Archives of Medical Research最新文献

{"title":"Multimodal Prognostic Model for Predicting Chronic Coronary Artery Disease in Patients Without Obstructive Sleep Apnea Syndrome","authors":"Yanan Xu ,&nbsp;Jun Wang ,&nbsp;Zhen Zhou ,&nbsp;Yi Yang ,&nbsp;Long Tang","doi":"10.1016/j.arcmed.2023.102926","DOIUrl":"https://doi.org/10.1016/j.arcmed.2023.102926","url":null,"abstract":"<div><h3>Background</h3><p>Obstructive sleep apnea syndrome<span> (OSAS), with metabolic disorders<span> as a central feature, is closely correlated with coronary artery disease (CAD). Our goal was to develop a prediction nomogram that integrated multimodal data that could accurately predict the prognosis of patients with chronic coronary disease (CCD).</span></span></p></div><div><h3>Methods</h3><p><span>We evaluated 393 patients with CCD with a low-to-intermediate pretest probability of OSAS based on polysomnography. A nomogram was constructed by means of least absolute shrinkage and selection operator (LASSO) and multiple </span>Cox regression analyses to identify independent risk factors for major adverse cardiovascular events (MACEs).</p></div><div><h3>Results</h3><p>Two hundred seventy-seven patients were randomly assigned to the training set, and 116 to the verification set. The constructed nomogram consisted of seven clinical variables: age, previous CAD, current alcohol consumption, neck circumference, apnea-hypopnea index (AHI), and triglyceride-glucose index (TyG). The nomogram showed good discriminatory power, as evidenced by Harrell's C-index values of 0.79 (95% confidence interval [CI] 0.731–0.849) in the training set and 0.78 (95% CI 0.678–0.882) in the verification set. Moreover, a high correlation was observed between the predicted and actual incidence of MACEs in both the training and verification sets. Decision curve analysis demonstrated excellent clinical utility of the nomogram based on net benefit and threshold probabilities.</p></div><div><h3>Conclusions</h3><p>We developed an integrated visualized prognostic nomogram that utilizes multi-modal data, including clinical characteristics, AHI, and TyG index, to predict MACEs in patients with CCD. This approach demonstrated excellent performance, highlighting the potential of combining different data sources to enhance prediction accuracy.</p></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138501681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and Future Perspectives of Microscopic and Endoscopic Transsphenoidal Surgery for Pituitary Adenomas: A Narrative Review","authors":"Gerardo Guinto ,&nbsp;Gerardo Y. Guinto-Nishimura ,&nbsp;Marcos V. Sangrador-Deitos ,&nbsp;Rodrigo Uribe-Pacheco ,&nbsp;Rene Soto-Martinez ,&nbsp;David Gallardo ,&nbsp;Patricia Guinto ,&nbsp;Alejandro Vargas ,&nbsp;Norma Aréchiga","doi":"10.1016/j.arcmed.2023.102872","DOIUrl":"10.1016/j.arcmed.2023.102872","url":null,"abstract":"<div><p>Transsphenoidal resection remains the standard treatment for most pituitary adenomas. However, the ideal surgical approach to safely access these lesions, either microsurgical or endoscopic, continues to be debated. Since the introduction of endoscopic transsphenoidal surgery, centers around the world have increasingly adopted this technique, experiencing a shift away from the conventional microsurgical approach. Large series reporting the efficacy and safety of endoscopic surgery have fueled a growing interest in comparing clinical outcomes between both approaches. Still, proving superiority of either surgical approach remains an elusive task due to the inherent drawbacks of surgical observational studies, as we are still faced with a growing body of evidence reporting conflicting results. Thus, a comprehensive discussion regarding the reach and limitations of both techniques becomes necessary. In this narrative review, we perform a critical appraisal of the literature and provide an expert opinion on the state-of-the-art in transsphenoidal surgery for pituitary adenomas. The advantages and limitations of each approach are assessed and compared from a technical standpoint, and their reported outcomes evaluated in the framework of this transition phase. Available evidence should be interpreted in light of individual patient characteristics and within the context of each medical center, taking into consideration the known impact that surgical expertise and multidisciplinary management hold on clinical outcomes.</p></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0188440923001108/pdfft?md5=64431682f88511a5efd155502e3ab675&pid=1-s2.0-S0188440923001108-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10430654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological Treatment of Non-Functioning Pituitary Adenomas","authors":"Guadalupe Vargas-Ortega ,&nbsp;Baldomero Gonzalez-Virla ,&nbsp;Carlos Alfonso Romero-Gameros","doi":"10.1016/j.arcmed.2023.102917","DOIUrl":"10.1016/j.arcmed.2023.102917","url":null,"abstract":"<div><p><span>Treatment strategies for </span>NFPA<span> include surgery, radiotherapy, medical treatment, or follow-up. The treatment of NFPAs with compressive symptoms is surgical. However, in case of post-surgical tumor remnants, there may be treatment strategies that include observation and radiotherapy. Recently, medical treatment with cabergoline (CAB) has been recommended to contain and/or reduce the size of the tumor remnant.