Pub Date : 2015-12-10DOI: 10.1024/0040-5930/a000735
S. Krähenbühl
Adverse drug reactions (ADR} are the downside of active pharmacotherapies and can only partially be avoided. Risk factors have been identified for certain ADR which should be taken into account for the choice and dosing of critical drugs. Medical staff have a legal obligation to report severe ADR and ADR caused by newly licensed drugs. Such reports are important for monitoring the safety of drugs that are on the market.
{"title":"[Adverse drug reaction - Definitions, risk factors and pharmacovigilance].","authors":"S. Krähenbühl","doi":"10.1024/0040-5930/a000735","DOIUrl":"https://doi.org/10.1024/0040-5930/a000735","url":null,"abstract":"Adverse drug reactions (ADR} are the downside of active pharmacotherapies and can only partially be avoided. Risk factors have been identified for certain ADR which should be taken into account for the choice and dosing of critical drugs. Medical staff have a legal obligation to report severe ADR and ADR caused by newly licensed drugs. Such reports are important for monitoring the safety of drugs that are on the market.","PeriodicalId":87030,"journal":{"name":"Therapeutische Umschau und medizinische Bibliographie. Revue therapeutique et bibliographie medicale","volume":"30 1","pages":"669-71"},"PeriodicalIF":0.0,"publicationDate":"2015-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86903980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-10DOI: 10.1024/0040-5930/a000736
A. Malinovska, R. Bingisser, C. Nickel
The effect of medication is always a balance between their beneficial effects and any adverse reactions they might elicit. The main risk for adverse drug events {ADEs) is polypharmacy, which is the simultaneous use of multiple drugs.This often applies to older patients, who suffer from multiple diseases and therefore take multiple medications. Thus, itis not surprising, that ADEs are frequention older patients and account up to 16% of emergency visits. It is still under discussion, whether age is an independent risk factor for ADEs. However, there are some age-related changes in the pharmacokinetic and pharmacodynamics properties of many drugs, which may influence the highly fragile balance between benefit and harm in older patients. Though there are multiple risk factors for and causes of ADEs, it could be shown that a lot of ADEs are preventable and even predictable: Budnitz eta/. showed that almost two thirds of emergency hospitalisations occur due to four medication classes: warfarin, oral antiplatelet agents, insulin and oral hypoglycaemic agents. Nevertheless, only 40-60% ofA DEs are recognized in the emergency department. This might be explained by the broad clinical symptoms, ranging from bleeding due to anticoagulants to the more nonspecific symptom of weakness due to hyponatraemia secondary to thiazide diuretics. Detecting and avoiding ADEs could be aided by using lists such as Beers criteria or STOPP/FART which list medications which are potentially inappropriate for older patients.
{"title":"[Adverse drug events of older patients presenting in the emergency department].","authors":"A. Malinovska, R. Bingisser, C. Nickel","doi":"10.1024/0040-5930/a000736","DOIUrl":"https://doi.org/10.1024/0040-5930/a000736","url":null,"abstract":"The effect of medication is always a balance between their beneficial effects and any adverse reactions they might elicit. The main risk for adverse drug events {ADEs) is polypharmacy, which is the simultaneous use of multiple drugs.This often applies to older patients, who suffer from multiple diseases and therefore take multiple medications. Thus, itis not surprising, that ADEs are frequention older patients and account up to 16% of emergency visits. It is still under discussion, whether age is an independent risk factor for ADEs. However, there are some age-related changes in the pharmacokinetic and pharmacodynamics properties of many drugs, which may influence the highly fragile balance between benefit and harm in older patients. Though there are multiple risk factors for and causes of ADEs, it could be shown that a lot of ADEs are preventable and even predictable: Budnitz eta/. showed that almost two thirds of emergency hospitalisations occur due to four medication classes: warfarin, oral antiplatelet agents, insulin and oral hypoglycaemic agents. Nevertheless, only 40-60% ofA DEs are recognized in the emergency department. This might be explained by the broad clinical symptoms, ranging from bleeding due to anticoagulants to the more nonspecific symptom of weakness due to hyponatraemia secondary to thiazide diuretics. Detecting and avoiding ADEs could be aided by using lists such as Beers criteria or STOPP/FART which list medications which are potentially inappropriate for older patients.","PeriodicalId":87030,"journal":{"name":"Therapeutische Umschau und medizinische Bibliographie. Revue therapeutique et bibliographie medicale","volume":"10 1","pages":"673-7"},"PeriodicalIF":0.0,"publicationDate":"2015-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78905015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-10DOI: 10.1024/0040-5930/a000745
