The Journal of cardiovascular surgery最新文献

{"title":"Occlusion of the false lumen, management of aortic side branches.","authors":"Thomas LE Houérou, Mickael Palmier, Joshua Burk, Antoine Gaudin, Alessandro Costanzo, Jeremy Bendavid, Dominique Fabre, Stéphan Haulon","doi":"10.23736/S0021-9509.25.13361-2","DOIUrl":"10.23736/S0021-9509.25.13361-2","url":null,"abstract":"<p><p>Complete thrombosis of the false lumen in chronic aortic dissection is essential to achieve positive aortic remodeling. However, persistent perfusion through aortic collaterals, dissected supra-aortic trunks (SAT), and renovisceral arteries often complicate this process. Our approach to treat chronic dissections integrates TEVAR and custom-made FBEVAR, often combined with supra-aortic trunk debranching or frozen elephant trunk (FET) procedures. Preemptive embolization of aortic side branches (intercostal, lumbar, mediastinal, bronchial, and mammary arteries) is a key strategy to prevent endoleaks and facilitate false lumen thrombosis. Based on preoperative imaging and anatomical considerations, endovascular access routes and embolization materials are carefully selected. A staged strategy targeting re-entry tears and aortic collaterals encourages progressive false lumen occlusion. False lumen embolization often includes false lumen endografts (FLE) implantation. Follow-up imaging is mandatory to plan iterative embolizations which are often required to achieve complete thrombosis. In this study, we comprehensively describe our approach to perform staged embolization, close postoperative surveillance, and an aggressive strategy targeting endoleaks that are critical to promote aortic remodeling and ensure long-term success.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"232-238"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277318","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":"The current false lumen endograft and clinical experience for false lumen occlusion in chronic aortic dissection.","authors":"Márton Berczeli, Björn Sonesson, John Mogensen, Angelos Karelis, Nuno V Dias","doi":"10.23736/S0021-9509.25.13356-9","DOIUrl":"10.23736/S0021-9509.25.13356-9","url":null,"abstract":"<p><p>False lumen management of chronic aortic dissections has evolved during the past decade. Thoracic endovascular aortic repair (TEVAR) continues to be the mainstay of endovascular dissection treatment and relies on the adequate sealing of the proximal entry tear. However, TEVAR alone often fails to achieve aortic remodeling due to persistent distal retrograde perfusion of the false lumen with continuous aneurysmatic degeneration. Endovascular occlusion of this retrograde false lumen flow using dedicated false lumen endografts (FLEs), has therefore gained popularity. Similar to other endografts, FLE design has evolved from extra-large vascular plug through physician modified version, to different iterations of a custom-made, self-occluding endografts. This manuscript summarizes the evolution of false lumen occluders, characteristics of the last generation of the device and currently available literature clinical experience.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"218-226"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129957","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":"Blood pressure monitoring is key in aortic dissection.","authors":"Alice Lopes, Tara M Mastracci","doi":"10.23736/S0021-9509.25.13352-1","DOIUrl":"10.23736/S0021-9509.25.13352-1","url":null,"abstract":"<p><p>Blood pressure (BP) control is essential for both the prevention and long-term management of aortic dissection. While office BP monitoring remains the most widely used method, its limitations in detecting BP variability, masked hypertension, and nocturnal hypertension highlight the need for alternative approaches. Ambulatory BP monitoring and home BP monitoring offer superior prognostic value, enabling more precise BP assessment and treatment optimization. However, challenges such as accessibility, patient compliance, and integration into clinical workflows persist. Digital health solutions, including telemonitoring, artificial intelligence-driven analysis, and wearable BP monitoring devices, hold promise in overcoming these barriers and improving long-term BP control. As strict BP management remains central to reducing complications, emerging evidence suggests it may also contribute to favorable aortic remodeling, potentially altering disease progression. Leveraging these advancements could shift BP management in aortic dissection from risk mitigation to proactive disease modification, optimizing patient outcomes in both prevention and follow-up.