Blood Coagulation & Fibrinolysis最新文献

{"title":"Evaluation of a 4 min 4000g centrifugation protocol for routine coagulation assays.","authors":"Sylvain Lamoine, Jean-Sébastien Blanchet, Aurélien Lebreton, Elodie Boissier","doi":"10.1097/MBC.0000000000001363","DOIUrl":"https://doi.org/10.1097/MBC.0000000000001363","url":null,"abstract":"<p><p>Centrifugation is a critical step in sample preparation and accounts for an important part of turnaround time. This step is further critical for hemostasis, which requires a low platelet count to produce reliable results. For automated laboratories, centrifugation can represent a bottleneck and thus a shorter centrifugation time would benefit tube flow and turnaround time. We compared a rapid centrifugation protocol (4000g 4 min) with the recommended protocol (2200g 15 min) at two different centers, after one or two centrifugation cycles. The effect of each protocol was assessed on the platelet count at every step to verify the capacity of the protocol to yield platelet-poor plasma (PPP). Results on 16 coagulation parameters were compared to verify the reliability of rapid centrifugation. In one center, a consecutive two-cycle centrifugation had been tested on platelet count. A single centrifugation cycle, using the rapid protocol, produced plasma with increased residual platelets compared with the GEHT (Groupe Etude sur l'Hémostase et la Thrombose) protocol. Despite this difference, the coagulation results were interchangeable between the protocols. In addition, a second centrifugation cycle produces plasma with a mean residual platelet less than or equal to 10 × 109/l. A single cycle of rapid centrifugation can be used to assess prothrombin time (PT), activated partial thromboplastin time (aPTT), aPTT kaolin, thrombin time (TT), fibrinogen, antithrombin (AT), D-dimers, anti-Xa, factor II (FII), factor V (FV), factor VII (FVII), and factor X (FX). For frozen plasmas, a double-cycle followed by a third cycle should be performed to ensure that 100% of samples contain less than 10 × 109/l platelets.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963450","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":"Recessively inherited protein C deficiency in two sisters: intracerebral hemorrhage and coagulopathy complications.","authors":"Goran G B Banjac, Boban B B Banjac, Lidija L B Banjac","doi":"10.1097/MBC.0000000000001365","DOIUrl":"https://doi.org/10.1097/MBC.0000000000001365","url":null,"abstract":"<p><strong>Background: </strong>Protein C (PROC) deficiency is a rare hematological disorder caused by mutations in the PROC gene, leading to severe coagulopathy in homozygous cases. This report highlights the hematological challenges in managing homozygous protein C deficiency, particularly its association with intracerebral hemorrhage and thrombosis.</p><p><strong>Case report: </strong>We describe two sisters with a homozygous PROC gene mutation (c.797A>G, p.Tyr266Cys), presenting with protein C activity <10%. The older sister (born 2020) developed neonatal intracerebral hemorrhage, followed by recurrent hemorrhage and deep vein thrombosis by 2025, managed with heparin, warfarin, and rivaroxaban. The younger sister (born 2022) also experienced neonatal hemorrhage and required anticoagulant therapy with heparin and warfarin. Both developed neurological complications, including epilepsy.</p><p><strong>Conclusion: </strong>Homozygous protein C deficiency can lead to severe neonatal coagulopathy, necessitating early diagnosis and aggressive anticoagulant therapy. This case underscores the importance of multidisciplinary management and genetic screening in affected families.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963939","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":"A new approach to personalized assessment of functional platelet disorders in children with inherited thrombocytopenias by flow cytometry.","authors":"Dmitrii Mikhailovich Polokhov, Anastasiya Alexandrovna Ignatova, Evgeniya Alexandrovna Ponomarenko, Irina Viktorovna Mersiyanova, Anna Leonidovna Khoreva, Aleksandr Vladimirovich Poletaev, Elena Vladislavovna Raykina, Galina Anatolievna Novichkova, Mikhail Aleksandrovich Panteleev, Pavel Aleksandrovich Zharkov","doi":"10.1097/MBC.0000000000001364","DOIUrl":"https://doi.org/10.1097/MBC.0000000000001364","url":null,"abstract":"<p><p>Inherited thrombocytopenias are variable in the count and size of platelets, which is related with the number of receptors and intracellular structure. So, the reference ranges do not allow interpretation of functional disorders, especially in macrothrombocytopenias and microthrombocytopenias. The flow cytometry diagnostic approach to use the reference values is necessary. Seventy-five pediatric patients were divided into three groups by platelet size: 25 with normothrombocytopenia ( RUNX1, ANKRD26, ETV6 , and CYCS ), 25 with microthrombocytopenia ( WAS ), 25 with macrothrombocytopenia ( MYH9, TUBB1, SLFN14 , and BSS ). Platelet size, granularity, GPIb/V/IX, GPIIb/IIIa, granules, and