S. Weiler, R. Bellmann, G. Kullak-Ublick
Rare cases of high anion gap metabolic acidosis during long-term paracetamol administration in therapeutic doses with causative 5-oxoproline (pyroglutamic acid} accumulation have been reported. Other concomitant risk factors such as malnutrition, alcohol abuse, renal or hepatic dysfunction, comedication with flue/oxacillin, vigabatrin, netilmicin or sepsis have been described. The etiology seems to be a drug-induced reversible inhibition of glutathione synthetase or 5-oxoprolinase leading to elevated serum and urine levels of 5-oxoproline. Other more frequent differential diagnoses, such as intoxications, ketoacidosis or lactic acidosis should be excluded. Causative substances should be stopped. 5-oxoproline concentrations in urine can be quantified to establish the diagnosis. Adverse drug reactions, which are not listed or insufficiently described in the respective Swiss product information, should be reported to the regional pharmacovigilance centres for early signal detection. 5-0 xoproline acidosis will be integrated as a potential adverse drug reaction in the Swiss product information for paracetamol.
{"title":"[5-0xoproline (pyroglutamic acid) acidosis and acetaminophen- a differential diagnosis in high anion gap metabolic acidosis].","authors":"S. Weiler, R. Bellmann, G. Kullak-Ublick","doi":"10.1024/0040-5930/a000745","DOIUrl":"https://doi.org/10.1024/0040-5930/a000745","url":null,"abstract":"Rare cases of high anion gap metabolic acidosis during long-term paracetamol administration in therapeutic doses with causative 5-oxoproline (pyroglutamic acid} accumulation have been reported. Other concomitant risk factors such as malnutrition, alcohol abuse, renal or hepatic dysfunction, comedication with flue/oxacillin, vigabatrin, netilmicin or sepsis have been described. The etiology seems to be a drug-induced reversible inhibition of glutathione synthetase or 5-oxoprolinase leading to elevated serum and urine levels of 5-oxoproline. Other more frequent differential diagnoses, such as intoxications, ketoacidosis or lactic acidosis should be excluded. Causative substances should be stopped. 5-oxoproline concentrations in urine can be quantified to establish the diagnosis. Adverse drug reactions, which are not listed or insufficiently described in the respective Swiss product information, should be reported to the regional pharmacovigilance centres for early signal detection. 5-0 xoproline acidosis will be integrated as a potential adverse drug reaction in the Swiss product information for paracetamol.","PeriodicalId":87030,"journal":{"name":"Therapeutische Umschau und medizinische Bibliographie. Revue therapeutique et bibliographie medicale","volume":"27 1","pages":"737-41"},"PeriodicalIF":0.0,"publicationDate":"2015-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88129586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-10DOI: 10.1024/0040-5930/a000740
T. Dieterle
Due to the high prevalence of cardiovascular diseases and the corresponding prescription of cardiac drugs, side effects and interactions may occur in a substantial number of patients. They can be explained by either pharmacokinetic or pharmaco-dynamic drug interactions which may be desired, but may also be life-threatening. Despite the fact that the novel oral anticoagulants are well tolerated, several factors restricting the use of these drugs, such as renal failure, have to be considered. The use of antihypertensive drugs may be limited by concomitant use of drugs that either induce of inhibit enzymatic metabolism, respectively inhibit renal drug, electrolyte, and/or water excretion. In this respect, the interaction between beta-blockers, ACE inhibitors, angiotensin receptor blockers and thiazide diuretics with non-steroidal antiinflammatory drugs is especially important. Muscle disorders are frequent side effects in patients undergoing statin therapy and affect up to 5% of patients. They may manifest as mild myalgia, but also as life-threatening rhabdomyolysis.
