Acta Colombiana de Cuidado Intensivo最新文献

{"title":"Azul de metileno como terapia complementaria en el manejo del shock séptico refractario en los pacientes con cáncer: experiencia clínica","authors":"Víctor Hugo Nieto Estrada ,&nbsp;Julián Andrés Mendoza Rodríguez ,&nbsp;Daniel Leonardo Molano Franco ,&nbsp;Anacaona Martínez del Valle ,&nbsp;María Catalina Sánchez Higuera ,&nbsp;María Margarita Dussan Trujillo ,&nbsp;Paola Andrea Rojas González ,&nbsp;Juliana Alejandra Ortiz Murcia ,&nbsp;José David Mójica Rodríguez ,&nbsp;Angie Viviana Súarez Cuadros ,&nbsp;Valeria Rocha Yaruro","doi":"10.1016/j.acci.2025.05.004","DOIUrl":"10.1016/j.acci.2025.05.004","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the clinical experience with the use of methylene blue as a complementary therapy in the management of refractory septic shock in a cohort of cancer patients.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>High-complexity oncological Intensive Care Unit.</div></div><div><h3>Participants</h3><div>Ninety-four adult patients with confirmed cancer diagnoses admitted to the ICU between October 2022 and January 2024.</div></div><div><h3>Interventions</h3><div>No specific interventions were performed; retrospective data were analyzed.</div></div><div><h3>Main outcome measures</h3><div>Total norepinephrine dose before and after methylene blue administration<strong>,</strong> Total epinephrine dose before and after methylene blue administration<strong>,</strong> ICU mortality, Multiple organ dysfunction.</div></div><div><h3>Results</h3><div>A total of 94 oncology patients with septic shock and refractory vasoplegia were included, of which 44.7% were women, with a median age of 63 years. The predominant etiology was Gram-negative bacilli (35.1%). The group treated with methylene blue showed a higher need for mechanical ventilation (97.9 vs. 66%) and greater use of norepinephrine and vasopressin, although with a significant reduction in the cumulative dose of norepinephrine (from 15.08 to 11.3<!--> <!-->mg, <em>P</em> <!-->&lt;<!--> <!-->.05) and adrenaline compared to the control group. No significant reduction in mortality was observed with methylene blue (OR: 0.66; 95% CI: 0.25-1.7). Respiratory failure was the main predictor of mortality (OR: 15.1; 95% CI: 1.63-40.7). Methylene blue was not associated with adverse events.</div></div><div><h3>Conclusions</h3><div>The use of methylene blue as an adjuvant therapy in the management of refractory septic shock in oncology patients allows for a reduction in catecholamine dosage, demonstrating a vasopressor-sparing effect without being associated with significant adverse events. Although a trend toward a protective effect on mortality and organ dysfunction is observed, these results do not reach statistical significance. Hypoxemic respiratory failure is identified as the main predictor of poor prognosis in this population. Additional studies are needed to assess its effectiveness in different stages of septic shock and in specific subgroups of oncology patients.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 495-501"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842255","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}

{"title":"Daño axonal difuso posterior al trauma craneoencefálico en pediatría: la importancia de reconocerlo","authors":"Laura Andrea Apráez Henao ,&nbsp;Isabel Cristina Zuluaga Aristizabal ,&nbsp;Mauricio Fernández Laverde","doi":"10.1016/j.acci.2025.04.001","DOIUrl":"10.1016/j.acci.2025.04.001","url":null,"abstract":"<div><div>Diffuse axonal injury is a subtype of brain injury secondary to severe traumatic brain injury; the mechanism that explains the damage is due to rotational forces and rapid acceleration-deceleration that cause cutting and tearing of axonal white matter along with the blood vasculature, leading to cerebral edema and ischemic brain damage. Although most of the brain presents a normal structure, a minority of axons are affected, which is why findings of axonal damage in brain imaging require specialized techniques to visualize the damage. Despite understanding the trauma mechanism and neurological sequelae, there are few studies correlating radiological findings and histopathology, and there is limited data on treatment.</div><div>The objective of this study is to recognize the relevance of diffuse axonal injury in pediatrics, emphasizing its impact on functional and neurological prognosis. Despite being a severe injury, children have a significant potential for long-term neurological recovery, highlighting the importance of prolonged follow-up combined with rehabilitation therapies.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 512-518"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842257","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}

