European Heart Journal - Cardiovascular Pharmacotherapy最新文献

{"title":"Ischemic Limb Necrosis and Symmetrical Peripheral Gangrene During Vasopressor Support in Severe Shock States: Thromboinflammatory Microvascular Injury as the Pathogenic Mechanism.","authors":"Jerrold H Levy, Joseph R Shaw, Jean M Connors, Dominik F Draxler, Cheryl L Maier, Toshiaki Iba, Theodore E Warkentin","doi":"10.1093/ehjcvp/pvag078","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag078","url":null,"abstract":"<p><p>Ischemic limb necrosis and resulting symmetrical peripheral gangrene (SPG) are devastating complications of severe shock states, particularly septic shock, and are associated with major morbidity, limb loss, and mortality. These complications usually occur in patients requiring vasopressor support for cardiovascular resuscitation during profound circulatory collapse. In this setting, however, thromboinflammatory microvascular injury represents the principal mechanism underlying ischemic tissue injury. Life-threatening shock is characterized by endothelial injury, glycocalyx disruption, disseminated intravascular coagulation (DIC), impaired fibrinolysis, and ischemic hepatic injury (\"shock liver\") with endogenous natural anticoagulant factor depletion (antithrombin, protein C, protein S) that promotes diffuse thromboinflammatory microvascular thrombosis and impaired tissue perfusion independent of vasopressor therapy. Importantly, most critically ill patients receiving prolonged or high-dose vasopressor therapy do not develop ischemic limb necrosis in the absence of severe coagulopathy, DIC, or shock liver. In contrast, patients developing SPG typically exhibit DIC (severe thrombocytopenia, greatly elevated D-dimer levels), hepatic dysfunction, and multiorgan failure. Under these conditions, progressive microthrombosis in distal limbs produces acral ischemia and tissue necrosis. This review examines SPG in severe shock states through the framework of thromboinflammatory microvascular dysfunction, hepatic dysfunction, dysregulated coagulation with natural anticoagulant depletion, and endothelial injury, culminating in acral microthrombosis; we evaluate key limitations and confounders in the literature on vasopressor-associated ischemia; and discuss the clinical phenotype of SPG in septic shock and critical illness. Finally, we address some of the important clinical and treatment implications of ischemic limb necrosis during vasopressor support in critically ill patients with shock.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001533","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":"Response to letter translating cardio-rheumatology into practice: a multi-level pilot network.","authors":"Anne Grete Semb, Eirik Ikdahl, Anne Kerola","doi":"10.1093/ehjcvp/pvag061","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag061","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982481","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":"Antiemetic-Associated QT Prolongation: A Clinical Review and Risk-Stratified Prescribing Framework for Long QT Syndrome.","authors":"Ahmed T Moustafa, Omar Dabash, Pradosh Kumar Panigrahi, Habib Rehman Khan","doi":"10.1093/ehjcvp/pvag077","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag077","url":null,"abstract":"<p><strong>Background and aims: </strong>Nausea and vomiting accompany pregnancy, gastroenteritis, migraine, the perioperative period, and cytotoxic chemotherapy, and antiemetics are among the most frequently prescribed drugs worldwide. Several antiemetic classes delay ventricular repolarization and prolong the QT interval, a substrate for torsades de pointes (TdP), ventricular fibrillation, and sudden cardiac death. We synthesized the evidence on antiemetic QT liability and translated it into a three-tier, risk-stratified prescribing framework and stepwise clinical algorithm for patients with inherited or acquired long QT syndrome (LQTS) and other torsadogenic risk factors.</p><p><strong>Methods: </strong>We conducted a narrative review of PubMed/MEDLINE, EMBASE, and pharmacovigilance sources (FDA Adverse Event Reporting System, CredibleMeds/QTdrugs) through early 2026, prioritizing mechanistic studies, randomized comparisons, disproportionality analyses, and consensus statements on antiemetic QT liability and LQTS management.