{"title":"[Side effects and interactions of frequently used cardiovascular drugs].","authors":"T. Dieterle","doi":"10.1024/0040-5930/a000740","DOIUrl":"https://doi.org/10.1024/0040-5930/a000740","url":null,"abstract":"Due to the high prevalence of cardiovascular diseases and the corresponding prescription of cardiac drugs, side effects and interactions may occur in a substantial number of patients. They can be explained by either pharmacokinetic or pharmaco-dynamic drug interactions which may be desired, but may also be life-threatening. Despite the fact that the novel oral anticoagulants are well tolerated, several factors restricting the use of these drugs, such as renal failure, have to be considered. The use of antihypertensive drugs may be limited by concomitant use of drugs that either induce of inhibit enzymatic metabolism, respectively inhibit renal drug, electrolyte, and/or water excretion. In this respect, the interaction between beta-blockers, ACE inhibitors, angiotensin receptor blockers and thiazide diuretics with non-steroidal antiinflammatory drugs is especially important. Muscle disorders are frequent side effects in patients undergoing statin therapy and affect up to 5% of patients. They may manifest as mild myalgia, but also as life-threatening rhabdomyolysis.","PeriodicalId":87030,"journal":{"name":"Therapeutische Umschau und medizinische Bibliographie. Revue therapeutique et bibliographie medicale","volume":"46 1","pages":"701-10"},"PeriodicalIF":0.0,"publicationDate":"2015-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84815165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-10DOI: 10.1024/0040-5930/a000737
V. Gotta, J. N. van den Anker, M. Pfister
Developmental pharmacology influences the safety profile of drugs in pediatrics. Altered pharmacokinetics and/ or pharmacodynamics of drugs make pediatric patients susceptible to adverse drug reactions (ADRs), especially infants and newborns. Since the efficacy/ safety balance of most available drugs has not been formally evaluated in pediatric clinical trials, optimal dosing is rarely known in pediatrics. Suboptimal pediatric drug formulations make dose optimization even more difficult exposing pediatric patients to medication errors like overdosing and associated ADRs. We provide an overview of pediatric ADRs and discuss recent regulatory and pharmacological measures to understand and reduce risk of ADRs in pediatric patients.
{"title":"[Understanding and reducing the risk of adverse drug reactions in pediatric patients].","authors":"V. Gotta, J. N. van den Anker, M. Pfister","doi":"10.1024/0040-5930/a000737","DOIUrl":"https://doi.org/10.1024/0040-5930/a000737","url":null,"abstract":"Developmental pharmacology influences the safety profile of drugs in pediatrics. Altered pharmacokinetics and/ or pharmacodynamics of drugs make pediatric patients susceptible to adverse drug reactions (ADRs), especially infants and newborns. Since the efficacy/ safety balance of most available drugs has not been formally evaluated in pediatric clinical trials, optimal dosing is rarely known in pediatrics. Suboptimal pediatric drug formulations make dose optimization even more difficult exposing pediatric patients to medication errors like overdosing and associated ADRs. We provide an overview of pediatric ADRs and discuss recent regulatory and pharmacological measures to understand and reduce risk of ADRs in pediatric patients.","PeriodicalId":87030,"journal":{"name":"Therapeutische Umschau und medizinische Bibliographie. Revue therapeutique et bibliographie medicale","volume":"33 1","pages":"679-86"},"PeriodicalIF":0.0,"publicationDate":"2015-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87968369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-10DOI: 10.1024/0040-5930/a000739
A. R. Salili, F. Hammann, A. Taegtmeyer
Adverse drug events pose a great risk to patients, are an everyday clinical problem and can have potential/ega/ consequences. Computerized physician order entry or computerized provider order entry (CPOE} in combination with clinical decision support systems {CDSS) are popular and aim to reduce prescribing errors as well as identifying potentially harmful drug drug interactions. The quantifiable benejit these systems bring to patients, has however, yet to be definitively proven. This article focusses on the current standpoint of CPOE-/CDSS, their risks and benefits, the potential for improvement and their perspectives for the future.