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"247-257"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164180","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":"Bridging stents in endovascular repair of chronic aortic dissection: a scoping review.","authors":"Frida R Jonsdottir, Timothy A Resch","doi":"10.23736/S0021-9509.25.13383-1","DOIUrl":"10.23736/S0021-9509.25.13383-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Fenestrated and branched endovascular aortic repair (F/B-EVAR) is increasingly used in the treatment of chronic aortic dissection (cAD), particularly for post-dissection thoracoabdominal aortic aneurysms (PD-TAAA). These aneurysms differ significantly from degenerative aneurysms due to the presence of a true and false lumen, complex target vessel (TV) anatomy, and the higher potential for ongoing aortic remodeling. These factors contribute to technical challenges in target vessel cannulation and raise concerns about the long-term stability of target vessel bridging stents. Although bridging stents play a critical role in achieving durable sealing and target vessel patency, there are currently no clear guidelines for their selection in the setting of PD-TAAA, where anatomical complexity and luminal remodeling pose unique challenges. Bridging stent performance may be influenced by stent design, anatomical configuration, and procedure type, yet evidence specific to this patient population remains limited. This scoping review aims to assess the applicability and outcomes of available bridging stents in the endovascular treatment of PD-TAAA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidence acquisition: &lt;/strong&gt;This scoping review followed PRISMA-ScR guidelines. A systematic search was conducted in Ovid Medline using keywords related to chronic aortic dissection, bridging stents, FEVAR, and BEVAR. Studies were included if they reported on ≥10 patients with CTBAD treated by FEVAR or BEVAR, with target vessel-specific outcomes. Physician-modified endografts were excluded. Data on patient numbers, stent types, follow-up, and target vessel outcomes (stenosis, occlusion, endoleaks) were extracted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidence synthesis: &lt;/strong&gt;Of 50 records screened, three studies met the inclusion criteria, encompassing 375 patients and 1396 treated TVs. All studies were retrospective analyses of prospectively collected data in patients with PD-TAAA. Two studies provided selection criteria for FEVAR vs. BEVAR and specified bridging stent preferences. Fenestrations were typically bridged with balloon-expandable covered stents (BESG), while branches used either BESG or self-expanding covered stents (SESG). Target vessel stenosis or occlusion was more frequently associated with branches, with FEVAR showing superior target vessel patency in one study. No study directly compared BESG and SESG patency. TV-related endoleaks occurred in all studies; two reported no significant difference between FEVAR and BEVAR. Reinterventions were common across all cohorts, primarily due to TV-related complications, with rates approaching 50% at two years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In PD-TAAA, the choice between FEVAR, BEVAR, and bridging stent type is largely driven by anatomy and physician preference. The high rate of reinterventions due to target vessel-related complications highlights the need for close postoperative surveillance. Further research is essential","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"194-202"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181578","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":"Branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms: an institutional experience on preoperative planning, intraoperative execution, and pitfalls.","authors":"Roberto G Aru, Florent Porez, Thomas LE Houérou, Mickael Palmier, Antoine Gaudin, Dominique Fabre, Stéphan Haulon","doi":"10.23736/S0021-9509.25.13325-9","DOIUrl":"10.23736/S0021-9509.25.13325-9","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to evaluate the outcomes of branched endovascular aortic repair (BEVAR) in post-dissection thoracoabdominal aortic aneurysms (PD TAAAs), as well as define preoperative planning and intraoperative execution.</p><p><strong>Methods: </strong>Patients who underwent BEVAR in PD TAAAs from 2019 to 2024 were identified using a prospectively maintained electronic database at a single, tertiary-care hospital. Patient demographics, comorbidities, indication for the procedure, anatomic and procedural details, and outcomes were retrospectively recorded.</p><p><strong>Results: </strong>Thirty-four patients (74% male, median age 62 years) underwent BEVAR for PD TAAA. There was a high incidence of hypertension (79%) and stage III-V chronic kidney disease (41%). Prior aortic surgery was prevalent in the majority (62%) of patients, with an open (53%) and/or endovascular (35%) approach. BEVAR was commonly performed for asymptomatic PD-TAAA without rupture (71%). Target vessels (TV) arising from the false lumen (FL) and dissected TVs occurred in 32% and 11%, respectively. The majority underwent staged repair by an open (15%) and/or endovascular (47%) approach, most commonly zone 2 (24%) or 3 (15%) thoracic endovascular aortic repair (TEVAR). The off-the-shelf t-Branch (Cook Medical) was used in 24 (70%) patients. The proximal and distal landing zones were in prior/staged TEVAR (71%) and in native infrarenal aorta (65%), respectively. The bridging stent-graft was most commonly balloon-expandable (70%), including hybrid stenting with self-expandable stent-grafts. Adjunctive FL management and prophylactic embolization of type II endoleaks were performed in 56% and 79%, respectively. Technical success was 94%. Postoperative complications were most commonly self-limited acute kidney injury (9%); there was no episodes of spinal cord ischemia. There was a 30-day mortality of 6%. Thirty-day reinterventions were 3% (N.