</span></p><p>Based on the findings that many NFPAs show a dopamine receptor<span><span> (DR) and somatostatin receptor<span> (SR) expression, medical therapy with dopamine agonists (DAs) and somatostatin receptor ligands (SSRLs) has been tested as an alternative to prevent recurrence after surgery. The DAs have been the most extensively studied, showing some potential in terms of tumor shrinkage. SSRLs and other emerging medical options are much less studied. We will review and critically evaluate the current data on the medical therapy of NFPAs to elucidate their role in the management of this tumor type. In the case of actively growing remnants (more than 10% growth per year) and high-risk </span></span>pituitary adenomas, treatment with CAB at a dose of 1.5–3.0 mg is indicated for tumor containment and/or reduction. In relation to combined chemotherapy with CAB, there is little information in the literature to support its use. In our experience, CAB treatment can be used after radiotherapy as an adjuvant treatment.</span></p></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clavulanic Acid and its Potential Therapeutic Effects on the Central Nervous System","authors":"Luis Gerardo Balcazar-Ochoa ,&nbsp;Rosa Ventura-Martínez ,&nbsp;Guadalupe Esther Ángeles-López ,&nbsp;Claudia Gómez-Acevedo ,&nbsp;Omar Francisco Carrasco ,&nbsp;Raúl Sampieri-Cabrera ,&nbsp;Anahí Chavarría ,&nbsp;Abimael González-Hernández","doi":"10.1016/j.arcmed.2023.102916","DOIUrl":"https://doi.org/10.1016/j.arcmed.2023.102916","url":null,"abstract":"<div><p><span>Clavulanic acid<span> (CLAV) is a non-antibiotic β-lactam that has been used since the late 1970s as a β-lactamase inhibitor in combination with amoxicillin, another ß-lactam with </span></span>antibiotic activity<span>. Its long-observed adverse reaction profile allows it to say that CLAV is a well-tolerated drug<span> with mainly mild adverse reactions. Interestingly, in 2005, it was discovered that β-lactams enhance the astrocytic expression of GLT-1, a glutamate transporter<span><span> essential for maintaining synaptic glutamate<span><span> homeostasis involved in several pathologies of the </span>central nervous system<span> (CNS). This finding, along with a favorable pharmacokinetic profile, prompted the appearance of several studies that intended to evaluate the effect of CLAV in preclinical disease models. Studies have revealed that CLAV can increase GLT-1 expression in the </span></span></span>nucleus accumbens<span> (NAcc), medial prefrontal cortex<span><span> (PFC), and spinal cord of rodents, to affect glutamate and dopaminergic<span><span> neurotransmission<span>, and exert an anti-inflammatory effect by modulating the levels of the cytokines TNF-α and interleukin 10 (IL-10). CLAV has been tested with positive results in preclinical models of epilepsy, addiction, stroke, neuropathic and inflammatory pain, dementia, </span></span>Parkinson's disease, and sexual and anxiety behavior. These properties make CLAV a potential therapeutic drug if repurposed. Therefore, this review aims to gather information on CLAV's effect on preclinical </span></span>neurological disease models and to give some perspectives on its potential therapeutic use in some diseases of the CNS.</span></span></span></span></span></p></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138466373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy and Mortality in Pituitary Adenomas","authors":"Baldomero González-Virla ,&nbsp;Guadalupe Vargas-Ortega ,&nbsp;Carlos Alfonso Romero-Gameros","doi":"10.1016/j.arcmed.2023.102900","DOIUrl":"10.1016/j.arcmed.2023.102900","url":null,"abstract":"<div><h3>Background</h3><p><span><span><span><span>Pituitary adenomas (PA), comprising 10–20% of </span>intracranial tumors, are classified as functioning and non-functioning and are further divided by size. Non-functioning tumors cause mechanical symptoms while functioning ones result in hormonal hypersecretion syndromes. Initial </span>treatment<span> involves surgery, with medical treatment for prolactinomas. Radiotherapy (RT) is employed as an adjuvant treatment, with various modalities including conventional, </span></span>stereotactic radiosurgery<span> (SRS), and fractionated stereotactic RT<span> (FSRT). Although effective, RT is associated with complications and toxicities such as hypopituitarism, </span></span></span>optic neuritis<span>, secondary CNS tumors, and neurocognitive deficits.</span></p></div><div><h3>Aim</h3><p>Describe the information on mortality from radiotherapy as treatment of functioning PA.