Clinical Medicine Insights. Cardiology最新文献

{"title":"Patterns of Antihypertensive Drug Utilization among US Adults with Diabetes and Comorbid Hypertension: The National Health and Nutrition Examination Survey 1999-2014.","authors":"Anna Gu, Shireen N Farzadeh, You Jin Chang, Andrew Kwong, Sum Lam","doi":"10.1177/1179546819839418","DOIUrl":"10.1177/1179546819839418","url":null,"abstract":"<p><strong>Background: </strong>Diabetes and hypertension are the 2 leading risk factors for suboptimal cardiovascular and renal outcomes. These 2 conditions often coexist and can benefit from antihypertensive therapy, which may lead to blood pressure control and reduced risk for nephropathy (as evidenced by albuminuria).</p><p><strong>Objective: </strong>To quantify the trends of antihypertensive drug use and to assess the impact of antihypertensive treatment on the prevalence of blood pressure control and albuminuria, among US adults with coexisting diabetes and hypertension.</p><p><strong>Methods: </strong>In this serial cross-sectional study, we analyzed data from the 1999-2014 National Health and Nutrition Examination Survey (N = 3586). We determine the prevalence of antihypertensive use, drug classes used, and their association with blood pressure control and albuminuria.</p><p><strong>Results: </strong>During the study period, the study population experienced substantial increase in antihypertensive treatment (from 84.6% in 1999-2002 to 90.1% in 2011-2014, <i>P_trend</i>  < .01) and blood pressure control (from 37.1% to 46.9%, <i>P_trend</i>  < .01) and decrease in albuminuria (from 39.1% to 31.3%, <i>P_trend</i>  = .02). These trends were particularly pronounced in the subgroups using angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers. In multivariate analysis, Blacks, Hispanics, and males were found more likely to have albuminuria than their respective counterparts. Achieving blood pressure control (odds ratio = 0.40, 95% confidence interval [CI]: 0.32-0.49) was associated with lower rates of albuminuria.</p><p><strong>Conclusion and relevance: </strong>Despite continued improvement in antihypertensive therapy, the burden of uncontrolled blood pressure and albuminuria remains substantial among US adults with diabetes and hypertension. Tailoring pharmacotherapy based on patient characteristics and comorbidities is needed to further improve these outcomes.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"13 ","pages":"1179546819839418"},"PeriodicalIF":2.3,"publicationDate":"2019-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/8a/10.1177_1179546819839418.PMC6463235.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37180426","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":"Physical Exercise for Individuals with Hypertension: It Is Time to Emphasize its Benefits on the Brain and Cognition.","authors":"Maria Lm Rêgo, Daniel Ar Cabral, Eduardo C Costa, Eduardo B Fontes","doi":"10.1177/1179546819839411","DOIUrl":"10.1177/1179546819839411","url":null,"abstract":"<p><p>Hypertension affects more than 40% of adults worldwide and is associated with stroke, myocardial infarction, heart failure, and other cardiovascular diseases. It has also been shown to cause severe functional and structural damage to the brain, leading to cognitive impairment and dementia. Furthermore, it is believed that these cognitive impairments affect the mental ability to maintain productivity at work, ultimately causing social and economic problems. Because hypertension is a chronic condition that requires clinical treatment, strategies with fewer side effects and less-invasive procedures are needed. Physical exercise (PE) has proven to be an efficient and complementary tool for hypertension management, and its peripheral benefits have been widely supported by related studies. However, few studies have specifically examined the potential positive effects of PE on the brain in hypertensive individuals. This narrative review discusses the pathophysiological mechanisms that hypertension promotes in the brain, and suggests PE as an important tool to prevent and reduce cognitive damage caused by hypertension. We also provide PE recommendations for hypertensive individuals, as well as suggestions for promoting PE as a method for increasing cognitive abilities in the brain, particularly for hypertensive individuals.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"13 ","pages":"1179546819839411"},"PeriodicalIF":2.3,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/cc/10.1177_1179546819839411.PMC6444761.