Annals of Pharmacotherapy最新文献

{"title":"Evaluating Rebound Hypotension Following Vasopressor Discontinuation Strategies in Patients With Septic Shock.","authors":"Skyler Starkel, Brian R Schuler, Mary P Kovacevic, Jeremy R DeGrado, Paul M Szumita, Kevin M Dube","doi":"10.1177/10600280251335344","DOIUrl":"https://doi.org/10.1177/10600280251335344","url":null,"abstract":"<p><strong>Background: </strong>The 2021 Surviving Sepsis guidelines recommend which vasopressor to initiate first; however, there is a paucity of data to guide the order of vasopressor discontinuation. Retrospective studies have demonstrated an increased risk of hypotension within 24 hours if vasopressin is discontinued first; however, using a shorter timeframe may be of higher clinical relevance and more reflective of vasopressor pharmacokinetic properties.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate differences in the incidence of rebound hypotension within the first 6 hours following norepinephrine or vasopressin discontinuation in patients with septic shock.</p><p><strong>Methods: </strong>This was a single-center, retrospective analysis of adult patients with septic shock admitted to an intensive care unit (ICU) who had either vasopressin (AVP1) or norepinephrine (NE1) discontinued first between January 1, 2021 and December 31, 2021. The major outcome was the incidence of hypotension within 6 hours of first discontinued agent. A Kaplan-Meier curve evaluated time to hypotension. Notable minor outcomes included incidence of hypotension within 12 and 24 hours, ICU length of stay (LOS), ICU mortality, and time to shock resolution.</p><p><strong>Results: </strong>During the study period, 580 patients were evaluated for inclusion, of which 209 were included: 150 in the NE1 group and 59 in the AVP1 group. There was no difference in incidence of hypotension within 6 (54% vs 61%), 6-12 (14.7% vs 10.2%), or 12-24 (6.7% vs 10.2%) hours, ICU LOS, ICU mortality, and shock resolution between groups. The Kaplan-Meier curve showed no differences between groups in time to hypotension within 6 hours of vasopressor discontinuation (<i>p</i> = 0.1)Conclusion and Relevance:This is the first study to evaluate the impact of vasopressor discontinuation order in septic shock within 6 hours, finding no differences in hypotension regardless of discontinuation order. Application of this data gives reassurance the order of vasopressor discontinuation may not impact clinical outcomes.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251335344"},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952616","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":"Sodium Zirconium Cyclosilicate for the Acute Management of Hyperkalemia in the Emergency Department.","authors":"Nicole Gasparovic, Amanda Buckallew, Sara Richter","doi":"10.1177/10600280251336245","DOIUrl":"https://doi.org/10.1177/10600280251336245","url":null,"abstract":"<p><strong>Background: </strong>Limited evidence exists examining the use of potassium binders for the acute management of hyperkalemia.</p><p><strong>Objective: </strong>The objective of the study is to evaluate the use of sodium zirconium cyclosilicate (SZC) for the acute management of hyperkalemia.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated patients presenting to the emergency department with an initial potassium ≥5.6 mEq/L and treated with the institutional hyperkalemia order set.</p><p><strong>Results: </strong>Overall, 189 patients were included. There was no significant difference in serum potassium change from baseline to first potassium within 6 hours between the SZC and non-SZC groups (-1.096 ± 0.71 vs -1.067 mEq/L ± 0.81, <i>P</i> = 0.798), respectively. No significant difference was seen between the SZC and non-SZC groups for time from initial hyperkalemia to order set medication administration (1.9 ± 1 vs 2.5 ± 2.9 hours, <i>P</i> = 0.63), mean hospital length of stay (5.5 ± 4.5 vs 6.6 days ± 6.9, <i>P</i> = 0.197), or potassium level at first recheck (5.17 ± 0.68 vs 5.34 mEq/L ± 0.76, <i>P</i> = 0.108). Time from the first medication administration to potassium recheck differed by about 1 hour between groups (4.1 ± 3.1 vs 5.1 hours ± 3.2, <i>P</i> = 0.035), and patients in the SZC group were less likely to have a potassium >6 mEq/L at the first recheck (10.1% vs 21%, <i>P</i> = 0.047).</p><p><strong>Conclusion and relevance: </strong>The optimal use of SZC in the acute management remains uncertain based on results from this study with no difference in potassium levels at first recheck.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251336245"},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973362","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":"Management of Direct Oral Anticoagulants Surrounding Placement or Revision of Cardiac Implantable Electronic Devices.","authors":"Anna Crider, Clara Ting, Julie Kelly Doyle, Jessica Grandoni, Megan Rhoten","doi":"10.1177/10600280251316327","DOIUrl":"https://doi.org/10.1177/10600280251316327","url":null,"abstract":"<p><strong>Background: </strong>Pocket hematoma is a rare complication in patients on anticoagulation after placement of cardiac implantable electronic devices (CIEDs). Current guidance for periprocedural management of direct oral anticoagulants (DOACs) varies.