Annals of Internal Medicine最新文献

{"title":"H5N1 Influenza: What Physicians Need to Know.","authors":"Christine Laine,Amir Qaseem,Darilyn V Moyer,Deborah Cotton","doi":"10.7326/annals-24-02440","DOIUrl":"https://doi.org/10.7326/annals-24-02440","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":39.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215509","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":"Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause.","authors":"","doi":"10.7326/annals-24-00610-ps","DOIUrl":"https://doi.org/10.7326/annals-24-00610-ps","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":39.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215504","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":"Guidelines Recommending That Clinicians Advise Patients on Lifestyle Changes: A Popular but Questionable Approach to Improve Public Health.","authors":"Minna Johansson,Amanda Niklasson,Loai Albarqouni,Karsten Juhl Jørgensen,Gordon Guyatt,Victor M Montori","doi":"10.7326/annals-24-00283","DOIUrl":"https://doi.org/10.7326/annals-24-00283","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":39.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215507","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":"Complementary and Alternative Therapies for Genitourinary Syndrome of Menopause : An Evidence Map.","authors":"Kristen E Ullman,Susan Diem,Mary L Forte,Kristine Ensrud,Catherine Sowerby,Nicholas Zerzan,Maylen Anthony,Adrienne Landsteiner,Nancy Greer,Mary Butler,Timothy J Wilt,Elisheva R Danan","doi":"10.7326/annals-24-00603","DOIUrl":"https://doi.org/10.7326/annals-24-00603","url":null,"abstract":"BACKGROUNDWomen seeking nonhormonal interventions for vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM) may seek out complementary and alternative medicine or therapies (CAMs).PURPOSETo summarize published evidence of CAMs for GSM.DATA SOURCESOvid MEDLINE, EMBASE, and CINAHL from inception through 11 December 2023.STUDY SELECTIONRandomized controlled trials (RCTs) 8 weeks or more in duration that evaluated the effectiveness or harms of CAMs for postmenopausal women with GSM and reported 1 or more outcomes of interest, with sample sizes of 20 or more participants randomly assigned per group.DATA EXTRACTIONData were abstracted by 1 reviewer and verified by a second.DATA SYNTHESISAn evidence map approach was used to organize and describe trials. Studies were organized by type of intervention, with narrative summaries for population, study characteristics, interventions, and outcomes. Fifty-seven trials were identified that investigated 39 unique interventions. Studies were typically small (n < 200), and most were done in Iran (k = 24) or other parts of Asia (k = 9). Few trials evaluated similar combinations of populations, interventions, comparators, or outcomes. Most studies (k = 44) examined natural products (that is, herbal or botanical supplements and vitamins), whereas fewer reported on mind and body practices (k = 6) or educational programs (k = 7). Most studies reported 1 or 2 GSM symptoms, mainly sexual (k = 44) or vulvovaginal (k = 30). Tools used to measure outcomes varied widely. Most trials reported on adverse events (k = 33).LIMITATIONSOnly English-language studies were used. Effect estimates, risk of bias, and certainty of evidence were not assessed.CONCLUSIONThere is a large and heterogeneous literature of CAM interventions for GSM. Trials were small, and few were done in North America. Standardized population, intervention, comparator, and outcomes reporting in future RCTs are needed.PRIMARY FUNDING SOURCEAgency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684).","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":39.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215506","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 Between Hospital Type and Resilience During COVID-19 Caseload Stress : A Retrospective Cohort Study.","authors":"Maniraj Neupane,Sarah Warner,Alex Mancera,Junfeng Sun,Christina Yek,Sadia H Sarzynski,Roxana Amirahmadi,Mary Richert,Emad Chishti,Morgan Walker,Bruce J Swihart,Steven H Mitchell,John Hick,Bram Rochwerg,Eddy Fan,Cumhur Y Demirkale,Sameer S Kadri","doi":"10.7326/m24-0869","DOIUrl":"https://doi.org/10.7326/m24-0869","url":null,"abstract":"BACKGROUNDImbalances between hospital caseload and care resources that strained U.S. hospitals during the