Clinical and Experimental Emergency Medicine最新文献

{"title":"The Role of Fomepizole in Acetaminophen-related Poisoning: A Narrative Review.","authors":"Frank Chen, Shelly Zq Lu, Harleen Choha, Anthony Lau","doi":"10.15441/ceem.25.059","DOIUrl":"https://doi.org/10.15441/ceem.25.059","url":null,"abstract":"<p><strong>Objective: </strong>N-acetylcysteine as the gold standard antidote may not be sufficient in managing cases of acetaminophen-related poisoning with delayed presentations or with massive ingestions. Existing human reports up until July 2021 have suggested that fomepizole may play a potential role in acetaminophen overdoses through inhibition of CYP2E1-mediated NAPQI production and JNK-mediated oxidative damage. This narrative review aims to build upon the repertoire of literature and case studies summarized by existing systematic and scoping reviews with the latest evidence regarding the use of fomepizole in acetaminophen-poisoning to better understand the hepatoprotective role and safety profile of this medication as well as its practical place in therapy.</p><p><strong>Methods: </strong>A systematic search was completed through November 2024 in MEDLINE and EMBASE. Studies involving human patients with acetaminophen toxicity who received fomepizole treatment were included. Each patient case was thoroughly summarized in tables from which clinical trends including the risk of hepatotoxicity, quantity of ingestion, time of presentation since ingestion, therapeutic and dosing regimens, and clinical outcomes were identified.</p><p><strong>Results: </strong>A total of 30 studies and 45 patients across 18 case reports and six case series were included in this review. When used in adjunct with N-acetylcysteine, fomepizole seemed to result in favourable laboratory and clinical outcomes in most patients that were at high risk of hepatotoxicity with late presentations or massive acetaminophen ingestions.</p><p><strong>Conclusion: </strong>Available data suggests fomepizole may complement N-acetylcysteine in severe acetaminophen toxicity. Though lacking detailed clinical outcome analyses, case studies suggest fomepizole may improve hepatotoxicity, survival, and transplant-free days.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844789","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":"Ketorolac analgesia in the emergency department in adults: systematic review and meta-analysis.","authors":"Antimo Tessitore, Luisa Zupin, Fulvio Celsi, Valeria Capaci, Alessandro Amaddeo, Egidio Barbi, Giorgio Cozzi","doi":"10.15441/ceem.25.002","DOIUrl":"https://doi.org/10.15441/ceem.25.002","url":null,"abstract":"<p><strong>Background and objective: </strong>Acute painful conditions are a common reason to emergency department (ED) referral, and a broad variety of analgesic drugs may be used. Among them, ketorolac is a Non-Steroidal Anti-Inflammatory Drug (NSAID) increasingly used in the last two decades. In order to clarify the available evidence about the use of ketorolac in the ED setting, a systematic review and meta-analysis was performed.</p><p><strong>Databases and data treatment: </strong>A search was performed in PubMed for English written articles updated to February 2023. Only randomized controlled trials regarding adult patients with acute painful conditions treated in the ED were selected. A meta-analysis was performed to evaluate the effectiveness of ketorolac in different pain conditions.</p><p><strong>Results: </strong>: Forty randomized controlled trials were selected including studies focused on acute renal colic, headache, traumatic and non-traumatic musculoskeletal pain, and biliary colic. In these studies, ketorolac was mainly compared to opioids and in general showed a similar analgesic efficacy. On the other hand, when compared to other NSAIDs, ketorolac does not seem to have a stronger analgesic effect.</p><p><strong>Conclusion: </strong>s: This systematic review indicates that ketorolac is a valuable option, alternative to opioids, to induce analgesia in adult ED patients, as our meta-analysis showed no significant difference in efficacy compared to opioids or other NSAIDs. Nevertheless, the evidence regarding its efficacy compared to other commonly NSAIDs is still limited and should be further explored in future studies.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844697","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":"Skull fractures may be associated with hyperfibrinolysis in patients with isolated traumatic brain injury.","authors":"Gaku Fujiwara, Naoto Shiomi","doi":"10.15441/ceem.24.344","DOIUrl":"https://doi.org/10.15441/ceem.24.344","url":null,"abstract":"<p><strong>Objectives: </strong>To identify the association between skull fracture (SF) and hyperfibrinolysis (HF) among patients with isolated traumatic brain injury.