Critical Care Medicine最新文献

{"title":"Prognostic Accuracy of the Phoenix Sepsis Criteria for Mortality in Children With Suspected Infection: A Systematic Review and Meta-Analysis.","authors":"Chieh-Ching Yen, Kuang-Yu Niu, Shang-Jun ZhangJian","doi":"10.1097/CCM.0000000000007312","DOIUrl":"10.1097/CCM.0000000000007312","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the pooled prognostic accuracy of the Phoenix Sepsis Criteria (PSC) for in-hospital mortality and compare its performance with the International Pediatric Sepsis Consensus Conference (IPSCC) criteria in children with suspected infection.</p><p><strong>Data sources: </strong>PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched.</p><p><strong>Study selection: </strong>Eligible studies included prospective or retrospective studies evaluating the PSC among children younger than 18 years with suspected infection in hospital settings.</p><p><strong>Data extraction: </strong>Two investigators independently screened, extracted study characteristics and accuracy data, and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.</p><p><strong>Data synthesis: </strong>A total of 15 studies (16 cohorts; 2,601,038 encounters) were included. The PSC demonstrated pooled sensitivity of 0.77 (95% CI, 0.67-0.85), specificity of 0.73 (95% CI, 0.51-0.87), diagnostic odds ratio of 9.2 (95% CI, 5.1-16.8), and area under the curve (AUC) of 0.81 (95% CI, 0.75-0.84). In contrast, the IPSCC showed lower performance (AUC, 0.71; difference, 0.10 [95% CI, 0.04-0.19]). In subgroup analyses, PSC specificity was lower in the ICU compared with the emergency department (ED) cohorts (0.48 vs. 0.99).</p><p><strong>Conclusions: </strong>The PSC demonstrates good prognostic accuracy for mortality and outperforms the IPSCC criteria. However, performance varies by setting, and the PSC is intended for prognostic risk stratification rather than frontline early sepsis screening. Further validation in the ED, ward, and lower-resource settings, as well as the development of context-specific clinical decision support tools, are warranted.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2717-2727"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Hemodynamic Indices Into the Definition of Refractory Septic Shock: Is There a Role for Catecholamine Refractoriness and Assistance Guide Based on Cardiogenic Shock Hemodynamics (CRASH) Index?","authors":"Enrique Monares-Zepeda,Christopher Barrera-Hoffmann","doi":"10.1097/ccm.0000000000007246","DOIUrl":"https://doi.org/10.1097/ccm.0000000000007246","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"404 1","pages":"2781-2782"},"PeriodicalIF":8.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"H3.1 Nucleosomes in Sepsis: A Biomarker, a Mechanism, or Both?","authors":"Hannah Crowley, Jean-Sebastien Rachoin","doi":"10.1097/CCM.0000000000007321","DOIUrl":"10.1097/CCM.0000000000007321","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2776-2778"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Care Aggression and Violence Events (CAVE) Against Nurses in the ICU: Epidemiology and Risk Factors for Recurrence.","authors":"Anja I Frei, Sebastian Berger, Pascale Grzonka, Simon A Amacher, Paulina Kliem, Caroline E Gebhard, Sabina Hunziker, Raoul Sutter","doi":"10.1097/CCM.0000000000007264","DOIUrl":"10.1097/CCM.0000000000007264","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify and characterize aggression and violence against nurses, identify associated clinical characteristics, evaluate measures in response, and explore predictors of recurrent incidents in the ICU.</p><p><strong>Design: </strong>Retrospective single-center study. Incidence and characteristics of aggression and violence against ICU nurses were the primary outcomes. Aggression was defined as hostile behavior or resistance to care without intent to harm. Violence comprised verbal, physical, or sexual acts to threaten or inflict harm. Secondary outcomes included risk factors for recurrent incidents, defined as multiple episodes of aggression/violence separated by greater than or equal to 24 hours. Multivariable analyses were performed to identify potential independent associations.</p><p><strong>Setting: </strong>Data were collected from 2023 to 2024 at the tertiary medical-surgical ICU with up to 35 beds at the University Hospital Basel. Nursing operations followed a three-shift system: day (07:00-15:00), late (15:00-23:00), and night (23:30-07:00).</p><p><strong>Subjects: </strong>Clinical reports from ICU nurses were screened.