pandemic have persisted after the pandemic amid ongoing staff shortages. Understanding which hospital types were more resilient to pandemic overcrowding-related excess deaths may prioritize patient safety during future crises.OBJECTIVETo determine whether hospital type classified by capabilities and resources (that is, extracorporeal membrane oxygenation [ECMO] capability, multiplicity of intensive care unit [ICU] types, and large or small hospital) influenced COVID-19 volume-outcome relationships during Delta wave surges.DESIGNRetrospective cohort study.SETTING620 U.S. hospitals in the PINC AI Healthcare Database.PARTICIPANTSAdult inpatients with COVID-19 admitted July to November 2021.MEASUREMENTSHospital-months were ranked by previously validated surge index (severity-weighted COVID-19 inpatient caseload relative to hospital bed capacity) percentiles. Hierarchical models were used to evaluate the effect of log-transformed surge index on the marginally adjusted probability of in-hospital mortality or discharge to hospice. Effect modification was assessed for by 4 mutually exclusive hospital types.RESULTSAmong 620 hospitals recording 223 380 inpatients with COVID-19 during the Delta wave, there were 208 ECMO-capable, 216 multi-ICU, 36 large (≥200 beds) single-ICU, and 160 small (<200 beds) single-ICU hospitals. Overall, 50 752 (23%) patients required admission to the ICU, and 34 274 (15.3%) died. The marginally adjusted probability for mortality was 5.51% (95% CI, 4.53% to 6.50%) per unit increase in the log surge index (strain attributable mortality = 7375 [CI, 5936 to 8813] or 1 in 5 COVID-19 deaths). The test for interaction showed no difference (P = 0.32) in log surge index-mortality relationship across 4 hospital types. Results were consistent after excluding transferred patients, restricting to patients with acute respiratory failure and mechanical ventilation, and using alternative strain metrics.LIMITATIONResidual confounding.CONCLUSIONComparably detrimental relationships between COVID-19 caseload and survival were seen across all hospital types, including highly advanced centers, and well beyond the pandemic's learning curve. These lessons from the pandemic heighten the need to minimize caseload surges and their effects across all hospital types during public health and staffing crises.PRIMARY FUNDING SOURCEIntramural Research Program of the National Institutes of Health Clinical Center.","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":39.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215505","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":"Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause : A Systematic Review.","authors":"Elisheva R Danan,Catherine Sowerby,Kristen E Ullman,Kristine Ensrud,Mary L Forte,Nicholas Zerzan,Maylen Anthony,Caleb Kalinowski,Hamdi I Abdi,Jessica K Friedman,Adrienne Landsteiner,Nancy Greer,Rahel Nardos,Cynthia Fok,Philipp Dahm,Mary Butler,Timothy J Wilt,Susan Diem","doi":"10.7326/annals-24-00610","DOIUrl":"https://doi.org/10.7326/annals-24-00610","url":null,"abstract":"BACKGROUNDPostmenopausal women commonly experience vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM).PURPOSETo evaluate effectiveness and harms of vaginal estrogen, nonestrogen hormone therapies, and vaginal moisturizers for treatment of GSM symptoms.DATA SOURCESMedline, Embase, and CINAHL through 11 December 2023.STUDY SELECTIONRandomized controlled trials (RCTs) of at least 8 weeks' duration enrolling postmenopausal women with at least 1 GSM symptom and reporting effectiveness or harms of hormonal interventions or vaginal moisturizers.DATA EXTRACTIONRisk of bias and data extraction were performed by one reviewer and verified by a second reviewer. Certainty of evidence (COE) was assessed by one reviewer and verified by consensus.DATA SYNTHESISFrom 11 993 citations, 46 RCTs evaluating vaginal estrogen (k = 22), nonestrogen hormones (k = 16), vaginal moisturizers (k = 4), or multiple interventions (k = 4) were identified. Variation in populations, interventions, comparators, and outcomes precluded meta-analysis. Compared with placebo or no treatment, vaginal estrogen may improve vulvovaginal dryness, dyspareunia, most bothersome symptom, and treatment satisfaction. Compared with placebo, vaginal dehydroepiandrosterone (DHEA) may improve dryness, dyspareunia, and distress, bother, or interference from genitourinary symptoms; oral