</p><p><strong>Methods: </strong>This study was the retrospective cohort study based on the nationwide neurotrauma database in Japan. Adult patients with isolated traumatic brain injury (head abbreviated injury scale (AIS) >2, any other AIS <3) registered in the JNTDB from 2015 to 2017 were included. To examine the association between SF and HF, we conducted multivariable logistic regression analyses to calculate the adjusted odds ratios (ORs) of SF with their 95% confidence intervals (CIs) for HF. HF was defined as a D-dimer level ≥ 38 mg/L on arrival based on the previous study.</p><p><strong>Results: </strong>A total of 335 patients were enrolled and the median age of the cohort was 64 years (interquartile range, 44-76 years). HF was observed in 161 patients (48.1%). The association of SF with HF yielded an adjusted odds ratio (OR) of 4.78 (95% CI: 2.71-8.42) compared to non-SF in multivariable logistic regression analysis. In addition, the association of skull base fracture, skull vault fracture, and combination of skull base and vault fracture with HF yielded the corresponding adjusted ORs of 3.60 (95% CI: 1.20-10.81), 4.99 (95% CI: 2.63-9.44), and 4.84 (95% CI: 2.41-9.72), respectively, relative to non-SF.</p><p><strong>Conclusion: </strong>This multicenter observational study demonstrated the association of SF with HF in patients with isolated TBI.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844788","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":"Comparison of Regional Wall Motion Abnormalities in STEMI(+) vs. STEMI(-) Occlusion Myocardial Infarction.","authors":"Alexander Bracey, H Pendell Meyers, Caleb Watkins, Gautam R Shroff, Daniel Lee, Adam Singer, Stephen W Smith","doi":"10.15441/ceem.24.373","DOIUrl":"https://doi.org/10.15441/ceem.24.373","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to determine if there are similar rates of regional wall motion abnormalities (RWMAs) in patients with acute coronary occlusion myocardial infarction (ACOMI, or OMI for short) with and without STEMI criteria on electrocardiogram (ECG).</p><p><strong>Methods: </strong>We performed a retrospective review of a database of patients at high risk for acute coronary syndrome (ACS) with previously established outcomes for the presence of OMI in order to compare rates of RWMA in patients presenting with STEMI(+) OMI vs. STEMI(-) OMI. Furthermore, we compared how often the RWMA aligned with the anatomical territory observed on ECG.</p><p><strong>Results: </strong>Among 808 patients, 551 underwent formal echocardiography, including 256 of 265 OMI patients and 295 of 543 patients with No Occlusion. Of the 256 OMIs that underwent formal echocardiography, only 41% (105/256) met STEMI criteria. 90% (94/105) of STEMI(+) OMI patients had RWMA compared to 82% (124/151) of STEMI(-) OMI patients (p = 0.10 [95 CI: -1.63% to 15.6%]). Both groups had greater prevalence of RWMA than the NOMI group (45%). RWMA matched the anatomic territory predicted by ECG in 92.5% of STEMI(+) OMI, 82.3% of STEMI(-) OMI, and 2.9% of the NOMI cohorts.</p><p><strong>Conclusion: </strong>Location of RWMA was well-correlated with ECG findings regardless of the presence or absence of STEMI criteria. Prospective study is warranted to determine the utility of echocardiography in the detection of STEMI(-) OMI.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844695","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":"Efficacy of ketamine versus etomidate for rapid sequence intubation, among critically ill patients in terms of mortality and success rate: A systematic review and meta-analysis of randomized controlled trials.","authors":"Anjishnujit Bandyopadhyay, Partha Haldar, Chhavi Sawhney, Abhishek Singh","doi":"10.15441/ceem.24.363","DOIUrl":"https://doi.org/10.15441/ceem.24.363","url":null,"abstract":"<p><strong>Introduction: </strong>Etomidate as well as ketamine are hemodynamically stable induction agents for rapid sequence intubation (RSI) in critically ill patients. Despite, their relative stability in terms of hemodynamics, the impact of choice of agent, on mortality and success of the procedure, is debatable and has not yet been explored via systematic review and meta-analysis.</p><p><strong>Aim and objective: </strong>The objective of this systematic review is to compare the efficacy of ketamine versus etomidate for RSI in terms of mortality, hemodynamic parameters, and success rate.</p><p><strong>Methodology: </strong>A comprehensive search was conducted throughout PubMed, Embase, and Web of Science from starting date of database until April 2024. Randomized controlled trials, comparing safety and efficacy of ketamine against etomidate as induction drugs for critically ill patients undergoing RSI were included. Primary outcome was risk of 28-day mortality, while secondary outcome included success rate, and post-induction hypotension. Pooled relative-risks (RR) with 95% confidence intervals (CI) were calculated using random-effects meta-analysis.