{"title":"Enseñando bajo presión: los retos de educar en cuidado intensivo","authors":"Andres Felipe Yepes-Velasco,&nbsp;Lorena Moreno-Araque,&nbsp;Manuel Castaño","doi":"10.1016/j.acci.2025.04.004","DOIUrl":"10.1016/j.acci.2025.04.004","url":null,"abstract":"<div><div>Teaching in the intensive care unit (ICU) represents a multifaceted challenge that goes beyond the mere transmission of medical knowledge. This unique environment requires developing both technical and interpersonal competencies in a highly complex context. The critical nature of patients, combined with healthcare demands, creates a scenario where educators must carefully balance educational needs with patient safety. Frequently, this balance tips toward immediate clinical care, which can reduce practical learning opportunities for residents. This review explores the key challenges that clinical teachers encounter while educating in high-workload environments such as the ICU.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 531-540"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842259","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}

{"title":"Lidocaína como estrategia para minimizar la tos y controlar la presión intracraneal en una paciente neurocrítica: reporte de caso","authors":"Andrés Mauricio Enríquez Popayán,&nbsp;Joismer Alejandro Henao Cruz","doi":"10.1016/j.acci.2025.04.003","DOIUrl":"10.1016/j.acci.2025.04.003","url":null,"abstract":"<div><div>Neurocritical patients require specific management aimed at neuroprotection, therefore it is important to ensure and aggressive respiratory efforts such as coughing should be avoided. Here, we present the case of a 72-year-old patient who was treated with systemic neuroprotective measures such as inhibition of the cough reflex; for this purpose, the artificial airway was made patent with prior instillation of lidocaine. During this intervention, no increase in the optic nerve sheath was observed, as well as inhibiting the spontaneous ventilatory response, achieving ventilatory coupling and a neuroprotective state.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 559-563"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842263","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}

{"title":"Survey on knowledge and perception of paroxysmal nocturnal hemoglobinuria among Colombian physicians: A cross-sectional study","authors":"Víctor Hugo Nieto Estrada ,&nbsp;José Rojas-Suarez ,&nbsp;Diana Borré-Naranjo ,&nbsp;Jheremy Reyes ,&nbsp;Anacaona Martinez del Valle","doi":"10.1016/j.acci.2025.04.006","DOIUrl":"10.1016/j.acci.2025.04.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease with severe clinical manifestations, for which diagnosis and treatment may be limited by medical knowledge and barriers to specialized care access.</div></div><div><h3>Objective</h3><div>To assess the perception and level of knowledge about PNH among physicians from different specialties in a national context.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted using a structured survey targeting general practitioners, residents, and specialists. The questionnaire assessed six dimensions: signs and symptoms, pathophysiology, diagnosis, treatment, prognosis, and access to diagnosis and treatment. Knowledge perception was evaluated, and objective questions were included to measure the level of knowledge in each dimension. The internal consistency of the instrument was high, with an adequate Cronbach's alpha.</div></div><div><h3>Results</h3><div>Two hundred eighteen responses were received from a calculated sample of 355. Most surveyed physicians perceived their knowledge of PNH as low. However, objective knowledge assessment suggests a gap between general practitioners and specialists, with an overall knowledge level considered moderate. Hematologists demonstrated a high level of knowledge, but access barriers to specialized care may contribute to delayed diagnoses.</div></div><div><h3>Conclusion</h3><div>Using a standardized instrument, it is demonstrated that knowledge gaps regarding PNH across different levels of medical training could affect the early recognition of the disease. Therefore, it is recommended to strengthen medical education on PNH and improve strategies for access to specialized care to optimize disease management.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 468-475"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842252","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}