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>During 2190 shifts, 308 aggressive or violence incidents (14% of shifts) were reported. Most occurred during late (37%) or night (34%) shifts; 75% involved violence. Violent incidents were combined in nature (79% physical, 43% verbal, and 3% sexual). Patients were mainly involved (97%) and predominantly male (71%; median age 67; 90% emergency admissions). Psychiatric comorbidities, drug, and alcohol abuse were found in 20-33%. Recurrent aggression/violence occurred in 27%, predicted by longer ICU stay (adjusted odds ratio [OR] = 1.05/every additional hour), aggression as the first incident (adjusted OR = 6.9), and verbal violence as the first incident (adjusted OR = 4.3). Nurses (89%, two-thirds female, median 7 yr' experience) rarely documented harm (1.3%), but patients were reported to suffer complications in 60% of incidents, mainly from oversedation and physical harm from restraints.</p><p><strong>Conclusions: </strong>Violence in the ICU is frequent and almost always caused by patients. Recurring violence was independently associated with longer ICU stay, initial aggression, and verbal violence. Staff harm was rare, but incidents were frequently associated with complications in patients.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2728-2740"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Properties of the Patient Dignity Inventory in a Longitudinal Cohort of Acute Respiratory Failure Survivors.","authors":"Lydia E Federico, Craig Kwiatkowski, C Jessica Dine, Yingying Lu, Taara V Prasad, Erich Dress, Stefania Scott, Michael O Harhay, Rachel A Hadler, Rachel Kohn","doi":"10.1097/CCM.0000000000007272","DOIUrl":"10.1097/CCM.0000000000007272","url":null,"abstract":"<p><strong>Objectives: </strong>Although greater than 50% of acute respiratory failure (ARF) survivors develop postintensive care syndrome, dignity-centered interventions-shown to improve psychosocial and existential outcomes in other longitudinally impaired populations-remain largely unexplored in ARF survivorship. We aimed to validate the Patient Dignity Inventory (PDI) among ARF survivors by evaluating internal consistency and generalizability and establishing a minimal clinically important difference (MCID).</p><p><strong>Design/setting/patients: </strong>Prospective cohort study (June 2022 to April 2023) of mechanically ventilated (≥24 h) adults in four University of Pennsylvania hospitals' ICUs.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Patients completed the PDI within 1 month of ICU discharge and at 3, 6, and 12 months. We assessed internal consistency using Cronbach's alpha (reliability of questions measuring the same construct; range 0-1) and exploratory factor analysis to identify dignity-related distress domains. We evaluated generalizability using multilevel mixed-effects modeling to estimate variance attributable to patients, questions, and timepoints, which informed phi coefficient calculation (score consistency; range 0-1). We calculated MCID by averaging anchor-based (EuroQol-5 Dimension MCID = 0.11 from baseline to 12 months) and distribution-based (average of se of the mean, 0.3 × sd , and 5% of baseline score range) estimates.Of 967 eligible patients, 103 patients (11%) enrolled at baseline, with 70% retention at 12 months. PDI demonstrated excellent internal consistency across timepoints (Cronbach's alpha = 0.94-0.96). Factor analysis identified 2-3 factors per timepoint, with physical, psychologic, and cognitive impairments predominating early, and existential and interpersonal concerns increasing longitudinally. Seventy-five percent of score variance was attributable to patient differences and 25% to timepoint, yielding phi = 0.93 (excellent consistency).</p><p><strong>Conclusions: </strong>The PDI is a valid, reliable instrument for assessing dignity among ARF survivors longitudinally, demonstrating excellent internal consistency and generalizability, providing a foundation for designing and evaluating dignity-centered interventions addressing ARF survivors' evolving needs.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2766-2772"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The authors reply.","authors":"HyunBin You, Wei Pan, Deepshikha C Ashana, Sharron L Docherty, Christopher E Cox, Tolu O Oyesanya","doi":"10.1097/CCM.0000000000007291","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007291","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"54 10","pages":"2787-2788"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneous Treatment Effects of Renal Replacement Therapy in Critically Ill Patients: A Multicenter Observational Study Using a Japanese ICU Registry.","authors":"Sae Nakamura, Kosuke Inoue, Kazunari Takahashi, Shun Maeda, Tomoko Fujii","doi":"10.1097/CCM.0000000000007282","DOIUrl":"10.1097/CCM.0000000000007282","url":null,"abstract":"<p><strong>Objective: </strong>Randomized trials evaluating the timing of renal replacement therapy (RRT) have informed current practice toward more conservative initiation strategies because of the lack of mortality benefit from early initiation. However, the optimal indications for RRT to offer lifesaving benefits remain uncertain. We aimed to estimate heterogeneous treatment effect of RRT and to identify patient groups associated with benefit or harm.