</p><p><strong>Results: </strong>Four studies (n= 1663) were meta-analyzed. There was no statistically significant difference between the two drugs for: 28-day mortality RR 0.95 (95% CI: 0.72-1.25), (heterogeneity- I2 39%, level of certainty of evidence per GRADE: moderate); first pass success rate 1.00, (0.97- 1.03); post induction cardiac arrest 1.10 (0.62- 1.96). Post induction hypotension was higher in the ketamine group 1.30 (1.03- 1.64), although result was not statistically significant.</p><p><strong>Conclusion: </strong>There is no difference in mortality outcomes for ketamine vs etomidate, when used for RSI in critically ill patients. ketamine, however, is associated with higher risk of post induction hypotension.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844696","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":"Serum lactate to albumin ratio at hospital arrival and neurological outcome of out-of-hospital cardiac arrest: a nationwide multicenter observational study.","authors":"Toshinari Kawama, Toshihiro Hatakeyama, Takashi Sano, Koki Nakada, Tasuku Matsuyama, Takeyuki Kiguchi, Benjamin W Berg, Tetsuhisa Kitamura, Hisao Matsushima","doi":"10.15441/ceem.24.339","DOIUrl":"https://doi.org/10.15441/ceem.24.339","url":null,"abstract":"<p><strong>Objective: </strong>We investigated the possible association between lower serum lactate to albumin ratio upon hospital arrival and out-of-hospital cardiac arrest (OHCA) outcome.</p><p><strong>Methods: </strong>Records from the Japanese Association for Acute Medicine-Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry were used for this multicenter observational study. Enrolled patients were ≥18 years old with OHCA of medical etiology who were hospitalized after spontaneous circulation returned between June 1, 2014, and December 31, 2021. We excluded those with missing data or those who failed to meet predefined inclusion criteria. The primary outcome was a cerebral performance category scale of 1 or 2 which indicated 30-day survival with favorable neurological outcome. Patients were divided into quartiles based on serum lactate to albumin ratios. The multivariable logistic regression analysis included adjustment for multiple factors.</p><p><strong>Results: </strong>Data from 4,413 patients were analyzed. The primary outcome was achieved by 558 of 1,104 patients (50.5%) in the first quartile (lactate to albumin ratio, ≤2.23), 240 of 1,111 patients (21.6%) in the second quartile (lactate to albumin ratio >2.23-3.39), 96 of 1,096 patients (8.8%) in the third quartile (lactate to albumin ratio >3.39-4.70), and 24 of 1,102 patients (2.2%) in the fourth quartile (lactate to albumin ratio, >4.70). Adjusted odds ratios (95% confidence intervals) for the primary outcome in the second, third, and fourth quartile compared with the first quartile were 0.33 (0.26-0.42), 0.19 (0.14-0.26), and 0.07 (0.04-0.11), respectively.</p><p><strong>Conclusion: </strong>A statistically significant association between categorization in the lower lactate to albumin ratio quartile group and favorable neurological outcome after OHCA was identified.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844698","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":"Epidemiology of deep venous thrombosis in US emergency departments during an 8-year period.","authors":"Eric Moyer, Kyle Bernard, Michael Gottlieb","doi":"10.15441/ceem.24.299","DOIUrl":"10.15441/ceem.24.299","url":null,"abstract":"<p><strong>Objective: </strong>Deep vein thrombosis (DVT) is a significant cause of morbidity and mortality worldwide, accounting for substantial healthcare utilization. However, management strategies have evolved, and current data on the incidence, admission rates, and medical management of DVT in the emergency department (ED) setting are needed.</p><p><strong>Methods: </strong>This cross-sectional study analyzed ED presentations for DVT from 2016 to 2023 using the Cosmos database. Inclusion criteria were patients aged ≥18 years with an ICD-10 code for acute extremity DVT. The outcomes were incidence rates, admission rates, and anticoagulant prescriptions. Data were analyzed using descriptive statistics, and subgroup analyses were performed for upper and lower extremity DVTs.</p><p><strong>Results: </strong>Of 190,144,463 total ED encounters, 368,044 (0.2%) were due to DVT. Among the DVT cases, 119,986 patients (32.6%) were admitted, at a stable rate during the study period. Apixaban was the most prescribed anticoagulant (40.3%), followed by rivaroxaban (28.3%), enoxaparin (7.9%), warfarin (3.6%), and dabigatran (0.3%). Use of apixaban increased from 12.4% in 2016 to 56.2% in 2023. Lower extremity DVTs accounted for 88.5% of cases, with a 32.1% admission rate, whereas upper extremity DVTs accounted for 11.7% of cases, with a 37.0% admission rate.