ospemifene may improve dryness, dyspareunia, and treatment satisfaction; and vaginal moisturizers may improve dryness (all low COE). Vaginal testosterone, systemic DHEA, vaginal oxytocin, and oral raloxifene or bazedoxifene may provide no benefit (low COE) or had uncertain effects (very low COE). Although studies did not report frequent serious harms, reporting was limited by short-duration studies that were insufficiently powered to evaluate infrequent serious harms.LIMITATIONSMost studies were 12 weeks or less in duration and used heterogeneous GSM diagnostic criteria and outcome measures. Few studies enrolled women with a history of cancer.CONCLUSIONVaginal estrogen, vaginal DHEA, oral ospemifene, and vaginal moisturizers may improve some GSM symptoms in the short term. Few long-term data exist on efficacy, comparative effectiveness, tolerability, and safety of GSM treatments.PRIMARY FUNDING SOURCEAgency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684).","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":39.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215503","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":"Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial.","authors":"Sarah R Kingsbury, Puvan Tharmanathan, Ada Keding, Fiona E Watt, David L Scott, Edward Roddy, Fraser Birrell, Nigel K Arden, Mike Bowes, Catherine Arundel, Michelle Watson, Sarah J Ronaldson, Catherine Hewitt, Michael Doherty, Robert J Moots, Terence W O'Neill, Michael Green, Gulam Patel, Toby Garrood, Christopher J Edwards, Phil J Walmsley, Tom Sheeran, David J Torgerson, Philip G Conaghan","doi":"10.7326/M24-0303","DOIUrl":"10.7326/M24-0303","url":null,"abstract":"<p><strong>Background: </strong>Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain.</p><p><strong>Objective: </strong>To assess symptomatic benefits of methotrexate in knee OA (KOA).</p><p><strong>Design: </strong>A multicenter, randomized, double-blind, placebo-controlled trial done between 13 June 2014 and 13 October 2017. (ISRCTN77854383; EudraCT: 2013-001689-41).</p><p><strong>Setting: </strong>15 secondary care musculoskeletal clinics in the United Kingdom.</p><p><strong>Participants: </strong>A total of 207 participants with symptomatic, radiographic KOA and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication were approached for inclusion.</p><p><strong>Intervention: </strong>Participants were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 to 25 mg) or matched placebo over 12 months and continued usual analgesia.</p><p><strong>Measurements: </strong>The primary end point was average knee pain (numerical rating scale [NRS] 0 to 10) at 6 months, with 12-month follow-up to assess longer-term response. Secondary end points included knee stiffness and function outcomes and adverse events (AEs).</p><p><strong>Results: </strong>A total of 155 participants (64% women; mean age, 60.9 years; 50% Kellgren-Lawrence grade 3 to 4) were randomly assigned to methotrexate (<i>n</i> = 77) or placebo (<i>n</i> = 78). Follow-up was 86% (<i>n</i> = 134; methotrexate: 66, placebo: 68) at 6 months. Mean knee pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) at 6 months in the methotrexate group and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; <i>P</i> = 0.030). There were also statistically significant treatment group differences in favor of methotrexate at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; <i>P</i> = 0.045) and function (5.01 points [CI, 1.29 to 8.74]; <i>P</i> = 0.008). Treatment adherence analysis supported a dose-response effect. Four unrelated serious AEs were reported (methotrexate: 2, placebo: 2).</p><p><strong>Limitation: </strong>Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance.</p><p><strong>Conclusion: </strong>Oral methotrexate added to usual medications demonstrated statistically significant reduction in KOA pain, stiffness, and function at 6 months.</p><p><strong>Primary funding source: </strong>Versus Arthritis.