</p><p><strong>Design: </strong>Multicenter observational study.</p><p><strong>Setting: </strong>A nationwide intensive care registry in Japan, Japanese Intensive Care Patient Database.</p><p><strong>Patients: </strong>Adult patients who were admitted to the ICUs from 2018 through 2023 were included, excluding those with end-stage kidney disease, early death, readmission, or normal renal function.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Exposure was RRT during the ICU stay. Hospital mortality was the primary outcome. After 1:1 propensity score matching to adjust for confounding, 18,794 patients (9,397 per group) were analyzed. On average, RRT was associated with higher hospital mortality (risk difference, 6.1% points [95% CI, 3.4-8.7]). However, our machine learning-based causal forest algorithm showed substantial heterogeneity of treatment effects heterogeneity of treatment effects (HTEs) (rank-weighted average treatment effect, -8.2 percentage points [95% CI, -9.7 to -6.7]). Patients characterized by elevated serum creatinine, reduced urine output, and elevated blood urea nitrogen levels showed potential mortality benefit from RRT, whereas relatively preserved renal function was more likely to be associated with harm.</p><p><strong>Conclusions: </strong>Although RRT was associated with an increased risk of hospital mortality overall, HTEs were identified in selected subgroups that may benefit from RRT. These findings support a data-driven approach to defining clinically applicable optimal RRT indications to guide more judicious use of RRT.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2590-2600"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Remote Respiratory Therapy in a Donor Center ICU Using a Telecritical Care Platform.","authors":"Michael Ghio, Heather Pavlichko, Arpit Patel, Jamie Ann Acero-Webb, Brianna Howley, Elizabeth Brown, Kathleen O'Neill, Jose L Pascual, Niels D Martin","doi":"10.1097/CCM.0000000000007231","DOIUrl":"10.1097/CCM.0000000000007231","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility, safety, and operational impact of delivering comprehensive remote telecritical care respiratory therapy (eRT), including full ventilator management, in a dedicated brain-dead donor care ICU.</p><p><strong>Design: </strong>Prospective observational study conducted over a 12-month period (from October 2023 to October 2024).</p><p><strong>Setting: </strong>An eight-bed brain-dead donor care ICU utilizing a telecritical care platform with real-time audiovisual monitoring and remote ventilator interface capability.</p><p><strong>Subjects: </strong>Organ donors ( n = 182) managed during the study period.</p><p><strong>Interventions: </strong>All respiratory therapy (RT) care, including ventilator management and procedural support, was delivered remotely. In-person RT support was available as needed.</p><p><strong>Measurements and main results: </strong>Procedural workload, in-person RT utilization, safety events, donor outcomes, and full-time equivalent (FTE) labor requirements were recorded. eRT completed 3872 respiratory procedures, totaling 1782 hours of remote care. In-person RT support was required for 119 hours (6.1%), primarily for transport and advanced airway interventions. No airway losses, emergency RT activations, cardiac arrests, or delays in care occurred. Remote RT support resulted in an estimated savings of 2.2 FTEs and $306,952 in avoided labor costs. A total of 520 organs were procured, with an observed-to-expected recovery ratio of 1.19.</p><p><strong>Conclusions: </strong>Comprehensive remote RT, including full ventilator management, was safely and effectively implemented in a donor care ICU. This model substantially reduced bedside staffing requirements while maintaining favorable donor outcomes, supporting broader adoption and highlighting the need for regulatory pathways enabling secure remote ventilator access.