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37137103","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":"Impact of Cine Frame Selection on Quantitative Coronary Angiography Results.","authors":"Shigenori Ito,&nbsp;Kanako Kinoshita,&nbsp;Akiko Endo,&nbsp;Masato Nakamura","doi":"10.1177/1179546819838232","DOIUrl":"https://doi.org/10.1177/1179546819838232","url":null,"abstract":"We evaluated intra- and interobserver variability of quantitative coronary angiography (QCA) due to cine frame selection for 9 coronary stenoses. The projection was selected in advance. Cine frames were selected by 2 blinded experts (blind frame QCA) followed by assignment by supervisor (pre-selected frame QCA). Each expert analyzed 18 frames twice with a 3-month interval. A total of 72 measurements by 2 experts were used for intra- and interobserver variability analysis in calibration factor (CF), minimal lumen diameter (MLD), percent diameter stenosis (%DS), interpolated reference diameter (Int R), and lesion length (LL). Accuracy, precision, and coefficient of variation (CV) were calculated based on 2 measurements. For interobserver variability, intraclass correlation coefficient (ICC) was evaluated. Regarding intraobserver variability, precision (CV) was 0.0026 (1.45), 0.220 (25.1), 0.282 (11.0), 7.626 (11.8), and 4.042 (28.7) for blind frame QCA and 0.0044 (2.46), 0.094 (11.2), 0.225 (8.6), 3.924 (5.9), and 1.941 (12.1) for pre-selected frame QCA and regarding interobserver variability, precision (CV) was 0.0037 (2.09), 0.271 (31.8), 0.307 (11.9), 10.10 (15.4), and 5.121 (39.5) for blind frame QCA and 0.0050 (2.82), 0.098 (11.4), 0.246 (9.5), 5.253 (8.0), and 2.857 (19.0) for pre-selected frame QCA in CF, MLD, Int R, %DS, and LL, respectively. Intraclass correlation coefficient of Int R was almost perfect in blind and pre-selected frame QCA. Intraclass correlation coefficient of MLD, %DS, and LL were substantial/lower by blind frame QCA and improved to almost perfect by pre-selected frame QCA. Blind cine film selection might affect intra- and interobserver variability, especially in MLD and LL. In the multiple linear regression analysis, blind frame QCA was selected as an explanatory factor of QCA variability in MLD, %DS, and LL. The error range due to frame selection must be taken into consideration in clinical use.","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"13 ","pages":"1179546819838232"},"PeriodicalIF":3.0,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179546819838232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37139771","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":"Contrast Enhancement and Image Quality Influence Two- and Three-dimensional Echocardiographic Determination of Left Ventricular Volumes: Comparison With Magnetic Resonance Imaging.","authors":"Jonas Jenner,&nbsp;Peder Sörensson,&nbsp;John Pernow,&nbsp;Kenneth Caidahl,&nbsp;Maria J Eriksson","doi":"10.1177/1179546819831980","DOIUrl":"https://doi.org/10.1177/1179546819831980","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of image quality and contrast enhancement (CE) on left ventricular (LV) volume determination by two- (2D) and three-dimensional (3D) echocardiography (2DE/3DE).</p><p><strong>Methods: </strong>We studied 32 post-myocardial infarction (MI) patients without (2DE/3DE) and with CE (CE2DE/CE3DE), in comparison with cardiac magnetic resonance imaging (CMR).</p><p><strong>Results: </strong>Two-dimensional echocardiography showed the largest negative bias versus CMR for diastolic and systolic volumes (-59, -28 mL, respectively) with lower biases for CE2DE (-37, -22 mL), 3DE (-31, -17 mL), and CE3DE (-17, -11 mL). Bias for ejection fraction (EF) ranged from -2.1% for 2DE to +1.4% for CE3DE. Agreement (intraclass correlation coefficient, ICC) for EF between CMR and 3DE (0.86 without and 0.85 with contrast) was better than for 2DE (0.73 without and 0.69 with contrast). The inter-/intra-observer coefficients of variation for EF varied from 16%/10% (2DE) to 6.9%/6.6% (CE2DE), and 8.3%/4.8% (3DE) to 6.7%/6.8% (CE3DE), respectively. The agreement (ICC) with CMR for EF measured by 2DE/3DE changed from 0.64/0.84 with poor image quality to 0.81/0.87 with moderate to good image quality.</p><p><strong>Conclusions: </strong>Three-dimensional echocardiography was more accurate than 2DE for estimating LV volumes, with less inter-/intra-observer variability in EF values. Contrast enhancement improved accuracy for both 2DE and 3DE and improved the inter-observer variability of EF estimates for 2DE and 3DE. Image quality had more impact on the agreement of EF values with CMR for 2DE than for 3DE. Our results emphasize the importance of using the same technique for longitudinal studies of LV EF and specially LV volumes.