procoagulant platelets were analyzed at rest and after activation by a mixture of TRAP+CRP. In addition to the absolute value indicators, a calculated 'index at rest/after activation' in relative units was introduced for personalized changes assessment. The hemorrhage was assessed using a Pediatric Bleeding Questionnaire. The control consisted of 40 children. The bleeding score ranged from 0 to 20 (median of 2). Upon activation, in all groups, weakening in platelet size contraction and procoagulant platelet formation ( P  ≤ 0.02) were observed. In normothrombocytopenia and microthrombocytopenia groups, increased granularity upon activation, attenuation of CD42b shedding/internalization, correlation ( r  ≥ -0.65) between a decrease of procoagulant platelets less than 5% and increase of bleeding were found. Additionally, reduction of δ-granules ( P  ≤ 0.01) in normothrombocytopenias, attenuation of externalization and activation of GP IIb/III, and granules release ( P  ≤ 0.001) in the microthrombocytopenia were detected. The use of 'activation indexes' in relative units allowed to identify and characterize morphofunctional abnormality patterns in different platelet size thrombocytopenia groups and interpreted control values for detecting personalized patient disorders regardless of platelet size.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958315","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":"Predictive value of miR-24-3p and miR-1277-5p in hemodialysis patients with vascular access thrombosis.","authors":"Raziyeh Jalakani, Ali Khodadadi, Eisa Rezaei, Niloofar Motamed, Amir Hooshang Bavarsad, Seyed Amin Mohammadi, Zahra Mohammadi, Gholamreza Khamisipour","doi":"10.1097/MBC.0000000000001357","DOIUrl":"https://doi.org/10.1097/MBC.0000000000001357","url":null,"abstract":"<p><p>One of the complications of chronic kidney disease (CKD) is venous thromboembolism (VTE). Currently, the D-dimer test is used for the diagnosis of VTE. This test has low diagnostic value and specificity. Circulating microRNAs are present in plasma, serum, and other body fluids and have recently been shown to be valuable biomarkers in numerous illnesses. Therefore, this study aimed to evaluate the diagnostic potential of serum microRNAs as noninvasive biomarkers for VTE diagnosis in hemodialysis patients. Serum samples were collected from 42 hemodialysis patients with thrombosis, 42 hemodialysis patients without thrombosis, and 42 healthy individuals. After the synthesis of cDNA from serum, the expression of miR-24-3P and miR-1277-5P was measured by qRT-PCR. The data were analyzed using SPSS 20 and GraphPad Prism7 software. The expression level of miR-24-3P in the thrombotic and nonthrombotic hemodialysis groups was significantly greater than that in the healthy groups after adjustment for hyperglycemia (P = 0.003, P = 0.04). Receiver-operating characteristic (ROC) analysis revealed that the area under the curve (AUC) values were 0.769 and 0.649, respectively. However, in the thrombotic group compared with the nonthrombotic group after adjustment for hyperglycemia, no significant difference was detected (P = 0.063), and the AUC was 0.62. After adjustment for age, sex, and BMI, there was a significant difference between the thrombotic group and the nonthrombotic group (P = 0.002), and the AUC was 0.71. Compared with that in the control group, the odds ratio (OR) of increased miR-1277-5P expression was greater in the thrombotic group (P = 0.05, OR = 1.618). There was no significant difference between the nonthrombotic group and the control group (P = 0.73, OR = 0.914). Our results indicated that miR-24-3P is not a reliable marker for examining thrombosis in the studied samples, while miR-1277-5P has a positive association with VAT and could be considered a diagnostic and therapeutic marker.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976855","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":"An atypical presentation of catastrophic antiphospholipid syndrome with refractoriness to treatment.","authors":"Shannon Zhang, Jesse Qiao","doi":"10.1097/MBC.0000000000001348","DOIUrl":"10.1097/MBC.0000000000001348","url":null,"abstract":"<p><p>Catastrophic antiphospholipid syndrome (CAPS) is a rare and life-threatening manifestation of antiphospholipid syndrome (APS). Diagnosing CAPS can be particularly challenging, especially due to significant overlap in pathophysiology, signs, and symptoms with other complex hematologic conditions, including thrombotic microangiopathies (TMA) and immune-mediated thrombocytopenia (ITP). In many cases, definitive diagnosis is not clear, leading to delays in care and poor outcomes. Here, we present an elderly patient with previously diagnosed APS now presenting with suspected CAPS, admitted to our inpatient service with a complicated hospital course. The patient received daily plasma exchange, steroids, intravenous immunoglobulin, and therapeutic heparin for anticoagulation. Despite treatment, there was worsening of thrombocytopenia suggesting refractoriness to ongoing treatment. We outline our diagnostic approach, clinical evaluation, treatment strategies, and differential diagnoses pertinent to our atypical clinical presentation of CAPS.