{"title":"Oxigenoterapia conservadora vs. liberal en pacientes críticos con ventilación mecánica invasiva. Revisión sistemática y metaanálisis","authors":"Andrés Esteban Salazar Molina ,&nbsp;Héctor Hernández Garcés ,&nbsp;Omar Patricio Bustamante Celleri ,&nbsp;Marco Antonio Carangui Urgilés","doi":"10.1016/j.acci.2025.05.002","DOIUrl":"10.1016/j.acci.2025.05.002","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the benefits and risks of conservative versus liberal oxygen therapy in in patients with IMV.</div></div><div><h3>Design</h3><div>Systematic review with meta-analysis and TSA of RCTs published in MEDLINE/PubMed, Web of Science, SciELO, Embase, Scopus, and the Cochrane Central of Register of Clinical trials, through December 2024. No language restrictions.</div></div><div><h3>Population</h3><div>Patients admitted to ICU with IMV, older than 18 years.</div></div><div><h3>Intervention</h3><div>Conservative oxygen therapy: SatO2 88–92% and/or PaO2 between 55–80<!--> <!-->mmHg; Liberal oxygen therapy: SatO2 ≥<!--> <!-->94% or PaO2 ≥<!--> <!-->90<!--> <!-->mmHg.</div></div><div><h3>Measurements</h3><div>Overall mortality, in-ICU mortality, at 28 and 90 days, length of stay, ventilator-free days, and complications.</div></div><div><h3>Results</h3><div>We included 10 RCTs (n<!--> <!-->=<!--> <!-->5254), all of which were classified as low risk of bias, except for one. Meta-analysis and TSA showed no differences between conservative and liberal strategies regarding overall mortality (RR 0.98; 95% CI 0.96–1.01; p<!--> <!-->=<!--> <!-->0.29, I2: 0%), ICU (RR 0.99; 95% CI 0.96–1.02; p<!--> <!-->=<!--> <!-->0.41, I2: 7%), 28-day (RR 0.98; 95% CI 0.95–1.02; p<!--> <!-->=<!--> <!-->0.4, I2: 0%), or 90-day (RR 0.97; 95% CI 0.94–1.01; p<!--> <!-->=<!--> <!-->0.17, I2: 0%). We found no differences regarding hospital and ICU stay, ventilator-free days, or complications. Subgroup and sensitivity analysis did not modify the results.</div></div><div><h3>Conclusion</h3><div>We found no beneficial or harmful effects when comparing a conservative versus a liberal strategy with respect to all-cause mortality in adult IMV patients. Other clinical outcomes of interest were also comparable between the two groups.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 476-485"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842253","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}

{"title":"Riesgo de hemorragia gastrointestinal asociado al uso de corticoides en los pacientes críticos: revisión de revisiones sistemáticas y metaanálisis","authors":"Matías Agustín Atencio ,&nbsp;Joaquín Andrés Luini ,&nbsp;Agostina Dana Villa ,&nbsp;Romina Ayelén Hegel ,&nbsp;Santiago Hiebaum ,&nbsp;Agustín Yañez Schmidt ,&nbsp;Iñaki Manuel Dopazo Danieli ,&nbsp;Lucas Gonzalo Duran","doi":"10.1016/j.acci.2025.04.002","DOIUrl":"10.1016/j.acci.2025.04.002","url":null,"abstract":"<div><div>Gastrointestinal bleeding (GIB) has been associated with corticosteroid use, leading to the routine implementation of gastric prophylaxis in critically ill patients. However, the evidence remains contradictory. This systematic review of systematic reviews (SR) and meta-analysis aimed to synthesize the available evidence regarding the risk of GIB in critically ill patients treated with corticosteroids.</div><div>Systematic reviews published between 2019 and 2024 were identified, including studies that evaluated patients over 16 years old in critical condition receiving corticosteroids. Out of 365 retrieved studies, 7 met the inclusion criteria. The quality of the evidence was assessed using AMSTAR II. Additionally, a d<em>e novo</em> meta-analysis was conducted using RevMan 5.4 to integrate outcomes related to GIB risk, intensive care unit (ICU) mortality, and hospital length of stay.</div><div>Regarding GIB, the analysis included 53 randomized controlled trials (RCTs) with a total of 29,701 participants, showing a global relative risk (RR) of 1.13 (95% CI: 0.97-1.33). For mortality, the analysis of 23 RCTs with 4,596 participants indicated an RR of 0.85 (95% CI: 0.79-0.92), with high certainty of evidence. Concerning ICU length of stay, 22 RCTs with 4,635 participants reported a mean difference of −0.66 days (95% CI: −1.69 to 0.37).</div><div>This review indicates that corticosteroid use in critically ill patients is not associated with a significant increase in GIB risk. Furthermore, corticosteroids have been shown to reduce ICU mortality, reinforcing their role in the management of critically ill patients.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 519-530"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842258","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}

