Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia最新文献

{"title":"[Diastolic Dysfunction in CKD: Cause or Effect?s].","authors":"Eugenio Lembo, Roberta Bottino, Ida Matarazzo, Claudia Annoiato, Mariarosaria Scognamiglio, Roberta Rossano, Laura Peccarino, Valentina Pirozzi, Feliciana Palumbo, Luigi Di Martino, Francesco Cascone, Filomena Gagliardi, Federica Marzano, Simona Andriella, Tino Paolo Ambrosino, Luca Della Volpe, Roberto Mangiacapra, Giuseppe Conte","doi":"10.69097/42-01-2025-04","DOIUrl":"10.69097/42-01-2025-04","url":null,"abstract":"<p><p>Left Ventricular Diastolic Dysfunction (LVDD) describes changes in the heart's structure and function, leading to impaired ventricular relaxation and increased filling pressures during the diastolic phase of the cardiac cycle. In the context of isolated LVDD, the left ventricular end-diastolic volume, global contractility, and ejection fraction (EF) are normal, with EF being 50% or higher. However, as filling pressures progressively increase, diastolic dysfunction worsens. LVDD is classified into varying degrees of severity along a continuum that may ultimately lead to heart failure. The diagnosis of LVDD in its early stages is carried out using echocardiographic criteria, which also help to determine the severity of diastolic dysfunction. The most recent update of echocardiographic criteria includes three categories: normal, indeterminate and diastolic dysfunction, that allow us to define better the CV risk of patients with or without CKD. The prevalence of left ventricular diastolic dysfunction (LVDD) increases among the elderly, as well as in populations with hypertension and diabetes, which heightens their cardiovascular risk. Additionally, these conditions are frequently linked to chronic kidney disease (CKD). Although LVDD and CKD share a common pathogenic pattern, the relationship between the two conditions is not yet well understood.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536805","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 Among Potassium Binders on the Management of Hyperkalemia on Chronic Dialysis Patients: A Protocol for Systematic Review.","authors":"Veronica Maressa, Alessandra Farina, Valeria Cernaro, Guido Gembillo, Elisa Longhitano, Giovanni Taverna, Domenico Santoro, Vincenzo Calabrese","doi":"10.69097/42-01-2025-02","DOIUrl":"10.69097/42-01-2025-02","url":null,"abstract":"<p><p><b>Introduction.</b> Treating hyperkalemia is one of the main goals of supportive care in patients on hemodialysis. In this context, therapy with new potassium binders is a promising resource. <b>Objective.</b> The main aim is to evaluate the difference in serum potassium concentration after treatment with sodium zirconium cyclosilicate or patiromer compared to placebo/sodium polystyrene sulfonate/calcium polystyrene sulfonate. <b>Methods.</b> We will perform systematic research in PubMed, EMBASE, CINAHLE, and grey literature will be screened. We will screen RCTs on patients treated with SZC or patiromer in chronic hemodialysis, without sex or age restriction, which include the differences in serum potassium concentration, adverse events (AEs), and mortality as outcomes. <b>Expected results.</b> This systematic review is expected to provide a comprehensive evaluation of the efficacy and adverse effects of new potassium binders, compared to sodium polystyrene sulfonate or calcium polystyrene sulfonate or placebo, on serum potassium concentration, in a sample of hemodialysis patients. Furthermore, possible gaps in actual knowledge can be highlighted, suggesting new research. <b>Conclusions.</b> The present protocol for a systematic review will consider all existing evidence from published RCTs about the efficacy of HIF-PHIs on hemodialysis patients.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536919","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":"Saving Fistula in Case of Distal Ischemia or High Flow: Literature Review of Current Surgical and Endovascular Techniques with Proposal of Decisional Algorithm.","authors":"Marco Taurisano, Cosma Cortese, Andrea Mancini, Marcello Napoli","doi":"10.69097/42-01-2025-06","DOIUrl":"10.69097/42-01-2025-06","url":null,"abstract":"<p><p>Arteriovenous fistulas (AVFs) are the preferred vascular access for chronic hemodialysis patients due to their lower rates of infectious and thrombotic complications, reduced morbidity and mortality, and increased durability compared to central venous catheters. However, the creation of AVFs has become increasingly challenging due to the rising prevalence of chronic diseases like diabetes, hypertension, and cardiovascular conditions, which are leading causes of end-stage renal disease (ESRD). These comorbidities, coupled with the aging dialysis population, have led to an increase in peripheral vascular diseases, complicating AVF management. This paper discusses two major complications of AVFs: Hemodialysis Access-Induced Distal Ischemia (HAIDI) and high-flow AVFs. HAIDI is characterized by ischemia in extremities due to reduced capillary