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":"101-107"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456751","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":"Effectiveness of different anticoagulation regimens in critically ill patients - experience from COVID 19 patients.","authors":"Igor Vasković, Marija Marković, Ivo Udovičić, Ljiljana Arsenović, Mihailo Stojić, Aleksandra Ignjatović, Dragana Jovanović, Vojislava Nešković","doi":"10.1097/MBC.0000000000001354","DOIUrl":"10.1097/MBC.0000000000001354","url":null,"abstract":"<p><p>This study compared the efficacy of therapeutic anticoagulation guided by anti-Xa levels vs. a D-dimer-based protocol in ICU patients with COVID-19. Given the heightened risk of thrombosis despite anticoagulation therapy in some cases, we hypothesised that anti-Xa measurement improves anticoagulation effectiveness and clinical outcomes in this population. We retrospectively analysed data from ICU patients at COVID Hospital Karaburma between April 2020 and December 2021. The primary outcome was the incidence of failed noninvasive ventilation necessitating intubation. Secondary endpoints included mortality rates, thromboembolic and bleeding complications, and anticoagulation effectiveness assessed by antifactor Xa activity. The analysis included 395 patients - 137 in the anti-Xa group and 258 in the D-dimer group. The D-dimer group showed a higher rate of failed noninvasive ventilation requiring intubation (65.7% vs. 50%, P  = 0.009). The overall mortality was 48.3%, significantly higher in the D-dimer group (52.7%) compared to the anti-Xa group (40.1%, P  = 0.02). Thromboembolic complications were lower in the anti-Xa group (2.9%) than in the D-dimer group (9.7%, P  = 0.014), with no significant difference in bleeding. Following the first LMWH administration, 70.8% of patients had anti-Xa levels below the therapeutic and 11.7% below the prophylactic range. Anti-Xa-guided anticoagulation improves survival and reduces thromboembolic complications compared to D-dimer-based treatment without increasing bleeding risk. This study highlights the potential of the anti-Xa assay in managing anticoagulation in critically ill COVID-19 patients. Our findings provide a foundation for future research on using anti-Xa measurements as a guiding tool to optimise anticoagulation therapy in other critically ill populations.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":"82-89"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571866","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":"Concurrent hemophagocytic lymphohistiocytosis and thrombotic microangiopathy in a patient with Epstein-Barr virus infection and gastric adenocarcinoma: the puzzle started with microangiopathic hemolytic anemia.","authors":"Kehua Zhou, Aniqa Faraz, Yazhini Vallatharasu","doi":"10.1097/MBC.0000000000001349","DOIUrl":"10.1097/MBC.0000000000001349","url":null,"abstract":"<p><p>Malignancy-associated-hemophagocytic lymphohistiocytosis (HLH) is rare and often seen in high-grade lymphomas and acute leukemias; solid-tumor-associated HLH is extremely uncommon. The diagnosis of malignancy-associated-HLH remains challenging in clinical practices as it masquerades as and coexists with many other conditions. Here we presented a case with concurrent solid-tumor-associated HLH and thrombotic microangiopathy. The patient was an 80-year-old male with microangiopathic hemolytic anemia (MAHA), progressive bi-lineage cytopenia, and active Epstein-Barr virus (EBV) infection. Extensive lab works excluded all other alternative etiologies for MAHA but B12 deficiency, malignancy, and EBV infection. Concurrently, poorly differentiated gastric adenocarcinoma-associated HLH and thrombotic microangiopathy (TMA) were confirmed with extensive lab work. This patient passed away despite high-dose dexamethasone treatment. In the paper, we also discussed the possible pathophysiology of EBV infection in the development of MAHA and HLH and reviewed the treatment options for HLH and TMA.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":"108-112"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456777","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":"An exceptional presentation of nephrotic syndrome: bilateral massive pulmonary embolism.","authors":"Büşra Daştan İnce, Zeynelabidin Ozturk, Nilgün Eroğlu, Hasibe Gökçe Çinar, Bahriye Uzun Kenan, Ali Fettah","doi":"10.1097/MBC.0000000000001353","DOIUrl":"10.1097/MBC.0000000000001353","url":null,"abstract":"<p><p>Venous thromboembolism (TE) and arterial TE are rare in children, but can cause severe morbidity and mortality. The incidence of TE is 8.6-57 per 100 000 among hospitalized children and 0.14-0.9 per 100 000 in the general pediatric population. The risk of TE is increased in pediatric nephrotic syndrome (NS) patients. The incidence of thromboembolic