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"13 ","pages":"1179546819831980"},"PeriodicalIF":3.0,"publicationDate":"2019-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179546819831980","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37206652","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":"Contrast-Induced Acute Kidney Injury: Review and Practical Update","authors":"R. Morcos, M. Kucharik, Pirya Bansal, Haider Al Taii, Rupesh Manam, Joel A Casale, H. Khalili, Brijeshwar Maini","doi":"10.1177/1179546819878680","DOIUrl":"https://doi.org/10.1177/1179546819878680","url":null,"abstract":"Contrast-induced acute kidney injury (CI-AKI) is an important consideration in patients undergoing cardiac catheterization. There has been a continuous strive to decrease morbidity and improve procedural safety. This review will address the pathophysiology, predictors, and clinical management of CI-AKI with a concise overview of the pathophysiology and a suggested association with left atrial appendage closure. Minimizing contrast administration and intravenous fluid hydration are the cornerstones of an effective preventive strategy. A few adjunctive pharmacotherapies hold promise, but there are no consensus recommendations on prophylactic therapies.","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"33 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80304991","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":"A Review of Randomized Controlled Trials Utilizing Telemedicine for Improving Heart Failure Readmission: Can a Realist Approach Bridge the Translational Divide?","authors":"M. Gonzalez Garcia, Farhad Fatehi, N. Bashi, M. Varnfield, P. Iyngkaran, A. Driscoll, C. Neil, D. Hare, B. Oldenburg","doi":"10.1177/1179546819861396","DOIUrl":"https://doi.org/10.1177/1179546819861396","url":null,"abstract":"Background: Telemedicine and digital health technologies hold great promise for improving clinical care of heart failure. However, inconsistent and contradictory findings from randomized controlled trials have so far discouraged widespread adoption of digital health in routine clinical practice. We undertook this review study to summarize the study outcomes of the use of exploring the evidence for telemedicine in the clinical care of patients with heart failure and readmissions. Methods: We inspected the references of guidelines and searched PubMed for randomized controlled trials published over the past 10 years on the use of telemedicine for reducing readmission in heart failure. We utilized a modified realist review approach to identify the underlying contextual mechanisms for the intervention(s) in each randomized controlled trial, evaluating outcomes of the intervention and understanding how and under what conditions they worked. To provide uniformity, all extracted data were synthesized using adapted domains from the taxonomy for disease management created by the Disease Management Taxonomy Writing Group. Results: A total of 12 papers were eligible, 6 of them supporting and 6 others undermining the use of telemedicine for improving heart failure readmission. In general terms, those studies not supporting the use of telemedicine were multicentre, publicly funded, with large amount of participants, and long duration. The patients had also better rates of treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker and beta-blockers, and telemonitoring and automatic transmission of vital signs were less utilized, in comparison with the studies in which telemedicine use was supported. The analysis of the environment, intensity, content of interventions, method of communication, quality of the underlying model of care and the ability, capability, and interest from health workers can help us to envisage probabilities of success of telemedicine use. Conclusions: A realist lens may aid to understand whom and in which circumstances the use of telemedicine can add any substantial value to traditional models of care. Wider outcome criteria beyond major adverse cardiovascular events, for example, cost efficacy, should also be considered as appropriate for effecting guidelines on care delivery when robust prognostic therapeutics already exist.","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"79 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91280560","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":"Cancer Therapy-Related Cardiac Dysfunction: An Overview for the Clinician","authors":"I. Perez, Sara Taveras Alam, Gabriel A. Hernandez, Rhea Sancassani","doi":"10.1177/1179546819866445","DOIUrl":"https://doi.org/10.1177/1179546819866445","url":null,"abstract":"Cancer therapy-related cardiac dysfunction (CTRCD) is one of the most feared and undesirable side effects of chemotherapy, occurring in approximately 10% of the patients. It can be classified as direct (dose-dependent vs dose-independent) or indirect, either case being potentially permanent or reversible. Risk assessment, recognition, and prevention of CTRCD are crucial.","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"5 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72907000","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":"Applying the Capability, Opportunity, and Motivation Behaviour Model (COM-B) to