perfusion, potentially leading to severe outcomes such as tissue necrosis and digital amputations. Approximately 5% of hemodialysis patients with AVFs develop HAIDI, necessitating corrective treatment. High-flow AVFs, defined by excessive blood flow that disrupts overall circulatory dynamics, pose another significant challenge, particularly in patients with cardiovascular compromise. The management of these complications is complex and often requires specialized techniques to preserve the AVF and avoid its closure. This review presents both surgical and endovascular techniques aimed at reducing AVF flow and improving distal perfusion. Techniques discussed include vein approach like ligation, plication, banding, prosthetic graft interposition, and various arterial interventions like distal radial artery ligation and embolization. Additionally, the review presents techniques for anastomosis remodeling, offering innovative approaches to managing AVF complications. The review concludes with a proposed decision-making algorithm to guide clinicians in selecting appropriate interventions based on the specific AVF-related complications, ensuring optimal outcomes for hemodialysis patients. This comprehensive overview highlights the importance of individualized treatment strategies in the management of AVF complications.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536962","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":"Exploring Educational and Training Skills of Nephrology Nurses: Scoping Review.","authors":"Mauro Parozzi, Desirèe Andreoli, Sara Morales Palomares, Silvia Cappelletti, Giuliano Anastasi, Lea Godino, Domenica Gazineo, Gaetano Ferrara, Marco Sguanci, Stefano Mancin","doi":"10.69097/42-01-2025-05","DOIUrl":"10.69097/42-01-2025-05","url":null,"abstract":"<p><p><b>Background.</b> Chronic kidney disease poses global health risks, requiring specialized nursing skills and ongoing professional development. The objective of this review was to identify postgraduate nurse education programs in nephrology and dialysis. <b>Design.</b> A scoping review following the framework given by Arksey and O'Malley was conducted using five databases: Medline, Scopus, Cochrane Library, ASSIA and CINAHL. The research was supplemented by consulting gray literature. Screening of articles, data extraction and quality appraisal were independently performed by two authors. The included articles examined the modalities of skills acquisition by nephrology and dialysis nurses. Critical appraisal was conducted using JBI critical appraisal tools. <b>Results.</b> Out of 8789 records identified, 20 were included in this review. Analysis of the data indicated that nephrology and dialysis nurses acquire their skills through both structured training pathways and professional experience. This review identified a lack of standardized training pathways in this field, resulting in global heterogeneity in training programs. Educational interventions typically comprised theoretical and practical components, often delivered through a combination of teaching methods. Additionally, professional training was found to be essential for skill acquisition, with variations in reliance on mentorship, individual study, and direct experience. <b>Conclusion.</b> Despite the heterogeneity of existing training courses, this study outlines existing knowledge, laying the foundations for a review and standardization of training courses and underlining the need for a clear definition of nephrology and dialysis nurses' skills for curriculum development.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536862","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":"[Predisposing Factors and Strategies to Address Moral Distress in Dialysis Nurses: A Literature Review].","authors":"Elena Brioni, Maria Pia Guerriero, Cristiano Magnaghi, Diana Pozzi, Mirella Finazzi, Delli Zotti Giulia Bruna, Nadia Pennacchio, Clara Soliman, Debora Rosa, Giulia Villa, Duilio Fiorenzo Manara","doi":"10.69097/42-01-2025-10","DOIUrl":"10.69097/42-01-2025-10","url":null,"abstract":"<p><p><b>Introduction.</b> Moral Distress in the nursing profession represents an increasingly important issue. Patients undergoing dialysis treatment have a long and complex clinical path and the nurse is required to express clinical decisions balancing the obligations of care not only towards patients and family members, but also towards himself and the organization. It therefore happens that the nurse finds himself in situations in which he is not able to translate his moral beliefs into ethically concrete actions causing a sense of anguish and frustration. <b>Objective.</b> To identify and describe the predisposing factors and strategies to address the phenomenon of Moral Distress in nurses who work in dialysis. <b>Method.</b> A literature review was conducted from 01/01/2024 to 09/30/2024 by consulting four databases: PubMed, Embase, CINAHL and Scopus. The study included primary experimental, quasi-experimental, observational, qualitative studies and secondary studies such as reviews, meta-analyses and scoping reviews, which described the phenomenon of Moral distress, its predisposing factors and the related strategies to deal with it in the context of dialysis. <b>Results.