</p><p><strong>Results: </strong>QT prolongation across antiemetic classes is driven principally by IKr blockade (hERG/KCNH2). Risk is highly heterogeneous within classes: in a 2026 FAERS disproportionality analysis, ondansetron carried a substantially stronger QT-related signal than olanzapine (reporting odds ratio 27.2 vs 8.7), consistent with its dose-dependent effect among 5-HT3 antagonists, which prompted a 2012 FDA restriction on the 32 mg intravenous dose; palonosetron has minimal effect. Neurokinin-1 antagonists, low-risk antihistamines, anticholinergics, and 5-HT4 agonists carry little QT liability, while butyrophenones, phenothiazines, and promethazine carry greater risk. Serious events cluster in patients with electrolyte disturbance, bradycardia, polypharmacy, or underlying LQTS, particularly when QTc exceeds 500 ms or rises more than 60 ms from baseline.</p><p><strong>Conclusions: </strong>Antiemetic-associated arrhythmia is largely preventable. Structured risk assessment, electrolyte correction, ECG monitoring, and a stepwise selection strategy favouring agents with minimal QT liability allow clinicians to manage nausea and vomiting safely, even in high-risk populations.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982447","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":"Real-world analysis of adherence, persistence, and outcomes in patients receiving four-drug antihypertensive therapy.","authors":"Giuseppe Mancia, Sofie Brouwers, Silvia Calabria, Melania Leogrande, Luca Degli Esposti, Giovambattista Desideri, Krzysztof Narkiewicz","doi":"10.1093/ehjcvp/pvag073","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag073","url":null,"abstract":"<p><strong>Aims: </strong>Describe real-world use, adherence, persistence, and risk of non-fatal cardiovascular events (CVE) and mortality among patients receiving four-drug antihypertensive therapy.</p><p><strong>Methods and results: </strong>This was a retrospective, longitudinal cohort study of Italian administrative healthcare databases (N=7,160,298). Eligible patients were ≥18 years and received four-drug therapy between 2018 and 2022. Class- and molecule-level subcohort analyses required data for ≥1 year either side of four-drug therapy identification. Adherence and persistence were based on prescription availability. A Cox proportional hazards model was used for risk assessment.Among 228,594 eligible patients, 113,755 received either an angiotensin-converting enzyme inhibitor (ACEi; n=57,473) or angiotensin II receptor blocker (n=56,282), thiazide/thiazide-like diuretic (DIU), calcium channel blocker (CCB), and a fourth class (mostly beta-blockers [BBs]; n=87,022).In the Class subcohort (ACEi+DIU+CCB+BB; n=41,903), high adherence was more frequent among patients receiving two (52.1%) versus three (40.2%) or four (25.0%) pills (global P<0.001); persistence was also improved (P<0.02 from 6 months). Adherence and persistence were significantly higher with two versus three pills in the Molecule subcohort (perindopril, indapamide, amlodipine, and bisoprolol; n=8007). For persistent versus non-persistent patients, there was a risk reduction for CVE (12.4%; P<0.001) and mortality (16.4%; P<0.001) in the Class subcohort, with similar findings in the Molecule subcohort (20.9% [P=0.003] and 20.9% [P=0.002], respectively).</p><p><strong>Conclusion: </strong>In patients receiving four-drug antihypertensive therapy, adherence and persistence were significantly improved with lower pill burden. Persistence was associated with lower risks of CVE and mortality.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967238","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":"Switching to Angiotensin Receptor-Neprilysin Inhibitor and Reduced Risk of New-Onset Atrial Fibrillation in Heart Failure with Reduced Ejection Fraction: A Nationwide Propensity Score-Matched Study.","authors":"Young Jun Park, Dong-Hyuk Cho, Jimi Choi, Jong-Chan Youn, Mi-Na Kim, Chan Joo Lee, Jung-Woo Son, Byung-Su Yoo","doi":"10.1093/ehjcvp/pvag074","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag074","url":null,"abstract":"<p><strong>Aims: </strong>We investigated whether switching from traditional renin-angiotensin system (RAS) blockade to angiotensin receptor-neprilysin inhibitor (ARNI) is associated with a lower risk of new-onset atrial fibrillation (AF) than continuing RAS blockade in patients with heart failure with reduced ejection fraction (HFrEF) without prior AF.