</p><p><strong>Objective: </strong>The objective was to report the time before and after procedure that a DOAC was interrupted, compare with guideline best practice, and report the incidence of device-related pocket hematoma.</p><p><strong>Methods: </strong>This was a single-center retrospective chart review of patients admitted for CIED insertion or revision from January 2018 to September 2021. Patients were included if on apixaban, edoxaban, rivaroxaban, or dabigatran prior to a CIED procedure. Patients excluded if the time of last DOAC dose was not documented in the inpatient health record or if there was no record of patient advice on stopping time as an outpatient prior to procedure. Major endpoints included time from last dose of DOAC prior to and reinitiation after procedure. Minor endpoints included incidence of device-related pocket hematoma and major bleeding events defined by the International Society of Thrombosis and Haemostasis.</p><p><strong>Results: </strong>A total of 214 patients were included and analyzed. The median time a DOAC was held prior to procedure was 39.9 hours [24.4, 61.6] with 68.2% (146 patients) restarting at least 36 hours or more postprocedure. The incidence of device-related pocket hematoma was 8.9% (19 patients) and major bleeding occurred in 1.9% (4 patients).</p><p><strong>Conclusions and relevance: </strong>Time from last dose of DOAC prior to and reinitiation after procedure varies, and impaired renal function did not appear to be a factor in longer hold durations. The results of this study demonstrate that few patients continue DOAC therapy uninterrupted before CIED procedures. This study found that DOAC periprocedural management varies despite institutional and management guidelines from clinical trials and might not be driven by patient's renal function and clearance of DOAC.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251316327"},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971462","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":"Overview of Challenges With Using Cost-Effectiveness Analysis for Evaluating Medications.","authors":"Christopher J Edwards, Brian L Erstad","doi":"10.1177/10600280251327434","DOIUrl":"https://doi.org/10.1177/10600280251327434","url":null,"abstract":"<p><p>Countries such as Australia with universal healthcare perform cost-effectiveness evaluations of new prescription medications. In the United States, there is no assessment of cost-effectiveness analysis at the national level with the notable exception of the Advisory Committee on Immunization Practices that evaluates vaccines. The purpose of this paper is to provide an overview of the challenges of using cost-effectiveness for evaluating medications with an emphasis on the United States health care system. Cost-effectiveness analysis involves the value of a health outcome expressed in terms of cost relative to natural units or relative to utility measurements such as quality-adjusted life-years. Besides the assumptions underlying all cost-effectiveness analysis, there are challenges in appropriately assessing the cost and utility parameters. A major concern limiting the use of cost-utility analysis is that people with worse health due to age, disability, or co-morbidities always have lower utility values than an otherwise healthy patient with the same disease since the utility variable is calculated by the product of life-years and health utility weight. This had led to calls for revisions of cost-utility analyses, but characterizing the utility value is only one of several challenges with performing economic evaluations of medications in the absence of a single-payer system in the United States. Multiple criteria decision analysis is currently being used by the Food and Drug Administration (FDA) to provide information beyond modifications to the cost-effectiveness metric by taking into account multiple criteria and perspectives but controlling drug costs requires system-wide changes.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251327434"},"PeriodicalIF":2.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952596","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":"Clinical Outcomes of Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) and Glucagon-Like Peptide-1/Glucose-Dependent Insulinotropic Polypeptide Receptor Agonist (GLP-1/GIP RA) Exposures Presenting to the Emergency Department.","authors":"Hayley T Gartner, Reeves E Simmons, Herbert Z Wan, Dawn R Sollee, Sophia Sheikh","doi":"10.1177/10600280251334642","DOIUrl":"https://doi.org/10.1177/10600280251334642","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonist (GLP-1 RA) and glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide receptor agonist (GLP-1/GIP RA) use has become increasingly popular, leading to a rise in exposure calls to poison centers.</p><p><strong>Objective: </strong>To characterize the clinical effects and outcomes following GLP-1 and GLP-1/GIP RA exposures managed in the emergency department and identify factors prevalent among asymptomatic and symptomatic patients.