</b> The studies confirmed that the phenomenon of Moral Distress is very prevalent in the context of dialysis. The predisposing factors are related to: direct assistance with the dialysis patient (a), the work and organizational context (b) hierarchical barriers and impaired communication between nurses and the ward team (c). The strategies used suggest promoting the well-being of dialysis nursing staff; strategies such as: open communication with patients and relatives; opening of services that provide support on ethical reasoning and stress management; implementation of training activities regarding palliative care and end-of-life management. <b>Discussion.</b> Moral distress causes nursing staff working in dialysis to feel helpless, which can evolve into emotional exhaustion with physical and psychological repercussions that can affect the quality of care provided and increase abandonment of the profession. <b>Conclusions.</b> This literature review has identified the factors that determine the onset of Moral distress in the context of dialysis with the aim of outlining strategies to limit this phenomenon. In light of the results achieved, it becomes essential to implement research within nephrological contexts to prevent and contain the problem with the aim of ensuring high-quality care and at the same time the well-being of the professional.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536818","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":"Human Adenoviruses Infection and Kidney Transplantation: Pathogenesis, Diagnosis, and Treatment.","authors":"Esma'il Akade, Sana Pournazari, Gholam Abbas Kaydani, Mohammad Bahadoram, Faezeh Firouzi","doi":"10.69097/42-01-2025-03","DOIUrl":"10.69097/42-01-2025-03","url":null,"abstract":"<p><p>Human adenoviruses (HAdVs) are nonenveloped, icosahedral viruses with double-stranded DNA, classified within the Adenoviridae viral family. They are implicated in a diverse range of human illnesses. The HAdV group consists of 103 distinct genotypes, categorized into seven primary serotypes labeled A through G. This classification is based on the hemagglutinin properties of their fiber protein and their genomic similarities. While many infections caused by these viruses are either symptomless or self-limiting, certain populations, such as kidney transplant recipients, face heightened risks. Particularly, HAdV serotypes B1 and B2 are noteworthy for their ability to infect the kidneys, potentially leading to kidney damage and dysfunction. Diagnosis of HAdV infections typically involves histopathological examination, laboratory tests, and imaging techniques. Treatment strategies often hinge on restoring immune function. However, for HAdV infections, therapeutic options such as Cidofovir, Nitazoxanide, along with emerging approaches like nanoparticle- and siRNA-based medications, and monoclonal antibodies appear promising.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Italian Centre for Transplantation and the Italian Transplant Network].","authors":"Giuseppe Feltrin, Lia Bellis, Pamela Fiaschetti, Letizia Lombardini","doi":"10.69097/42-01-2025-01","DOIUrl":"https://doi.org/10.69097/42-01-2025-01","url":null,"abstract":"","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536821","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":"Balancing Efficacy, Health Status, and Cost-Effectiveness: A Comparative Study of Desidustat and Erythropoietin in Chronic Kidney Disease Patients on Hemodialysis.","authors":"Dharanidhar Reddy Yarramachu, K Sai Sindhu Singh, Pavuluri Lakshmi Aishwarya, Kumar K Manoj, Indhumathi Elayaperumal","doi":"10.69097/42-01-2025-09","DOIUrl":"10.69097/42-01-2025-09","url":null,"abstract":"<p><p><b>Background.</b> Anemia is a common problem that greatly affects the quality of life and prognosis of those with CKD (chronic kidney disease). The conventional course of treatment has traditionally used ESAs (erythropoiesis-stimulating agents) such as erythropoietin; however, more recent medications, such as Desidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), may be more advantageous in terms of both efficacy and cost. In this study, CKD patients receiving hemodialysis are compared for efficacy, safety, and cost-effectiveness between Desidustat and erythropoietin treatment. <b>Methods.</b> This prospective, single-center, open-label study with parallel groups was carried out at Saveetha Institute of Medical Sciences in Chennai. A total of 60 patients with CKD on maintenance hemodialysis were randomized to receive either Desidustat (100 mg orally, 3 times a week) or Erythropoietin (subcutaneous injections) for 12 weeks. At baseline, four weeks, eight weeks, and 12 weeks, hemoglobin levels, biomarkers (TSAT, ferritin, and hepcidin), and status of physical and mental health had been noted. The key finding was the proportion of hemoglobin responders (defined as a rise from baseline of ≥1g/dL). Secondary outcomes included predictors of hemoglobin response, adverse effects, and cost-effectiveness. <b>Results.