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2536-2542"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Resistive Index Responsiveness to a Mean Arterial Pressure Test As a Guide for Mean Arterial Pressure Target in the Early Phase of Septic Shock: A Physiological Study.","authors":"Nicolas Fage, Madjid Bouizegarene, Valerie Seegers, Antonin Courtais, Louis Bordeau, Ines Ziriat, Alain Mercat, François Beloncle, Nicolas Lerolle, Peter Radermacher, Julien Demiselle, Pierre Asfar","doi":"10.1097/CCM.0000000000007286","DOIUrl":"10.1097/CCM.0000000000007286","url":null,"abstract":"<p><strong>Objectives: </strong>Guidelines recommend targeting a mean arterial pressure (MAP) greater than or equal to 65 mm Hg in septic shock. Although experts advocate for individualized targets, no validated bedside tool exists. An increased renal resistive index (RRI) is associated with acute kidney injury, and increasing MAP can reduce RRI. This study investigated the physiologic impact of a higher MAP on renal function based on RRI evolution during a transient high MAP target test.</p><p><strong>Design: </strong>Prospective physiologic and randomized study.</p><p><strong>Setting: </strong>Medical ICU of a university hospital.</p><p><strong>Patients: </strong>Patients in the early phase of septic shock (norepinephrine ≥ 0.05 µg/kg/min base within 9 hr of initiation, with or without lactate > 2 mmol/L) without chronic kidney disease or immediate need for renal replacement therapy.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>All patients underwent a standardized 2-hour MAP test (65-70 followed by 80-85 mm Hg) with RRI measured at each period. RRI responders were defined by an RRI decrease greater than or equal to 0.05 during the MAP test. Following the MAP test, patients were randomized according to the \"low\" (65-70) or \"high\" (80-85 mm Hg) MAP target for 5 days, stratified by RRI response during the MAP test. Eighty patients were randomized; 23 (29%) were RRI responders. Among RRI responders, the higher MAP target was not associated with improved renal outcomes (i.e., diuresis, Kidney Disease: Improving Global Outcomes stage, need for renal replacement therapy, or serum creatinine). RRI nonresponders had higher urine output with a high MAP target, whereas no other renal parameter differed significantly; these findings should be considered exploratory.</p><p><strong>Conclusions: </strong>In early septic shock, a decrease in RRI during a MAP test did not identify patients who would benefit from higher MAP targets to improve renal function. Conversely, the absence of an RRI decrease during the MAP test may help identify patients in whom increasing MAP is associated with increased urine output.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2613-2624"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Net Ultrafiltration Rate and Mortality in Critically Ill Patients: A Multicenter Cohort Study With Analysis of Fluid Balance Changes.","authors":"Nadine C Monai, Carmen A Pfortmueller, Joerg C Schefold, Luca Cioccari, Martin Faltys","doi":"10.1097/CCM.0000000000007289","DOIUrl":"10.1097/CCM.0000000000007289","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the association between net ultrafiltration (NUF) rate and fluid balance changes with 28-day mortality in critically ill patients receiving continuous renal replacement therapy (CRRT).</p><p><strong>Design: </strong>Multicenter retrospective observational study.</p><p><strong>Setting: </strong>Data from two European mixed medical-surgical ICUs: University Hospital Bern, Switzerland, and Amsterdam University Medical Center, the Netherlands.</p><p><strong>Patients: </strong>Adult critically ill patients receiving CRRT for at least 24 hours.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We studied 973 critically ill adults undergoing a total of 6914 days of CRRT. NUF rates and fluid balance changes were calculated from hourly data and categorized into four predefined groups. NUF rates were classified as no NUF, low (< 1.01 mL/kg/h), moderate (1.01-1.75 mL/kg/h), or high (> 1.75 mL/kg/h). Fluid balance change was stratified as negative (< -1.5 L/day), moderate negative (-1.5 to -0.5 L/day), neutral (-0.5 to 0.5 L/day), or positive (> 0.5 L/day). Using multivariable regression, random forest modeling, and mediation analysis, we observed no independent association between NUF rate and 28-day mortality after accounting for fluid balance. Mediation analysis suggested that the apparent survival advantage observed among patients with higher NUF rates was largely mediated through achievement of a more negative fluid balance, rather than a direct effect of NUF rate itself. In contrast, more positive fluid balance changes were linked to adverse clinical outcomes including 28-day mortality.</p><p><strong>Conclusions: </strong>In this two-center cohort of CRRT patients, NUF rate was not independently associated with mortality. Instead, the key determinant of outcome was fluid balance change. These findings suggest clinicians should not make NUF decisions in isolation, but rather should be using NUF as a means to achieve patient-specific fluid balance targets.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2648-2659"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}