=4, 130 target vessels) for TV-related instability and 6% (N.=2, 34 patients) for FL perfusion. Based on a median follow-up of 18 months, primary and primary-assisted patency of the TV were 94% and 99%, respectively. Midterm reinterventions were 6% for TV-related instability and 35% for FL perfusion. There were no surgical conversions.</p><p><strong>Conclusions: </strong>BEVAR can be performed with high technical success in PD TAAAs. However, secondary interventions for TV instability and continued FL perfusion are frequent; thus, close follow-up is mandatory.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"178-193"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082964","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":"Challenges associated with chronic aortic dissections: single-center experience of iliac branch devices in chronic aortic dissections.","authors":"David Khangholi, Christos Vrettos, Nikolaos Konstantinou, Baban Assaf, Buland Tiwana, Dario Machado, Jan Stana, Nikolaos Tsilimparis","doi":"10.23736/S0021-9509.25.13404-6","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13404-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic aortic dissections extending into the iliac arteries present unique anatomical and procedural challenges. Iliac branch devices (IBDs) offer the potential to preserve pelvic perfusion and achieve distal false lumen exclusion, yet their use in dissected anatomies remains off-label and insufficiently studied. This study evaluates the safety, technical success, and mid-term outcomes of IBDs in patients with chronic post-dissection aneurysms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective single-center study included all patients treated with IBDs (Zenith&lt;sup&gt;®&lt;/sup&gt; Branch Endovascular Graft-Iliac Bifurcation, Cook Medical Bloomington, IN, USA) for chronic aortoiliac dissections between 2016 and 2024. Preoperative anatomy, procedural details, and clinical outcomes were analyzed. Primary endpoints were technical success and aneurysm shrinkage. Secondary endpoints included mortality, IBD-related endoleaks, occlusions and reinterventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 38 IBDs were implanted in 28 patients (mean age 59±11 years, 89% male). In 53% of cases, IBD implantation was performed simultaneously with f/bEVAR. Technical success was achieved in 100% of procedures. Aneurysm shrinkage was observed in all measured segments, with a mean reduction of 4.9 mm in the aorta, 5.4 mm at the aortic bifurcation, and 6.7 mm in the CIA (each P≤0.004). Estimated overall survival was 96% at 12 months and 86% at 36 months, declining to 62% at 60 months. Freedom from IBD-related endoleaks was 76%, from occlusion 91%, and from reintervention 75% at 36 months, with most adverse events clustering in the first year and event curves plateauing thereafter. A total of four IBD-related occlusions and eight reinterventions were recorded during follow-up. One early case of spinal cord ischemia after acute complicated type B dissection with contained rupture and one late case following embolic IIA branch occlusion were observed. General clinical complications occurred in 39% of patients, mainly due to hospital-acquired infections and acute kidney injury. Exploratory regression identified age, chronic kidney disease, aortic diameter, and pelvic tortuosity as predictors of overall mortality; custom-made IBDs predicted sac shrinkage, while self-expanding bridging stents and distal IIA relining were associated with occlusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In anatomically complex and predominantly younger patients, IBDs offer high technical success, favorable aneurysm remodeling and sustained preservation of pelvic perfusion. Despite their off-label use, endoleak, occlusion and reintervention rates remain acceptable when performed in experienced centers. The high rate of clinical complications reflects the complexity of simultaneous multilevel aortic repair and underscores the importance of meticulous perioperative care in this high-risk population. Further prospective multicenter studies are needed to validate these findi","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 3","pages":"203-217"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500031","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":"Tackling the ultimate endovascular challenge.","authors":"Stéphan Haulon","doi":"10.23736/S0021-9509.25.13434-4","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13434-4","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 3","pages":"165-166"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500033","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":"Fenestrated/branched aortic endovascular repair of chronic dissections managed after previous PETTICOAT.","authors":"Gabor Fazekas, Petroula Nana, Jose I Torrealba, Thomas LE Houérou, Giuseppe Panuccio, Stephan Haulon, Tilo Kölbel","doi":"10.23736/S0021-9509.25.13310-7","DOIUrl":"10.23736/S0021-9509.25.13310-7","url":null,"abstract":"<p><strong>Background: </strong>Previous PETTICOAT stents, applied in type B aortic dissections, may complicate subsequent fenestrated/branched endovascular aortic repair. This study presents the technical and clinical outcomes of f/bEVAR in chronic type A and B aortic dissections previously managed with PETTICOAT.