</p><p><strong>Methods and results: </strong>Using data from the Korean National Health Insurance Service (2017-2021), we identified 39,061 patients with HFrEF without prior AF who received either ARNI (n = 12,263) or traditional RAS blockade (n = 26,798). After 1:1 propensity score matching, 9,030 patients were included in each group. The primary outcome was new-onset AF within 1 year. In the propensity score-matched cohort, new-onset AF incidence was lower in the ARNI group (10.73 vs. 12.15 per 100 person-years; hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.81-0.98; P = 0.021). The composite outcome (new-onset AF, ischaemic stroke, or all-cause death) was also reduced (HR 0.85; 95% CI 0.79-0.92; P < 0.001). In competing risk analysis, ARNI was associated with a lower subdistribution hazard of new-onset AF (sHR 0.73; 95% CI 0.58-0.91; P = 0.005). In the unmatched cohort, the HR was 0.85 (95% CI 0.75-0.96) in an exploratory model including age, sex, hypertension, chronic kidney disease, prior ischaemic stroke, socioeconomic status, residential region, and beta-blocker use, and 0.94 (95% CI 0.87-1.02) after adjustment for all measured baseline covariates.</p><p><strong>Conclusion: </strong>In this large nationwide cohort of AF-naïve patients with HFrEF, switching to ARNI was associated with a lower risk of short-term new-onset AF than continuing traditional RAS blockade. As this was a retrospective study, further prospective studies are needed to confirm these findings.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967260","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":"Translating cardio-Rheumatology into practice: a multi-level pilot network.","authors":"G L Erre, F Cacciapaglia, G D Sanna, F Atzeni, E Bartoloni Bocci, C Bentivenga, C Borghi, E Gremese, A Manfredi, M Piga, G Sakellariou, M Savino, O Viapiana, F Romana Spinelli","doi":"10.1093/ehjcvp/pvag070","DOIUrl":"10.1093/ehjcvp/pvag070","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929351","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":"Sacubitril/valsartan and cardiac injury/stress and systemic inflammatory biomarkers in acute heart failure: a prespecified secondary analysis of the PREMIER study.","authors":"Shunichi Doi, Atsushi Tanaka, Takumi Imai, Goro Yoshioka, Teruhiro Sakaguchi, Masayoshi Ajioka, Takenori Ikoma, Yuichiro Maekawa, Nobuhiro Tanaka, Yuya Matsue, Keisuke Kida, Yoshihiro J Akashi, Koichi Node","doi":"10.1093/ehjcvp/pvag076","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag076","url":null,"abstract":"<p><strong>Aims: </strong>Acute heart failure (AHF) is accompanied by myocardial injury, wall stress, and systemic inflammatory activation. Whether initiating sacubitril/valsartan (Sac/Val) after haemodynamic stabilization modifies cardiac injury/stress and systemic inflammatory biomarkers is uncertain.</p><p><strong>Methods and results: </strong>The Program Angiotensin-Neprilysin Inhibition in Admitted Patients with Worsening Heart Failure (PREMIER) study was a multicentre, prospective, randomised, open-label trial with blinded endpoint assessment. Within 7 days of hospitalisation and after haemodynamic stabilisation, inpatients previously treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) were randomised to switch to Sac/Val or continue ACEI/ARB. In this pre-specified secondary analysis, high-sensitivity cardiac troponin T (hs-cTnT), soluble ST2 (sST2), C-reactive protein (CRP), and growth differentiation factor-15 (GDF-15) were measured at baseline and week 8. N-terminal pro-B-type natriuretic peptide (NT-proBNP) was also assessed. Among 365 patients with complete cardiac injury/stress and systemic inflammatory biomarker data, all biomarkers generally decreased over 8 weeks, but between-group differences in biomarker changes were not significant. In exploratory biomarker-stratified analyses, only baseline CRP showed a nominal treatment interaction for NT-proBNP (p for interaction=0.012).</p><p><strong>Conclusion: </strong>In haemodynamically stabilised patients hospitalised for AHF, no differential effects of Sac/Val versus continued ACEI/ARB therapy on cardiac injury/stress and systemic inflammatory biomarkers were demonstrated over 8 weeks. These findings do not support a broad biomarker-defined anti-inflammatory or cardioprotective effect of Sac/Val in this setting.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944027","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":"Eplerenone vs. spironolactone in heart failure: long-term cardiorenal and mortality outcomes in a registry-based cohort.","authors":"Karl Wärnberg, Carl Haggård, Karin Bergen, Henrik Falhammar, Buster Mannheimer, Krister Lindmark","doi":"10.1093/ehjcvp/pvag064","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag064","url":null,"abstract":"<p><strong>Aims: </strong>Eplerenone and spironolactone differ in pharmacological profile, but whether this translates into meaningful differences in clinical outcomes in heart failure (HF) remains uncertain. We compared the two agents in a registry-based new-user cohort with serial laboratory data.