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791741","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":"Long COVID Diagnostics: An Unconquered Challenge.","authors":"Annukka A R Antar, Paul G Auwaerter","doi":"10.7326/M24-0892","DOIUrl":"10.7326/M24-0892","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970447","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":"Differentiation of Prior SARS-CoV-2 Infection and Postacute Sequelae by Standard Clinical Laboratory Measurements in the RECOVER Cohort.","authors":"Kristine M Erlandson, Linda N Geng, Caitlin A Selvaggi, Tanayott Thaweethai, Peter Chen, Nathan B Erdmann, Jason D Goldman, Timothy J Henrich, Mady Hornig, Elizabeth W Karlson, Stuart D Katz, C Kim, Sushma K Cribbs, Adeyinka O Laiyemo, Rebecca Letts, Janet Y Lin, Jai Marathe, Sairam Parthasarathy, Thomas F Patterson, Brittany D Taylor, Elizabeth R Duffy, Monika Haack, Boris Julg, Gabrielle Maranga, Carla Hernandez, Nora G Singer, Jenny Han, Priscilla Pemu, Hassan Brim, Hassan Ashktorab, Alexander W Charney, Juan Wisnivesky, Jenny J Lin, Helen Y Chu, Minjoung Go, Upinder Singh, Emily B Levitan, Paul A Goepfert, Janko Ž Nikolich, Harvey Hsu, Michael J Peluso, J Daniel Kelly, Megumi J Okumura, Valerie J Flaherman, John G Quigley, Jerry A Krishnan, Mary Beth Scholand, Rachel Hess, Torri D Metz, Maged M Costantine, Dwight J Rouse, Barbara S Taylor, Mark P Goldberg, Gailen D Marshall, Jeremy Wood, David Warren, Leora Horwitz, Andrea S Foulkes, Grace A McComsey","doi":"10.7326/M24-0737","DOIUrl":"10.7326/M24-0737","url":null,"abstract":"<p><strong>Background: </strong>There are currently no validated clinical biomarkers of postacute sequelae of SARS-CoV-2 infection (PASC).</p><p><strong>Objective: </strong>To investigate clinical laboratory markers of SARS-CoV-2 and PASC.</p><p><strong>Design: </strong>Propensity score-weighted linear regression models were fitted to evaluate differences in mean laboratory measures by prior infection and PASC index (≥12 vs. 0). (ClinicalTrials.gov: NCT05172024).</p><p><strong>Setting: </strong>83 enrolling sites.</p><p><strong>Participants: </strong>RECOVER-Adult cohort participants with or without SARS-CoV-2 infection with a study visit and laboratory measures 6 months after the index date (or at enrollment if >6 months after the index date). Participants were excluded if the 6-month visit occurred within 30 days of reinfection.</p><p><strong>Measurements: </strong>Participants completed questionnaires and standard clinical laboratory tests.</p><p><strong>Results: </strong>Among 10 094 participants, 8746 had prior SARS-CoV-2 infection, 1348 were uninfected, 1880 had a PASC index of 12 or higher, and 3351 had a PASC index of zero. After propensity score adjustment, participants with prior infection had a lower mean platelet count (265.9 × 10⁹ cells/L [95% CI, 264.5 to 267.4 × 10⁹ cells/L]) than participants without known prior infection (275.2 × 10⁹ cells/L [CI, 268.5 to 282.0 × 10⁹ cells/L]), as well as higher mean hemoglobin A_1c (HbA_1c) level (5.58% [CI, 5.56% to 5.60%] vs. 5.46% [CI, 5.40% to 5.51%]) and urinary albumin-creatinine ratio (81.9 mg/g [CI, 67.5 to 96.2 mg/g] vs. 43.0 mg/g [CI, 25.4 to 60.6 mg/g]), although differences were of modest clinical significance. The difference in HbA_1c levels was attenuated after participants with preexisting diabetes were excluded. Among participants with prior infection, no meaningful differences in mean laboratory values were found between those with a PASC index of 12 or higher and those with a PASC index of zero.</p><p><strong>Limitation: </strong>Whether differences in laboratory markers represent consequences of or risk factors for SARS-CoV-2 infection could not be determined.</p><p><strong>Conclusion: </strong>Overall, no evidence was found that any of the 25 routine clinical laboratory values assessed in this study could serve as a clinically useful biomarker of PASC.</p><p><strong>Primary funding source: </strong>National Institutes of Health.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11408082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970498","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":"In sepsis or septic shock, prolonged vs. intermittent infusion of β-lactam antibiotics reduces mortality at 90 d.","authors":"Morgan K Walker, Jeffrey R Strich","doi":"10.7326/ANNALS-24-01751-JC","DOIUrl":"10.7326/ANNALS-24-01751-JC","url":null,"abstract":"<p><strong>Source citation: </strong>Abdul-Aziz MH, Hammond NE, Brett SJ, et al. <b>Prolonged vs intermittent infusions of β-lactam antibiotics in adults with sepsis or septic shock: a systematic review and meta-analysis.</b> JAMA. 12 June 2024. [Epub ahead of print.] 38864162.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118787","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}