complications in pediatric NS patients is approximately 3%. Herein we report a pediatric patient that presented with massive bilateral pulmonary embolism (PE) in whom the underlying condition was NS. At the onset of the clinical course the clinical findings were attributed to heart failure and, therefore, the diagnosis and treatment of NS was delayed. Based on the presented case, we think that clinicians should consider NS in pediatric patients with PE when hypoalbuminemia, diffuse edema, and massive proteinuria are present, and that timely initiation of NS treatment and concomitant administration of TE treatment can yield positive results. We further think that pediatric patients diagnosed with PE that have concomitant hypoalbuminemia, generalized edema, and massive proteinuria should be considered to have NS and that treatment for NS should be started without delay and concomitantly with TE treatment in order to achieve a positive result.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":"113-116"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575688","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":"Time-in-therapeutic range falls as the target international normalized ratio range increases in patients on warfarin.","authors":"Imran Malik, Paul Priest, Ian Jennings, Keith Gomez","doi":"10.1097/MBC.0000000000001347","DOIUrl":"10.1097/MBC.0000000000001347","url":null,"abstract":"<p><p>The main objective was to assess whether the time-in-therapeutic range (TTR) in patients on warfarin is affected by the international normalized ratio (INR) range. We also evaluated whether the performance of the INR is negatively impacted as its absolute value increases. First, we extracted key performance indicators of the INR from 22 surveys of the UK National External Quality Assurance Scheme (NEQAS). We then analysed TTR in 6584 warfarin monitoring episodes that were categorized by range and indication. NEQAS surveys in which the sample INR was above 3.0 had more participants outwith consensus with higher coefficient of variation and standard error mean. The outwith consensus percentage was correlated with the mean reported INR value. In warfarinised patients, we found that the TTR was lower at INR ranges above the standard 2.0 to 3.0. We concluded that the performance of the INR assay decreases at higher values. Furthermore, increasing the INR range above the standard 2.0 to 3.0 in warfarinised patients has an adverse effect on TTR. This is important because the INR range may be increased to try and improve efficacy, whereas these data suggest that it may have the opposite effect.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":"78-81"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456797","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":"CRISPR/Cas9 mediated generation of zebrafish f9a mutant as a model for hemophilia B.","authors":"Sanchi Dhinoja, Ayah Al Qaryoute, Afnan Deebani, Anthony De Maria, Pudur Jagadeeswaran","doi":"10.1097/MBC.0000000000001355","DOIUrl":"10.1097/MBC.0000000000001355","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to develop a zebrafish model for hemophilia B by creating a f9a knockout, as f9a has previously demonstrated functional similarity to human Factor IX.</p><p><strong>Methods: </strong>Using CRISPR/Cas9 technology, two gRNAs targeting exon 8 of the f9a gene, were injected along with Cas9 protein into single-cell zebrafish wild-type embryos. DNA was harvested from the tail tips of the resulting adult zebrafish and screened for mutations using PCR. The founder mutant was crossed with wild-type fish to confirm heritability and subsequently reared to homozygosity. Homozygous mutants were analyzed through quantitative RT-PCR and Western blot to assess f9a RNA and F9a protein levels, respectively. Functional assays like kinetic partial thromboplastin time (kPTT), bleeding assay in adult mutants, and venous laser injury on mutant larvae were performed to assess the hemostatic role.</p><p><strong>Results: </strong>Around 61 adults from the CRISPR/Cas9 knockouts were screened, which resulted in a mutant line with a 72 bp deletion in the exon 8 encoding catalytic domain. Quantitative RT-PCR and Western Blot analysis showed reduced levels of f9a RNA and F9a protein in the homozygous mutants compared to wild-type siblings. At five dpf, f9a homozygous mutant larvae demonstrated prolonged venous occlusion times in a laser injury assay. Additionally, plasma from the mutants displayed delayed fibrin formation in kPTT assays and exhibited increased bleeding after mechanical injury.</p><p><strong>Conclusion: </strong>This study created a zebrafish f9a knockout model that mimics the bleeding phenotype observed in hemophilia B patients, which will be valuable for evaluating novel therapeutic approaches for hemophilia B.</p>","PeriodicalId":8992,"journal":{"name":"Blood Coagulation & Fibrinolysis","volume":" ","pages":"90-98"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699480","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}