</p><p><strong>Methods: </strong>This case series included patients from two aortic centers, with chronic dissections managed with f/bEVAR for thoracoabdominal aneurysms following PETTICOAT. The PROCESS guidelines were followed. Technical parameters and clinical outcomes were assessed.</p><p><strong>Results: </strong>Eight male patients were included (63 [54-74] years). Two were managed for type I, five for type II and one for type V thoracoabdominal aneurysms. Six custom-made (two fenestrated, three branched and one combined) and two off-the-shelf branched endografts were used. Technical success was 100%. Adjunctive target vessel related procedures were performed in six cases, including pre-catheterization of stenotic renal arteries due to overlapping PETTICOAT stents, dissection flap fenestration for target vessel catheterization, in-situ fenestration after accidental celiac artery occlusion, and ballon-assisted bridging stent advancement through the PETTICOAT stent-struts. Balloon-expandable or self-expanding covered stents reinforced with balloon-expandable bare metal stents were used. No death occurred within 30 days. Two early reinterventions were performed: one relining renal bridging stent compression between the PETTICOAT stent-struts and one renal branch coiling due to bleeding. Median follow-up was 21 months. No death, reintervention or target vessel instability was detected.</p><p><strong>Conclusions: </strong>According to the described experience, f/bEVAR may be successfully applied in patients with previous PETTICOAT by experienced hands. However, technical challenges, needing immediate intra-operative or early post-operative management, are frequent.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"239-246"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034800","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":"Pitfalls in sizing and planning for fenestrated and branched stent-grafts in patients with chronic post-dissection thoracoabdominal aortic aneurysms.","authors":"Emanuel R Tenorio, Gustavo S Oderich","doi":"10.23736/S0021-9509.25.13416-2","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13416-2","url":null,"abstract":"<p><p>Fenestrated-branched endovascular aneurysm repair is increasingly utilized in managing chronic post-dissection thoracoabdominal aortic aneurysms (TAAAs), with multicenter data indicating outcomes comparable to those in degenerative TAAAs. However, the anatomical and technical considerations in chronic dissection are distinct, often involving collapse of the true lumen, separate origins of target vessels from the true versus false lumen, and persistent dissection flaps extending into the renovisceral segment. Transcatheter electrosurgical septotomy is an emerging adjunct technique that aids in expanding the true lumen and optimizing proximal and distal sealing zones and branch vessel alignment during subacute and chronic post-dissection TAAA repair. This article reviews the key principles in preoperative planning and device customization for FB-EVAR within this complex anatomical context.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"66 3","pages":"167-177"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500032","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":"What does anatomically eligible mean in contemporary thoracic endovascular aneurysm repair for type B aortic dissection?","authors":"Alexander H Zielinski, Timothy A Resch","doi":"10.23736/S0021-9509.25.13373-9","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13373-9","url":null,"abstract":"<p><p>Modern management of type B aortic dissection (TBAD) in some cases necessitate treatment by thoracic endovascular repair (TEVAR). Some patients are not anatomically eligible for simple, standard TEVAR, since critical side branches of the aorta would be covered by the stent graft and might require revascularisation. This commentary will outline some strategies for complex thoracic aortic repair in the aortic arch that could be considered in patients with dissection anatomy that does not allow for stand-alone TEVAR. Current guidelines provide vague guidance in assessment of anatomic eligibility for TEVAR. The principles of these adjunctive repair strategies - debranching of the supraaortic vessels, parallel grafts, physician-modified endografts and in-situ fenestrations - and short-term outcomes from a selection of larger studies (of >40 patients) are presented. The literature is somewhat heterogenous regarding patient selection and intervention strategy. Still, collectively, there seems to be a trend towards decreased morbidity and mortality, along with good technical outcomes, with newer strategies including dedicated TEVAR devices alone or in combination with physician-modification and/or in situ fenestration compared to conventional debranching and parallel grafting.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183295","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}