</p><p><strong>Methods and results: </strong>In this observational cohort study, adults with a first HF diagnosis in Stockholm County (2005-2019) who were prescribed either spironolactone or eplerenone within 6 months were identified from linked Swedish registries with individual-level laboratory results. Follow-up was analysed under an intention-to-treat principle. Outcomes included all-cause mortality, HF hospitalization, kidney function decline, and hyperkalaemia. The main analysis used multivariable Cox regression. Several sensitivity analyses were performed, including propensity score matching. Of 75 565 patients with new-onset HF, 12 046 initiated a mineralocorticoid receptor antagonist (11 039 spironolactone; 1007 eplerenone). Eplerenone was associated with lower all-cause mortality (hazard ratio 0.78, 95% confidence interval 0.62-0.98), a lower risk of more than 50% decline in estimated glomerular filtration rate (eGFR) (0.69, 0.54-0.88), sustained eGFR below 30 mL/min/1.73 m2 (0.69, 0.49-0.95), a composite kidney outcome (0.71, 0.56-0.90), and hyperkalaemia of 5.5 mmol/L or above (0.76, 0.60-0.96). The cause-specific hazard for HF hospitalization was higher with eplerenone (1.29, 1.11-1.51) but attenuated to 0.99 (0.87-1.12) when death was treated as a competing risk. Findings were robust across sensitivity analyses.</p><p><strong>Conclusion: </strong>Compared with spironolactone, eplerenone was associated with lower all-cause mortality and lower risks of kidney function decline and mild hyperkalaemia. These observational findings warrant confirmation in randomized comparisons.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918981","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":"Vagal activity related events and glucagon-like peptide-1 receptor agonists.","authors":"Lina Al-Ansary, Sebastian Kinnberg Nielsen, Mads Hashiba Jensen, Nina Nouhravesh, Caroline Sindet-Pedersen, Gunnar Gislason, Peter Vibe Rasmussen, Morten Lamberts, Anders Holt","doi":"10.1093/ehjcvp/pvag072","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag072","url":null,"abstract":"<p><strong>Background and aims: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RA) carry side-effects such as dizziness and nausea related to increased vagal tone. This study investigated associations between GLP-1 RA use and the risk of vagal activity related (VAR) events.</p><p><strong>Methods: </strong>Using the Danish health registers, patients with type 2 diabetes mellitus (T2DM) first-time initiated on GLP-1 RA (exposure) or SGLT-2i (active control) were identified between January 2010 and October 2022. Standardized 1-year absolute risks of VAR events (syncope, fractures, bradyarrhythmia, or cardiac device implantation) were computed to compare risk associated with GLP-1 RA and SGLT-2i initiation. Complementary analyses in patients treated for obesity were performed as well.</p><p><strong>Results: </strong>During the study period, 50 076 and 73 138 patients with T2DM were initiated on GLP-1 RA (47% women, median age: 59 years [IQR: 50-68]) or SGLT-2i (39% women, median age: 64 years [IQR: 55-72]). Comorbidity was equally prevalent. The standardized 1-year absolute risk of syncope was 0.58% (95% CI: 0.51%-0.66%) among patients initiated on GLP-1 RA and comparable to patients initiated on SGLT-2i (0.56% [95% CI: 0.50%-0.62%]). 1-year risks of fractures, bradyarrhythmia, and cardiac device implantation were equally low and with corresponding standardized risk ratios of 0.90 (95% CI: 0.79-1.01), 0.97 (95% CI: 0.67-1.28), and 0.86 (95% CI: 0.62-1.10), respectively. No associations were found in the group treated for obesity either.</p><p><strong>Conclusions: </strong>In nationwide cohorts of patients treated for T2DM or obesity, initiation of GLP-1 RA was not associated with an elevated risk of VAR events. Despite a proposed argumentation of vagal activity, GLP-1 RA use was not associated with an increased risk in real-life users.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911205","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":"Rethinking the CVOT Design in an Era of High-Performing Background Therapy.","authors":"Nicola Cosentino, Gianluca Pontone","doi":"10.1093/ehjcvp/pvag069","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag069","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857140","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}