged WNV-immune birds with SLEV genotype III or USUV. All birds were completely protected against secondary challenge, with no viremia detected. Low levels of cross-neutralizing antibodies against SLEV and USUV were found in the blood prior to secondary challenge. However, two naturally WNV-exposed house sparrows did develop SLEV genotype III and USUV viremia after inoculation. These results indicate that experimental WNV infection may protect birds against infection with SLEV genotype III and USUV; however, additional studies to investigate the role of avian immunity in flavivirus emergence are necessary.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"657-662"},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913736","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":"Care-Seeking Action after Helicobacter pylori Testing among a High-Risk Indigenous Population: A Cross-Sectional Study Follow-up.","authors":"Heidi E Brown, Krystelle Boyd, Melissa Howard, Denver Seaton, Rachelle L Begay, Priscilla R Sanderson, Robin B Harris","doi":"10.4269/ajtmh.24-0393","DOIUrl":"10.4269/ajtmh.24-0393","url":null,"abstract":"<p><p>Helicobacter pylori is one of the most common infectious agents linked to any malignancy. Recent studies report higher H. pylori prevalence and gastric cancer incidence rates in the Navajo Nation than in general U.S. populations. Little is known about barriers to care and treatment. Participants of the 2022 Navajo Healthy Stomach Project who had a positive urea breath test for H. pylori were contacted after 6 months to assess health care services sought, treatment received, and barriers to accessing care. Descriptive statistics identified perceived barriers to care seeking and treatment. Of individuals consented to recontact, 83 were surveyed (69.8% response rate). Just over half (52.8%) reported following up with an allopathic clinician. The most common reasons for not seeking care were lack of time (37.5%) and forgetting (25.0%). Care seeking was more common among those who felt that H. pylori was linked to their gastrointestinal symptoms (P = 0.03) or those less concerned about adverse effects of antibiotics (P = 0.07). Community engagement throughout the research process and intentionally sharing research finding with communities may be strategies to reduce barriers to care seeking after a positive H. pylori infection diagnosis.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"518-524"},"PeriodicalIF":1.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142884955","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":"Pericardial Abscess Due to Salmonella Typhi Infection.","authors":"Manli Zhang, Chunming Gao","doi":"10.4269/ajtmh.24-0441","DOIUrl":"10.4269/ajtmh.24-0441","url":null,"abstract":"<p><p>Typhoid fever is a human-specific disease caused by subspecies of Salmonella enterica (Salmonella Typhi). It spreads through ingestion of contaminated food or water and is diagnosed through blood culture or bone marrow culture. It typically presents as an intestinal infection, with a few patients developing severe disseminated infections. Here, we report a rare case of purulent pericarditis secondary to S. Typhi infection. A 67-year-old elderly male suffered from recurrent fever, diarrhea, and abdominal pain for 7 days. Initial blood and stool cultures were positive for Salmonella, and a follow-up blood culture confirmed S. Typhi. Magnetic resonance imaging showed pericardial abscess and hepatic abscess. After pericardiocentesis, the pericardial fluid culture grew S. Typhi, confirming the diagnosis of pericardial abscess secondary to S. Typhi infection. After percutaneous drainage of the pericardial abscess and administration of effective antibiotics, the patient's symptoms improved significantly. He subsequently recovered and was discharged from the hospital. During follow-up, there were no further recurrences. Disseminated infection secondary to Salmonella Typhi is extremely rare but can lead to serious life-threatening conditions. Our patient was found to have pericardial abscess caused by S. Typhi. Effective and adequate antibiotics, along with pericardial abscess drainage, can improve symptoms, assist in diagnosis, and enhance quality of life.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"544-547"},"PeriodicalIF":1.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885019","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}