{"title":"[ Preventing adverse drug events using clinical decision support systems].","authors":"A. R. Salili, F. Hammann, A. Taegtmeyer","doi":"10.1024/0040-5930/a000739","DOIUrl":"https://doi.org/10.1024/0040-5930/a000739","url":null,"abstract":"Adverse drug events pose a great risk to patients, are an everyday clinical problem and can have potential/ega/ consequences. Computerized physician order entry or computerized provider order entry (CPOE} in combination with clinical decision support systems {CDSS) are popular and aim to reduce prescribing errors as well as identifying potentially harmful drug drug interactions. The quantifiable benejit these systems bring to patients, has however, yet to be definitively proven. This article focusses on the current standpoint of CPOE-/CDSS, their risks and benefits, the potential for improvement and their perspectives for the future.","PeriodicalId":87030,"journal":{"name":"Therapeutische Umschau und medizinische Bibliographie. Revue therapeutique et bibliographie medicale","volume":"52 1","pages":"693-700"},"PeriodicalIF":0.0,"publicationDate":"2015-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72688520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-10DOI: 10.1024/0040-5930/a000743
K. Scherer Hofmeier, A. Bircher
In theory, all medicines can elicit allergic reactions. However, there are large differences in the frequency and clinical presentation of these reactions. Antibiotics, antiepileptic agents and NSADs trigger allergic reactions most frequently. The risk of drug allergy and of a complicated clinical course depends on the individual degree of immune activation, the dose, duration of treatment, route of administration, patient sex as well as HLA-traits, which are increasingly being identified. This article presents the commonest types of immune-mediated drug-related hypersensitivity reactions and discusses red flags which are associated with a complicated clinical course.
{"title":"[ Drug allergies: clinical presentation and red flags].","authors":"K. Scherer Hofmeier, A. Bircher","doi":"10.1024/0040-5930/a000743","DOIUrl":"https://doi.org/10.1024/0040-5930/a000743","url":null,"abstract":"In theory, all medicines can elicit allergic reactions. However, there are large differences in the frequency and clinical presentation of these reactions. Antibiotics, antiepileptic agents and NSADs trigger allergic reactions most frequently. The risk of drug allergy and of a complicated clinical course depends on the individual degree of immune activation, the dose, duration of treatment, route of administration, patient sex as well as HLA-traits, which are increasingly being identified. This article presents the commonest types of immune-mediated drug-related hypersensitivity reactions and discusses red flags which are associated with a complicated clinical course.","PeriodicalId":87030,"journal":{"name":"Therapeutische Umschau und medizinische Bibliographie. Revue therapeutique et bibliographie medicale","volume":"16 1","pages":"729-36"},"PeriodicalIF":0.0,"publicationDate":"2015-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78025931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-11-01DOI: 10.1024/0040-5930.65.11.657
E. Visca, C. Vökt, S. Tercanli
Gestational trophoblastic disease (GTD) is classified as a metastatic or non-metastatic lesion, furthermore, villous GTD is distinguished from non-villous GTD. Because of their higher incidence and their risk of persistent gestational trophoblastic neoplasia (pGTN), early diagnosis of molar pregnancies is of clinical importance. Advances in ultrasound (US) technology and frequent application of transvaginal sonography in early pregnancy have changed the clinical and pathological presentation of molar pregnancies. Based on US imaging and histopathological examination of products of conception, the majority of cases are diagnosed in early pregnancy, either as incidental findings or in women presenting with symptoms of miscarriage. Molar pregnancies have characteristic sonographic features which are more pronounced as pregnancy advances. In early pregnancy, overall US detection rates for molar pregnancies range between 34-56% depending on gestational age, sonographic features, histologic morphology, apparative equipment, and operator expertise. There also seems to be an intrinsic limit to US detection rates based on histomorphometric features of the hydropic villi. Thus, in early pregnancy, lack of typical sonographic features does not exclude molar pregnancy. If a condition predisposing for pGTN is not recognized at the time of evacuation, prognosis is worse. With increasing demand for medical management of miscarriages and abortions, when products of conception are usually not submitted for histological examination, sonographic assessment of the chorion is mandatory. In the case of suspicious findings, surgical management and histological examination are indicated.