{"title":"Utilidad del uso de la ultrasonografía para los accesos vasculares en los diferentes escenarios de la atención en salud: una revisión de alcance","authors":"Juan Santiago Serna-Trejos ,&nbsp;Stefanya Geraldine Bermúdez-Moyano ,&nbsp;Carlos Andrés Castro-Galvis ,&nbsp;Maria Alejandra Londoño-Osorio ,&nbsp;Laura Catalina Rodríguez-Fonseca ,&nbsp;David Altman-Salcedo ,&nbsp;Virginia Zarama-Córdoba","doi":"10.1016/j.acci.2025.03.002","DOIUrl":"10.1016/j.acci.2025.03.002","url":null,"abstract":"<div><div>The insertion of central vascular access is crucial in 75% of patients in intensive care units for the administration of venotoxic drugs, hemodynamic monitoring, and parenteral nutrition. Common insertion sites include the internal jugular vein, the subclavian or proximal axillary vein, and the femoral vein, each with specific risks of immediate and delayed complications. Real-time ultrasound guidance has been noted for reducing immediate complications during central venous catheter insertion, although its use is limited by equipment availability and the perception of a longer procedure. Direct ultrasound guidance is superior to indirect guidance in reducing mechanical complications, though its impact on infection rates remains debated. Infraclavicular insertion is recommended to minimize delayed complications, though its use is less frequent due to perceived technical difficulty and the risk of pneumothorax. A pre-procedural ultrasound analysis is advised to detect anatomical anomalies and select the optimal site for catheterization. Subsequently, a vascular, cardiac, pleural, and pulmonary ultrasound analysis helps detect and prevent catheter malposition and pleuropulmonary complications. For subclavian vein cannulation, real-time ultrasound guidance has shown higher success rates and fewer complications, although the certainty of the evidence is limited. Two-dimensional ultrasound for the internal jugular vein significantly reduces complications and improves first-attempt success rates. Additionally, ultrasound guidance improves success rates and reduces complications in arterial and peripheral venous cannulation, proving to be safer and more efficient for hemodialysis catheter insertion compared to methods based on anatomical landmarks.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 502-511"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842256","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}

{"title":"Porfiria neuropática, más allá que un reto diagnóstico. Reporte de caso y revisión de la literatura","authors":"Tatiana Patricia Buitrago-González ,&nbsp;Cinthya Katerine Galindo González ,&nbsp;Eder Cáceres ,&nbsp;Iván Mauricio González Zambrano","doi":"10.1016/j.acci.2025.02.003","DOIUrl":"10.1016/j.acci.2025.02.003","url":null,"abstract":"<div><div>Porphyria is a disease caused by a retrograde accumulation of precursors of the HEM group, which is essential for the hemoglobin funtion; generating organic toxicity. Acute hepatic porphyrias are characterized by neurological involvement, the most frequent is the acute intermittent porphyria. The neurological symptoms are explained by the toxicity induced by the enzyme aminolevulinic acid (ALA) and the critical deficiency of the HEM group. The clinical presentation is varied, as is the neurological onset; hence the complexity in its diagnosis, which must be early and timely.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 564-570"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842261","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}

{"title":"Resistencia antibiótica y exposición bacteriana de pacientes pediátricos en ventilación mecánica con humidificadores térmicos e intercambiadores de calor y humedad","authors":"Pablo Mattos Navarro ,&nbsp;Rosaura Caron Estrada","doi":"10.1016/j.acci.2025.05.003","DOIUrl":"10.1016/j.acci.2025.05.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Invasive mechanical ventilation is essential for children with severe respiratory failure but increases the risk of infections due to exposure to pathogenic microorganisms. There are 2<!--> <!-->main humidification technologies: heated humidifiers and heat and moisture exchangers. Although some studies suggest that the latter may reduce respiratory infections, the results are inconclusive, especially in children and infants.</div></div><div><h3>Objective</h3><div>To evaluate bacterial exposure and antibiotic resistance profile in mechanically ventilated pediatric patients using heated humidifiers and heat and moisture exchangers.</div></div><div><h3>Methods</h3><div>Descriptive cross-sectional study between 2016 to 2023, of 1920 endotracheal cultures taken after 48<!--> <!-->hours of intubation in mechanically ventilated pediatric patients and classified according to the type of humidifier. The frequency and resistance profile of the identified bacteria were determined.</div></div><div><h3>Results</h3><div>The percentage of positivity and the most frequently identified bacterial species were the same in both groups. The strains from heated humidifiers showed greater antibiotic resistance, 56% of which presented only 1 or 2 therapeutic options, compared to 28% in the group of heat and humidity exchangers. In addition, 50% of the strains in the heat and humidity exchangers had 4 or more therapeutic options, compared to 39% in the heat exchanger group.</div></div><div><h3>Conclusions</h3><div>No significant differences in bacterial exposure were found between the 2<!--> <!-->technologies. However, heated humidifier strains showed higher antibiotic resistance, suggesting a higher potential risk of infections with limited therapeutic options.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 486-494"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842254","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}