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients exposed to a GLP-1 or GLP-1/GIP RA across 3 poison centers between 2005 and 2023. Patients were included if they were managed at a healthcare facility and excluded if they coingested a medication that may cause significant hypoglycemia, the exposure was for suicidal intent, or the exposure was not followed to a known clinical outcome.</p><p><strong>Results: </strong>ToxSentryWeb identified 186 potential cases; 152 met the study criteria (130 symptomatic and 22 asymptomatic patients). Nausea (92%) and vomiting (76%) were the most reported clinical effects in the symptomatic group. Hypoglycemia occurred in 9% of patients. Most of the clinical effects lasted 8 to 24 hours. These effects were managed primarily with intravenous fluids (56%) and/or antiemetics (51%). Notably, a higher proportion of patients in the asymptomatic group were exposed to dulaglutide, and a higher proportion of patients in the symptomatic group were exposed to semaglutide.</p><p><strong>Conclusion and relevance: </strong>This study reveals a critical gap in understanding the clinical outcomes of GLP-1 and GLP-1/GIP RA exposures. Most patients experience mild gastrointestinal symptoms, which typically resolve within 8 to 24 hours with short-term observation. However, hypoglycemia was observed at a higher rate than previously reported despite the absence of concomitant hypoglycemic agents, underscoring the need for close monitoring. These findings suggest that providers should tailor observation times based on symptom severity, while emphasizing patient education on proper administration to prevent misuse and ensure optimal therapeutic outcomes.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251334642"},"PeriodicalIF":2.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954234","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":"Holiday Season Incretin Therapy for Long-Term Weight Maintenance.","authors":"Nicholas W Carris, Shawn Wallace, Marilyn Stern, Brian Bunnell","doi":"10.1177/10600280251330903","DOIUrl":"https://doi.org/10.1177/10600280251330903","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251330903"},"PeriodicalIF":2.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961276","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":"Impact of Remdesivir on Heart Rate and Bradycardia Incidence Among Hospitalized Adults With COVID-19.","authors":"Wesley D Kufel, Zoey J Zagoria, Robert W Seabury, Nabil Zeineddine, Stephen J Thomas, Sarah A Spinler, Jeffrey M Steele","doi":"10.1177/10600280251327154","DOIUrl":"https://doi.org/10.1177/10600280251327154","url":null,"abstract":"<p><strong>Background: </strong>Bradycardia is not currently described as an adverse effect in prescribing information for remdesivir but has been reported postapproval. Therefore, effects on heart rate (HR) and bradycardia incidence after remdesivir initiation may be underrecognized by clinicians.</p><p><strong>Objective: </strong>To evaluate HR and bradycardia incidence after remdesivir initiation among patients with COVID-19.</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study between May 1, 2020 and December 1, 2021. Hospitalized patients eligible for inclusion were ≥18 years and received > 1 dose of remdesivir. Patients were excluded if they were pregnant, incarcerated, or received new medications associated with bradycardia. The primary outcome was to evaluate differences in median HR among patients preremdesivir (up to 24 hours prior to remdesivir) and postremdesivir (first dose through the treatment duration). Secondary outcomes included bradycardia episodes postremdesivir, nadir HR postremdesivir, and interventions for bradycardia management. Variables to assess postremdesivir bradycardia were considered in multivariate logistic regression if they had a <i>P</i> < 0.1 on univariate analysis.</p><p><strong>Results: </strong>Among 514 patients, 328 were included. Most were male (53.4%), had severe COVID-19 (59.8%), and median (interquartile range [IQR]) age was 62 (23.7) years. Median (IQR) remdesivir duration was 4.9 (1.5) days. Median (IQR) HR was significantly lower postremdesivir than preremdesivir (74 (15) vs 87 (19), <i>P</i> < 0.001). There were significantly more bradycardia episodes postremdesivir than before (48.8% [160/328] vs (2.4% [8/328]), <i>P</i> < 0.001). Among 48.8% (160/328) of patients with bradycardia postremdesivir, median (IQR) nadir HR was 53 (6.8). Remdesivir was discontinued early in 1 patient (0.6%). In multivariate logistic regression, remdesivir duration (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04 to 1.54, <i>P</i> = 0.019) and median preremdesivir HR (OR = 0.96, 95% CI = 0.94 to 0.97, <i>P</i> < 0.001) were identified as significant predictors for bradycardia.</p><p><strong>Conclusion and relevance: </strong>Remdesivir was associated with a significantly lower HR and higher incidence of bradycardia among hospitalized patients with COVID-19. These data may help improve recognition and management of these remdesivir-associated effects during COVID-19 treatment.