</b> The proportion of hemoglobin responders was 83.33% in the Desidustat compared to 73.33% in the Erythropoietin group (p = 0.530), indicating no significant difference in efficacy. Hemoglobin levels increased gradually in both groups over 12 weeks. Higher serum albumin (OR = 3.32, 95% CI: 1.54-7.16, p = 0.008) and lower iPTH levels (OR = 0.98, 95% CI: 0.97-0.99, p = 0.004) have been important indicators of hemoglobin response. Hepcidin levels decreased significantly in the Desidustat group in contrast to Erythropoietin (p = 0.038), suggesting improved iron metabolism with Desidustat. No significant differences were noted in TSAT or ferritin levels. Adverse effects were comparable between the groups, with similar hospitalization and infection rates. Desidustat demonstrated better cost-effectiveness, with a lower monthly cost compared to Erythropoietin. <b>Conclusions.</b> When treating anemia in individuals with CKD receiving hemodialysis, Desidustat is a safe and efficient substitute for erythropoietin, with the added advantage of cost-effectiveness. Serum albumin and iPTH were significant predictors of hemoglobin response. To validate these results larger multicentric studies are necessary.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536827","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":"C3-Dominant Infection Related Crescentic Glomerulonephritis.","authors":"Wilson Suarez Molina, Andrés Fabián Salgado Zamora, Jorge Armando Pulido Saenz, Daniel Humberto Ducuara Rodríguez, Diana Carolina Sánchez Suarez, Angie Katherine González Ortiz, Rafael Enrique Andrade, Johanna Álvarez Figueroa, Laura Chacón Zambrano","doi":"10.69097/42-01-2025-08","DOIUrl":"10.69097/42-01-2025-08","url":null,"abstract":"<p><p>Infection related glomerulonephritis and more specifically streptococcal glomerulonephritis is a rare disease in adults, and so is C3 glomerulonephritis. It has been recognized that a clinical and morphological overlap between these two entities exists. We present a case of a 59-year-old man with previous treated HIV infection with virological response, treated hepatitis b infection, treated syphilis and non-Hodgkin lymphoma in remission; presenting and acute sore throat with high ASO titers two weeks before a rapidly progressive glomerulonephritis requiring dialysis since presentation; biopsy showed acute diffuse and proliferative glomerulonephritis with crescentic pattern with exclusive C3 staining. It was considered an acute crescentic glomerulonephritis meeting criteria for infection related glomerulonephritis but also had criteria for C3 glomerulonephritis.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536829","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. xylosoxidans and R. radiobacter-Induced Polimicrobic Peritonitis in Peritoneal Dialysis: A Case Report].","authors":"Roberta Casazza, Rossella De Leonardis, Mario Cozzolino","doi":"10.69097/42-01-2025-07","DOIUrl":"10.69097/42-01-2025-07","url":null,"abstract":"<p><p>Rhizobium radiobacter and Achromobacter xylosoxidans are two Gram-negative microorganisms found in soil. They are only rarely pathogenic to humans. There have been few cases reported of human infections, and even fewer cases of peritonitis in peritoneal dialysis. However, there is a higher risk in immunocompromised individuals. These microorganisms have the ability to form biofilms, leading to catheter-related infections, and possess intrinsic antibiotic resistance properties that are not well understood, making it challenging to identify specific therapies. We present a clinical case of a 61-year-old man undergoing automated peritoneal dialysis (APD) for end-stage renal disease due to light chain deposition disease in multiple myeloma. He was admitted to our department just over a month after starting replacement therapy due to a positive combur test and turbid fluid. The subsequent diagnosis was polymicrobial peritonitis caused by R. radiobacter and A. xylosoxidans. Despite initial empirical intraperitoneal antibiotic therapy with cefazolin and tobramycin, the treatment was optimized by introducing cefepime both intravenously and intraperitoneally, but without significant improvement. Given the diagnosis of refractory polymicrobial peritonitis, removal of the peritoneal catheter was necessary, resulting in drop-out from peritoneal dialysis. Although the outcome was unfavorable for the dialytic method, the purpose of our case report is to describe the first Italian case of peritonitis in peritoneal dialysis caused by these atypical pathogens in an immunocompromised patient. We hope this information will assist clinicians in their practice, as the available literature helped us in our diagnostic and therapeutic approach for this patient.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536801","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}