{"title":"[Sonographic diagnosis of gestational trophoblastic disease in early pregnancy].","authors":"E. Visca, C. Vökt, S. Tercanli","doi":"10.1024/0040-5930.65.11.657","DOIUrl":"https://doi.org/10.1024/0040-5930.65.11.657","url":null,"abstract":"Gestational trophoblastic disease (GTD) is classified as a metastatic or non-metastatic lesion, furthermore, villous GTD is distinguished from non-villous GTD. Because of their higher incidence and their risk of persistent gestational trophoblastic neoplasia (pGTN), early diagnosis of molar pregnancies is of clinical importance. Advances in ultrasound (US) technology and frequent application of transvaginal sonography in early pregnancy have changed the clinical and pathological presentation of molar pregnancies. Based on US imaging and histopathological examination of products of conception, the majority of cases are diagnosed in early pregnancy, either as incidental findings or in women presenting with symptoms of miscarriage. Molar pregnancies have characteristic sonographic features which are more pronounced as pregnancy advances. In early pregnancy, overall US detection rates for molar pregnancies range between 34-56% depending on gestational age, sonographic features, histologic morphology, apparative equipment, and operator expertise. There also seems to be an intrinsic limit to US detection rates based on histomorphometric features of the hydropic villi. Thus, in early pregnancy, lack of typical sonographic features does not exclude molar pregnancy. If a condition predisposing for pGTN is not recognized at the time of evacuation, prognosis is worse. With increasing demand for medical management of miscarriages and abortions, when products of conception are usually not submitted for histological examination, sonographic assessment of the chorion is mandatory. In the case of suspicious findings, surgical management and histological examination are indicated.","PeriodicalId":87030,"journal":{"name":"Therapeutische Umschau und medizinische Bibliographie. Revue therapeutique et bibliographie medicale","volume":"18 1","pages":"657-61"},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78840077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-01-01DOI: 10.4135/9781483349985.n112
C. Senn, A. Bücheli, M. Schaub, R. Stohler
The term club drugs refers to a variety of substances which are frequently used in the context of dance events or raves. MDMA - or more commonly ecstasy -, amphetamines, especially methamphetamine, ketamine and newly also GHB (and analoga) are frequently used club drugs. The spectrum of psychoactive effects of theses substances is broad and ranges from stimulant, entactogenig, halluzinogenic, to sedative aspects. Studies show that clubbers can be characterized by their high consumption of several substances; thus, can be considered a potential high risk group. Besides the classical club drug ecstasy more common substances such as alcohol, cannabis, and cocaine are also highly prevalent. The general practitioner has a key function in the early intervention and treatment of potentially problematic club drug users. It seems important that users are being informed in a balanced and evidenced based manner about possible risks associated with their drug use. In order to perform a psychosocial risk assessment an encompassing perspective should be adopted.
{"title":"[Club drugs].","authors":"C. Senn, A. Bücheli, M. Schaub, R. Stohler","doi":"10.4135/9781483349985.n112","DOIUrl":"https://doi.org/10.4135/9781483349985.n112","url":null,"abstract":"The term club drugs refers to a variety of substances which are frequently used in the context of dance events or raves. MDMA - or more commonly ecstasy -, amphetamines, especially methamphetamine, ketamine and newly also GHB (and analoga) are frequently used club drugs. The spectrum of psychoactive effects of theses substances is broad and ranges from stimulant, entactogenig, halluzinogenic, to sedative aspects. Studies show that clubbers can be characterized by their high consumption of several substances; thus, can be considered a potential high risk group. Besides the classical club drug ecstasy more common substances such as alcohol, cannabis, and cocaine are also highly prevalent. The general practitioner has a key function in the early intervention and treatment of potentially problematic club drug users. It seems important that users are being informed in a balanced and evidenced based manner about possible risks associated with their drug use. In order to perform a psychosocial risk assessment an encompassing perspective should be adopted.","PeriodicalId":87030,"journal":{"name":"Therapeutische Umschau und medizinische Bibliographie. Revue therapeutique et bibliographie medicale","volume":"378 1","pages":"109-13"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76614784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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