Guide the Development of Interventions to Improve Early Detection of Atrial Fibrillation","authors":"A. Jatau, G. Peterson, L. Bereznicki, C. Dwan, J. Black, Woldesellassie M. Bezabhe, B. Wimmer","doi":"10.1177/1179546819885134","DOIUrl":"https://doi.org/10.1177/1179546819885134","url":null,"abstract":"Objective: The primary objective of this study is to use the Capability, Opportunity, and Motivation Behaviour (COM-B) model to identify potential strategies aimed at improving the early detection of atrial fibrillation (AF) in the general population. Methods: We undertook a review of the literature to identify factors associated with participation in community-based screening for AF, followed by mapping of the factors generated into the components of the COM-B model, and validation of the model by an expert panel. The Behaviour Change Wheel (BCW) was used to nominate potential intervention strategies and steps to guide the design and implementation of community-based screening for AF. Results: A total of 28 factors from 21 studies were mapped into the COM-B model. Based on the BCW approach, 24 intervention strategies and 7 steps that could guide the design and implementation of community-based screening for AF were recommended. Conclusion: The application of the COM-B model demonstrated how factors influencing the participation of individuals with undiagnosed AF in community-based screening could be identified. The model could also serve as a guide for the design and implementation of interventions for improving AF detection in the general population.","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"2 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84832314","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":"Fusidic Acid: A Neglected Risk Factor for Statin-Associated Myopathy.","authors":"Josefine Rönnqvist,&nbsp;Pär Hallberg,&nbsp;Qun-Ying Yue,&nbsp;Mia Wadelius","doi":"10.1177/1179546818815162","DOIUrl":"https://doi.org/10.1177/1179546818815162","url":null,"abstract":"<p><strong>Background: </strong>Statins are widely used lipid-lowering drugs used for the prevention of cardiovascular disease. Statins are known to cause myopathy, an adverse drug reaction with various clinical features rhabdomyolysis.</p><p><strong>Objective: </strong>To describe clinical characteristics of statin-treated individuals who experienced myopathy and identify risk factors of statin-associated myopathy.</p><p><strong>Methods: </strong>A retrospective study was conducted on cases of statin-associated myopathy reported to the Swedish Medical Products Agency. Clinical factors were compared between cases and statin-treated controls not diagnosed with myopathy. Statistical methods were univariate and multivariate logistic regression and results were presented as odds ratio (OR) with 95% confidence interval (CI). To correct for multiple comparisons, the cutoff for statistical significance was set to <i>P</i> < .0017.</p><p><strong>Results: </strong>In total, 47 cases of statin-associated myopathy were compared with 3871 treated controls. Rhabdomyolysis was diagnosed in 51% of the cases. Markers for cardiovascular disease were more common in cases than controls. Statistical analysis revealed the following independent risk factors for myopathy: high statin dose (OR = 1.54, calculated using the standard deviation 19.82, 95% CI = 1.32-1.80, <i>P</i> < .0001), and concomitant treatment with fusidic acid (OR = 1002, 95% CI = 54.55-18 410, <i>P</i> < .0001), cyclosporine (OR = 34.10, 95% CI = 4.43-262.45, <i>P</i> = .0007), and gemfibrozil (OR = 12.35, 95% CI = 2.38-64.10, <i>P</i> = .0028).</p><p><strong>Conclusions: </strong>The risk of myopathy increases with statin dose and cotreatment with cyclosporine and gemfibrozil. Concomitant fusidic acid has previously only been noted in a few case reports. Considering that use of fusidic acid may become more frequent, it is important to remind of this risk factor for statin-associated myopathy.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"12 ","pages":"1179546818815162"},"PeriodicalIF":3.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179546818815162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36831458","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":"Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age.","authors":"Pupalan Iyngkaran,&nbsp;Danny Liew,&nbsp;Christopher Neil,&nbsp;Andrea Driscoll,&nbsp;Thomas H Marwick,&nbsp;David L Hare","doi":"10.1177/1179546818809358","DOIUrl":"https://doi.org/10.1177/1179546818809358","url":null,"abstract":"<p><p>This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"12 ","pages":"1179546818809358"},"PeriodicalIF":3.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179546818809358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36831906","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}