Annals of Pharmacotherapy最新文献

{"title":"B-Cell Maturation Antigen-Directed Immunotherapies for the Treatment of Relapsed/Refractory Multiple Myeloma: A Review of the Literature and Implications for Clinical Practice.","authors":"Matthew R Peery, Hailey Hill, Amanda Sharps, Aarti Zaver, Donald C Moore","doi":"10.1177/10600280241282115","DOIUrl":"10.1177/10600280241282115","url":null,"abstract":"<p><strong>Objective: </strong>To review the pharmacology, efficacy, safety, dosing and administration, and relevance to patient care and clinical practice of B-cell maturation antigen (BCMA) directed immunotherapies, including chimeric antigen receptor T-cell (CAR-T) therapy and bispecific antibodies (BsAb), for the management of relapsed/refractory multiple myeloma (RRMM).</p><p><strong>Data sources: </strong>A literature review of PubMed (1966 to July 2024) was conducted using the keywords <i>idecabtagene vicleucel</i>, <i>ciltacabtagene autoleucel, teclistamab, elranatamab</i>, and <i>multiple myeloma</i>. Data was also obtained from unpublished meeting abstracts and prescribing information.</p><p><strong>Study selection and data extraction: </strong>All relevant published articles, unpublished abstracts, and prescribing information on anti-BCMA immunotherapies for the treatment of RRMM were reviewed.</p><p><strong>Data synthesis: </strong>Idecabtagene vicleucel and ciltacabtagene autoleucel are BCMA-directed CAR-T cell therapies that have been compared to standard of care (SOC) regimens for MM in early relapse in the phase III trials KarMMa-3 and CARTITUDE-4, respectively. Both studies demonstrated a significantly improved in response rates, depth of response, and progression-free survival compared to SOC. BsAbs teclistamab and elranatamab have been evaluated in the phase II trials MajesTEC-1 and MagnetisMM-3, respectively. Overall response rates of 63 and 61% were observed with teclistamab and elranatamab, respectively, in a population of patients with heavily pretreated RRMM.Relevance to Patient Care and Clinical Practice in Comparison with Existing Drugs:BCMA-directed immunotherapies have demonstrated efficacy in the treatment of RRMM. Safety issues with BCMA-directed immunotherapies include cytokine release syndrome, neurotoxicity, infections, and cytopenias. Operational challenges and issues with access to care exist with these therapies as they may be limited to institutions with the infrastructure to safely administer and monitor patients for toxicities.</p><p><strong>Conclusion: </strong>BCMA-directed immunotherapies represent an important advancement in the management of RRMM and have significantly added to the available treatment options for this disease.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"463-472"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379958","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":"Engaging a New Treatment Paradigm: Elranatamab in Relapsed/Refractory Multiple Myeloma.","authors":"George Saied, Zachery Halford","doi":"10.1177/10600280241281742","DOIUrl":"10.1177/10600280241281742","url":null,"abstract":"<p><strong>Objective: </strong>To review the therapeutic profile of elranatamab, a novel bispecific T-cell-redirecting therapy, in treating relapsed or refractory (R/R) multiple myeloma (MM).</p><p><strong>Data sources: </strong>A PubMed search was conducted for English-language articles published from January 2000 through June 2024, using the search terms: <i>PF-06863135, elranatamab, Elrexfio</i>, and \"<i>Multiple Myeloma.</i>\" Additional data were obtained from ClinicalTrials.gov and other pertinent publications and meeting abstracts.</p><p><strong>Study selection and data extraction: </strong>Clinical trials, guidelines, and prescribing information pertaining to elranatamab were included.</p><p><strong>Data synthesis: </strong>The phase II MagentisMM-3 trial demonstrated an overall response rate of 61.0% (95% confidence interval, 51.8-69.6) in patients naïve to B-cell maturation antigen targeting therapy (cohort A, n = 123), establishing elranatamab monotherapy as a viable treatment option for patients with R/R MM who have received at least 4 prior lines of therapy. The duration of response and progression-free survival at 12 months were 75.3% and 56.6%, respectively.Relevance to patient care and clinical practice in comparison with existing drugs:Despite the promising activity of elranatamab in R/R MM, the significant treatment-related adverse effects (AEs) associated with this therapy necessitate careful monitoring and expert management. Common AEs include cytokine release syndrome, neurotoxicity, hematologic toxicity, and infectious complications. The cost-effectiveness of elranatamab has yet to be evaluated.</p><p><strong>Conclusions: </strong>Elranatamab is approved by the Food and Drug Administration as a treatment option for patients with heavily pretreated R/R MM. Further studies are warranted to identify the optimal treatment strategy for elranatamab and other bispecific antibodies in the management of R/R MM.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"473-484"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456326","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":"Reply: \"Exploring Safety in Gender-Affirming Hormonal Treatments: An Observational Study on Adverse Drug Events Using the Food and Drug Administration Adverse Event Reporting System Database\".","authors":"Lorenzo Villa-Zapata, Ainhoa Gomez-Lumbreras","doi":"10.1177/10600280241277860","DOIUrl":"10.1177/10600280241277860","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"493-494"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279366","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":"Detectable Concentrations With Inhaled Tobramycin in Critically Ill Infants and Children Following Implementation of Standardized Protocol.","authors":"Peter N Johnson, Eugenie Chang, Emily Cormack, Kaley Hornaday, Stephen B Neely, Courtney Ranallo, Hala Chaaban, Lucila Garcia-Contreras, Jamie L Miller","doi":"10.1177/10600280241282433","DOIUrl":"10.1177/10600280241282433","url":null,"abstract":"<p><strong>Background: </strong>A protocol was established for ventilator-associated tracheitis or pneumonia using inhaled tobramycin 300 mg every 12 hours in mechanically ventilated children via a vibrating mesh nebulizer, 30 cm from the endotracheal tube in the inspiratory loop of the mechanical ventilator.</p><p><strong>Objectives: </strong>The primary objective was to determine the incidence of detectable tobramycin trough concentrations >0.5 µg/mL. Secondary objectives included a comparison of clinical characteristics between those with and without detectable concentrations and identification of patients with acute kidney injury (AKI) as defined by the Kidney Diseases Improving Global Outcomes (KDIGO) criteria.</p><p><strong>Methods: </strong>This was a single-center retrospective study of critically ill children <18 years without cystic fibrosis receiving inhaled tobramycin between July 1, 2016, and August 31, 2021. Data collection included demographics, tobramycin regimen, and renal function. Analysis was performed using SAS 9.4, with a <i>P</i>-value <0.05, and a multivariable regression model was performed to identify factors for detectable concentrations and AKI.</p><p><strong>Results: </strong>Forty-four patients (66 courses) were included, with an overall age of 0.83 years. Thirty (68%) patients had detectable concentrations and 9 (20.5%) developed AKI. No significant differences in demographics, diagnosis, mechanical ventilation settings, and number of nephrotoxins were noted between those with and without detectable concentrations or AKI. Multivariable regressions did not identify factors associated with detectable concentrations or AKI.</p><p><strong>Conclusion and relevance: </strong>Detectable concentrations occurred with the majority of courses, with AKI associated with approximately one-fourth of courses. Clinicians should consider utilizing trough monitoring for all mechanically ventilated critically ill children receiving inhaled tobramycin.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"430-438"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339571","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":"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}