</p></div><div><h3>Methods</h3><p>A PubMed search spanning 2000–2017 was conducted for articles on pituitary RT.</p></div><div><h3>Results</h3><p><span>Conventional RT entails high-energy radiation over multiple sessions, while SRS delivers precise high doses in a single session. FSRT offers enhanced precision using a linear accelerator, delivering multiple doses. Optic structure proximity and tumor volume dictate RT modality. Studies have shown SRS and FSRT's efficacy in tumor and endocrine control, with variable risks and complications. Mortality rates in pituitary adenomas treated with RT have been evaluated, revealing complexities. Acromegaly<span>, associated with increased mortality due to cerebrovascular disease, may result from RT. Irradiation of non-functioning pituitary </span></span>macroadenomas<span> also elevates cerebrovascular risk, while radiotherapy-induced hypopituitarism is associated with increased cardiovascular mortality. RT-induced damage is attributed to microvascular lesions and arteriolar changes.</span></p></div><div><h3>Conclusion</h3><p>Modern techniques mitigate complications, and although safer, long-term studies are needed. Multidisciplinary evaluation guides the treatment decision, optimizing efficacy and minimizing risk, ultimately improving the patient's quality of life.</p></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impulse Control Disorders in Patients with Pituitary Tumors Treated with Dopamine Agonists: A Systematic Review","authors":"Ross Hamblin ,&nbsp;Niki Karavitaki","doi":"10.1016/j.arcmed.2023.102910","DOIUrl":"10.1016/j.arcmed.2023.102910","url":null,"abstract":"<div><h3>Background</h3><p><span>The increased prevalence of Impulse Control Disorders (ICDs) in dopamine agonist (DA) treated patients with </span>Parkinson's disease<span><span> is well described. Despite the frequent use of DAs in the management of pituitary tumors, the relationship between DAs and prevalence of ICDs </span>in patients with pituitary tumours is unclear.</span></p></div><div><h3>Aims</h3><p>To establish the prevalence of ICDs in patients with prolactinoma<span> or acromegaly and determine whether prevalence differs in those on DAs to those treated without.</span></p></div><div><h3>Methods</h3><p><span>Systematic review of the literature (registered </span><em>a priori</em>) reporting prevalence of ICDs in patients with prolactinoma or acromegaly (conducted June 2023). A narrative synthesis describing prevalence of ICDs according to assessment method was performed. Prevalence comparisons between patients with prolactinoma or acromegaly treated with DAs, to patients treated without, were summarised.</p></div><div><h3>Results</h3><p>Studies were largely retrospective, observational and heterogenous, with few patients with prolactinoma and acromegaly treated without DA. Prevalence of ICDs varied between 0–60% in patients with prolactinoma, and from 5–23% in studies with at least five patients with acromegaly. In most studies comparing DA exposed to non-DA exposed cases, DA use was not associated with ICDs.</p></div><div><h3>Conclusions</h3><p>Reported prevalence of ICDs in patients with prolactinoma and acromegaly varies considerably. Given ICDs were reported to be highly prevalent in some studies, clinicians should be mindful of these potentially serious disorders. ICD screening tools validated for use in patients with pituitary tumors combined with prospective studies including appropriate controls, are necessary to accurately establish prevalence of ICDs and true impact of DAs in their development.</p></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138178260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Spectrum of USP8 Pathogenic Variants in Cushing's Disease","authors":"Rosa G. Rebollar-Vega ,&nbsp;Julia M. Zuarth-Vázquez ,&nbsp;Laura C. Hernández-Ramírez","doi":"10.1016/j.arcmed.2023.102899","DOIUrl":"10.1016/j.arcmed.2023.102899","url":null,"abstract":"<div><p><span><span><span>Cushing's disease<span> (CD) is a life-threatening condition with a challenging diagnostic process and scarce treatment options. CD is caused by usually benign adrenocorticotrophic hormone (ACTH)-secreting pituitary </span></span>neuroendocrine tumors (PitNETs), known as </span>corticotropinomas. These tumors are predominantly of sporadic origin, and usually derive from the monoclonal expansion of a mutated cell. Somatic activating variants located within a hotspot of the </span><em>USP8</em> gene are present in 11–62% of corticotropinomas, making <em>USP8</em><span> the most frequent genetic driver of corticotroph neoplasia. In contrast, other somatic defects such as those affecting the glucocorticoid receptor gene (</span><em>NR3C1</em>), the <em>BRAF</em> oncogene, the deubiquitinase-encoding gene <em>USP48</em>, and <em>TP53</em><span> are infrequent. Moreover, patients with familial tumor<span> syndromes, such as multiple endocrine neoplasia<span>, familial isolated pituitary adenoma, and