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251327154"},"PeriodicalIF":2.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958780","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":"Olezarsen for the Treatment of Familial Chylomicronemia Syndrome.","authors":"Bradley Phillips, Cierra Abbott, Savanna Breit, Erin St Onge","doi":"10.1177/10600280251332500","DOIUrl":"https://doi.org/10.1177/10600280251332500","url":null,"abstract":"<p><strong>Objective: </strong>This review aims to evaluate the efficacy and safety of olezarsen (Tryngolza) in treating familial chylomicronemia syndrome (FCS), a rare genetic disorder characterized by severe hypertriglyceridemia.</p><p><strong>Data sources: </strong>A comprehensive literature search was conducted via PubMed from January 2022 to mid-March 2025, using keywords such as olezarsen, antisense oligonucleotide, triglyceride, hypertriglyceridemia, apolipoprotein C3 (APOC3), and cardiovascular.</p><p><strong>Study selection and data extraction: </strong>Relevant English-language studies assessing the pharmacokinetics, pharmacology, efficacy, or safety of olezarsen were included. Data from the US Food and Drug Administration (FDA)-approved package insert were also reviewed.</p><p><strong>Data synthesis: </strong>Olezarsen is an antisense oligonucleotide targeting APOC3 mRNA, a key regulator of plasma triglyceride levels. It has been shown to significantly reduce triglyceride levels via APOC3 protein degradation. Clinical trials have demonstrated substantial reductions in triglyceride levels and APOC3, with minimal adverse events. Phase 2 and 3 trials showed consistent efficacy and safety profiles, with common adverse events including COVID-19 infection, abdominal pain, and diarrhea.Relevance to Patient Care and Clinical Practice in Comparison to Existing Drugs:Olezarsen offers a targeted and effective treatment for FCS, addressing limitations of traditional therapies such as fibrates, omega-3 fatty acids, and statins. Its novel mechanism of action and once-monthly dosing regimen may improve patient adherence, providing significant advancement in FCS management.</p><p><strong>Conclusion and relevance: </strong>Olezarsen represents a new treatment for FCS, offering a targeted approach to significantly reduce triglyceride levels. Its integration into clinical practice has the potential to transform the management of FCS; however, more studies are needed to firmly establish its role.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251332500"},"PeriodicalIF":2.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954236","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":"The Acute Kidney Intervention and Pharmacotherapy (AKIP) List: Standardized List of Medications That Are Renally Eliminated and Nephrotoxic in the Acutely Ill.","authors":"Erin F Barreto, Alexis M Gaggani, Brandy N Hernandez, Nabihah Amatullah, Colleen M Culley, Britney Stottlemyer, Raghavan Murugan, Tezcan Ozrazgat-Baslanti, Azra Bihorac, John A Kellum, Kianoush B Kashani, Andrew D Rule, Sandra L Kane-Gill","doi":"10.1177/10600280241273191","DOIUrl":"10.1177/10600280241273191","url":null,"abstract":"<p><p>The objective of this project was to develop a standardized list of renally eliminated and potentially nephrotoxic drugs that will help inform initiatives to improve medication safety. Several available lists of medications from the published literature including original research articles and reviews, and from regulatory agencies, tertiary references, and clinical decision support systems were compiled, consolidated, and compared. Only systemically administered medications were included. Medication combinations were included if at least 1 active ingredient was considered renally dosed or potentially nephrotoxic. The medication list was reviewed for completeness and clinical appropriateness by a multidisciplinary team of individuals with expertise in critical care, nephrology, and pharmacy. An initial list of renally dosed and nephrotoxic drugs was created. After reconciliation and consensus from clinical experts, a standardized list of 681 drugs is proposed. The proposed evidence-based standardized list of renally dosed and potentially nephrotoxic drugs will be useful to harmonize epidemiologic and medication quality improvement studies. In addition, the list can be used for clinical purposes with surveillance in nephrotoxin stewardship programs. We suggest an iterative re-evaluation of the list with emerging literature and new medications on an approximately annual basis.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"371-377"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124548","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":"Comment on \"Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Nervous System Disorders: A Systematic Review and Meta-Analysis\".","authors":"Rachana Mehta, Shubham Kumar, Ranjana Sah","doi":"10.1177/10600280251330967","DOIUrl":"https://doi.org/10.1177/10600280251330967","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251330967"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750504","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}