</p><p><strong>Conclusion: </strong>This study provides a summary of DVT presentation and management in US EDs during an 8-year period. The findings highlight stable incidence rates, reduced admission rates compared with historical data, and a significant shift toward the use of direct oral anticoagulants, particularly apixaban, for outpatient management. These trends underscore the importance of evidence-based practices and ongoing research to optimize DVT management and improve patient outcomes.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"132-138"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonocclusive mesenteric ischemia in a toddler during hypothermia after cardiac arrest: a case report.","authors":"Koji Kanno, Kentaro Watanabe, Yu Kanokogi, Marina Tsujimura, Akira Yoshida, Tomoya Hanada, Yuji Yamagami, Yusuke Ito","doi":"10.15441/ceem.24.213","DOIUrl":"10.15441/ceem.24.213","url":null,"abstract":"<p><p>While nonocclusive mesenteric ischemia (NOMI) has been reported in a significant percentage of adults who were resuscitated after cardiac arrest, it is rare in children. This report presents the first known Japanese case of pediatric NOMI after return of spontaneous circulation following cardiac arrest. A 16-month-old boy experienced cardiac arrest due to asphyxiation from foreign bodies in the airway. After receiving 10 doses of adrenaline, with a maximum arrest time of 95 minutes, the patient achieved return of spontaneous circulation. However, 40 hours after onset, the patient developed NOMI, resulting in refractory hypotensive shock with decreased blood pressure, distended abdomen, and increased intravesical pressure. The patient was successfully rescued with two laparotomies and was discharged. Although NOMI is uncommon in children, appropriate treatment can be lifesaving.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"169-172"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underuse of rapid sequence intubation outside emergency departments: preliminary, retrospective, observational study with emergency physician insights.","authors":"Sung-Yeol Park, Sung-Bin Chon","doi":"10.15441/ceem.24.227","DOIUrl":"10.15441/ceem.24.227","url":null,"abstract":"<p><strong>Objective: </strong>Rapid sequence intubation (RSI) involves the administration of induction agents and neuromuscular blockers before endotracheal intubation (ETI). However, RSI is underutilized outside emergency departments (EDs). We compared RSI adoption rates and ETI outcomes outside and within the EDs and investigated whether RSI adoption affected ETI outcomes outside the EDs.</p><p><strong>Methods: </strong>This retrospective study included adults who underwent emergency ETI outside the operating room at one university hospital between March 2022 and February 2023. The exclusion criteria included cardiopulmonary resuscitation, intentional RSI avoidance, and tube exchange via an introducer. The primary outcome was first-pass success rate. Secondary outcomes were multiple attempts (≥3), prolonged ETI (>5 minutes), and complications. The association between RSI adoption and outcomes outside the ED was assessed using multivariate logistic regression.</p><p><strong>Results: </strong>A total of 490 ETI cases was included: 286 occurred outside the ED and 204 within the ED. The mean age was 68.3±14.7 years and 290 were male. Cases outside the ED received fewer RSI attempts than cases within the ED (12.6% vs. 86.8%, P<0.001). The former showed fewer incidents of first-attempt success (62.2% vs. 88.2%, P<0.001), more numerous multiple attempts (11.5% vs. 2.0%, P<0.001), longer total time of ETI (8.4±8.3 minutes vs. 2.5±2.5 minutes, P<0.001), and more frequent complications (32.2% vs. 19.6%, P=0.003). However, multivariate logistic regression revealed no significant association between RSI adoption and these outcomes outside the ED: odds ratio, 1.74 (95% confidence interval [CI], 0.783-3.84), 0.167 (95% CI, 0.022-1.30), 1.04 (95% CI, 0.405-2.69), and 1.50 (95% CI, 0.664-3.40), respectively.</p><p><strong>Conclusion: </strong>Outside the ED, RSI adoption was lower and ETI outcomes were poorer than those within the ED. However, no association was found between RSI adoption and ETI outcomes outside the ED.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"139-147"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"Characteristics of patients who return to the emergency department after an observation-unit assessment\".","authors":"Amélie Vromant, Yonathan Freund","doi":"10.15441/ceem.25.004","DOIUrl":"10.15441/ceem.25.004","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 2","pages":"183-184"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}