DICER1 rarely develop corticotropinomas. One of the main molecular alterations in </span></span></span><em>USP8</em><span><span>-driven tumors is an overactivation of the epidermal growth factor receptor (EGFR) signaling pathway, which induces </span>ACTH production. Hotspot </span><em>USP8</em> variants lead to persistent <em>EGFR</em><span> overexpression, thereby perpetuating the hyper-synthesis of ACTH. More importantly, they condition a characteristic transcriptomic signature that might be useful for the clinical prognosis of patients with CD. Nevertheless, the clinical phenotype associated with </span><em>USP8</em><span> variants is less well defined. Hereby we discuss the current knowledge on the molecular pathogenesis and clinical picture associated with </span><em>USP8</em> hotspot variants. We focus on the potential significance of the <em>USP8</em> mutational status for the design of tailored clinical strategies in CD.</p></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversies In Neuroendocrinology","authors":"Philippe Chanson ,&nbsp;Moises Mercado","doi":"10.1016/j.arcmed.2023.102922","DOIUrl":"10.1016/j.arcmed.2023.102922","url":null,"abstract":"","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138471376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Response to Treatment with First-Generation Somatostatin Receptor Ligands in Patients with Acromegaly","authors":"Montserrat Marques-Pamies ,&nbsp;Joan Gil ,&nbsp;Mireia Jordà ,&nbsp;Manel Puig-Domingo","doi":"10.1016/j.arcmed.2023.102924","DOIUrl":"10.1016/j.arcmed.2023.102924","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Predictors of first-generation somatostatin receptor ligands (fgSRLs) response in acromegaly have been studied for over 30 years, but they are still not recommended in clinical guidelines. Is there not enough evidence to support their use?</p><p>This systematic review aims to describe the current knowledge of the main predictors of fgSRLs response and discuss their current usefulness, as well as future research directions.</p></div><div><h3>Methods</h3><p>A systematic search was performed in the Scopus and PubMed databases for functional, imaging, and molecular predictive factors.</p></div><div><h3>Results</h3><p>A total of 282 articles were detected, of which 64 were included. Most of them are retrospective studies performed between 1990 and 2023 focused on the predictive response to fgSRLs in acromegaly. The usefulness of the predictive factors is confirmed, with good response identified by the most replicated factors, specifically low GH nadir in the acute octreotide test, T2 MRI hypointensity, high Somatostatin receptor 2 (SSTR2) and E-cadherin expression, and a densely granulated pattern. Even if these biomarkers are interrelated, the association is quite heterogeneous. With classical statistical methods, it is complex to define reliable and generalizable cut-off values worth recommending in clinical guidelines. Machine-learning models involving omics are a promising approach to achieve the highest accuracy values to date.</p></div><div><h3>Conclusions</h3><p>This survey confirms a sufficiently robust level of evidence to apply knowledge of predictive factors for greater efficiency in the treatment decision process. The irruption of artificial intelligence in this field is providing definitive answers to such long-standing questions that may change clinical guidelines and make personalized medicine a reality.</p></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acromegaly and Cancer: An Update","authors":"Karina Danilowicz,&nbsp;Soledad Sosa","doi":"10.1016/j.arcmed.2023.102914","DOIUrl":"10.1016/j.arcmed.2023.102914","url":null,"abstract":"<div><p><span>Acromegaly is a chronic and rare disease. The diagnosis usually takes several years. Multiple comorbidities are associated with acromegaly. Long-term exposure to growth factors may lead to complications such as the development of benign or malignant tumors. However, the association between acromegaly and cancer remains a matter of debate due to multiple limitations in epidemiological data. There is controversy between acromegaly and mortality, but evidence shows a significant improvement in mortality rates with disease control and careful management of comorbidities. Older age, increased growth hormone levels (GH) at last follow-up, higher insulin-like growth factor-1 (IGF-1) levels at diagnosis, </span>malignancy and radiotherapy were proposed as independent predictors of mortality.</p><p>In this review we summarize the current state of knowledge in this field. Incidence of different cancer types is described.</p><p>Rigorous surveillance of endocrine diseases may contribute to increased tumor detection. Personalized screening should probably be recommended.</p></div>","PeriodicalId":8318,"journal":{"name":"Archives of Medical Research","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138441815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}