Heart, Lung and Circulation最新文献

{"title":"Atrial Fibrillation Surgery in Australia: Are We Doing Enough?","authors":"Frazer Kirk, Matthew S Yong, Lavinia Tran, Andrew Newcomb, Cheng He, Andrie Stroebel","doi":"10.1016/j.hlc.2024.07.007","DOIUrl":"10.1016/j.hlc.2024.07.007","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to examine contemporary burden and treatment trends of atrial fibrillation (AF) in patients undergoing cardiac surgery in Australia and New Zealand. This allows comparison of contemporary practice with the Society of Thoracic Surgeons guideline recommendations for the surgical treatment of AF in patients undergoing cardiac surgery.</p><p><strong>Method: </strong>A 10-year retrospective review of the Australian & New Zealand Society of Cardiac & Thoracic Surgeons National Cardiac Surgery Database was performed, examining all adult cardiac surgery patients from 2011 to 2021. Patients were grouped by the presence or absence of AF, and simple descriptive statistical analysis was performed to assess baseline demographics and premorbid condition of the patients. The incidence of AF was analysed by type of surgery. Trends for surgical treatment of AF were then analysed using simple descriptive statistics, examining isolated left atrial appendage ligation, isolated surgical ablation, and combined ligation and ablation.</p><p><strong>Results: </strong>In the last 10 years, the Australian & New Zealand Society of Cardiac & Thoracic Surgeons database has recorded 140,680 patients who underwent cardiac surgery. Atrial fibrillation (AF) was present in 21,077 patients (14%). Patients with AF were generally older (72.25 vs 66.65 years; p<0.001). Among patients undergoing cardiac surgery, AF was more common in female than in male patients (18% vs 13%, respectively). Patients with AF more often had a higher classification of dyspnoea according to the New York Heart Association and lower ejection fractions compared with their AF-free counterparts. The incidence of AF as a comorbid condition was more frequent in patients undergoing mitral valve surgery or combined coronary artery bypass grafting and valve surgery (aortic, mitral, or both) compared with those undergoing isolated coronary or aortic surgery. Only 11.90% (n=2,509) of patients with AF received a combined ablation and left atrial appendage ligation, and 19.54% (n=693) of those received a Cox-Maze IV ablation.</p><p><strong>Conclusions: </strong>The burden of concomitant AF in patients undergoing cardiac surgery in Australia is higher than previously reported (14% vs 5%-11%). Despite strong recommendation for the surgical management of AF in patients undergoing cardiac surgery and clear evidence of its benefit, both left atrial appendage ligation and surgical ablation independently or concomitantly remain heavily underutilised in this cohort.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"1627-1637"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotypic Characterisation of Obstructive Sleep Apnoea in Acute Coronary Syndrome.","authors":"Benjamin K Tong, Seren Ucak, Hasthi Dissanayake, Sanjay Patel, Glenn M Stewart, Kate Sutherland, Brendon J Yee, Usaid Allahwala, Ravinay Bhindi, Philip de Chazal, Peter A Cistulli","doi":"10.1016/j.hlc.2024.07.014","DOIUrl":"10.1016/j.hlc.2024.07.014","url":null,"abstract":"<p><strong>Background: </strong>Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA.</p><p><strong>Method: </strong>Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram.</p><p><strong>Results: </strong>OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers.</p><p><strong>Conclusions: </strong>A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"1648-1658"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Eligibility and Prescription Rates in Patients Presenting With Recurrent Acute Coronary Syndromes.","authors":"William B He, Dylan Jape, Shane Nanayakkara, James A Shaw","doi":"10.1016/j.hlc.2024.07.012","DOIUrl":"10.1016/j.hlc.2024.07.012","url":null,"abstract":"<p><strong>Background: </strong>Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are novel medications for reducing low-density lipoprotein cholesterol (LDL-C) levels. In 2020, the Australian Pharmaceutical Benefits Scheme (PBS) began subsidising PCSK9 inhibitors for secondary prevention of cardiovascular disease in patients with LDL-C >2.6 mmol/L despite statin and ezetimibe therapy. This criterion was expanded to LDL-C >1.8 mmol/L in 2022.</p><p><strong>Method: </strong>A retrospective analysis was conducted on patients admitted to a quaternary hospital with acute coronary syndrome (ACS) between 2020-2022. PCSK9 inhibitor eligibility and prescribing patterns were compared between recurrent ACS patients (≥2 events within 5 years) and first-presentation ACS patients. Australian PBS 2020 and 2022 criteria were applied to assess eligibility.</p><p><strong>Results: </strong>Of 817 ACS patients with LDL-C >1.8 mmol/L, 118 (14.4%) were categorised as recurrent ACS (33.9% female, mean age 67 years, LDL-C 2.9 mmol/L). When compared with first-presentation ACS patients (n=699), recurrent ACS patients had significantly higher proportions already on statin therapy (49.2% vs 6.0%, p<0.001) and ezetimibe (20.3% vs 2.4%, p<0.001). Recurrent ACS patients had significantly higher proportions of 2020 PBS-eligible patients (11.0% vs 1.3%, p<0.001) and 2022 PBS-eligible patients (20.3% vs 2.2%, p<0.001). There were no significant differences in PCSK9 inhibitor prescription rates among eligible patients (four of 13, 30.8% vs four of nine, 44.4%, p=0.51). Univariate binary logistic regression demonstrated that statin intolerance was significantly associated with PCSK9 inhibitor prescription (odds ratio 10; 95% confidence interval 1.3-79.3; p=0.029).</p><p><strong>Conclusions: </strong>Despite significantly higher eligibility rates, PCSK9 inhibitor uptake remains low in recurrent ACS patients, demonstrating the need to raise further awareness about eligibility criteria and encourage proactive prescription to prevent recurrent cardiovascular events.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"1638-1647"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Related Differences in Outcome of Patients Treated With Microaxial Percutaneous Left Ventricular Assist Device for Cardiogenic Shock.","authors":"Johannes Mierke, Thomas Nowack, Frederike Poege, Marie Celine Schuster, Krunoslav Michael Sveric, Stefanie Jellinghaus, Felix J Woitek, Stephan Haussig, Axel Linke, Norman Mangner","doi":"10.1016/j.hlc.2024.07.010","DOIUrl":"10.1016/j.hlc.2024.07.010","url":null,"abstract":"<p><strong>Background: </strong>The use of microaxial percutaneous left ventricular assist devices (pLVADs) in cardiogenic shock (CS) has increased in recent years, despite limited evidence, and data on sex disparities are particularly scarce. This study aimed to compare short-term outcomes between males and females.</p><p><strong>Methods: </strong>Data were retrospectively collected from the Dresden Impella Registry, which is a large, prospective, single-centre registry that consecutively enrolled patients who received microaxial pLVAD. Inclusion criteria were CS due to left ventricular failure with serum lactate >4 mM. Patients with pLVAD other than Impella CP were excluded. The primary endpoint was the composite of all-cause mortality at 30 days or requirement of renal replacement therapy (RRT). Secondary endpoints were the components of the primary endpoint alone. Propensity score matched (PSM) analysis was used to adjust for baseline characteristics.</p><p><strong>Results: </strong>A total of 319 male (69 years; body mass index, 26.7 kg/m²) and 113 female patients (74 years; 27.9 kg/m²) were included in the study. The primary composite endpoint occurred less frequently in female patients in the unmatched analysis (♂ 75.9% [n=239] vs ♀ 64.4% [n=72]; p=0.040) but not in the PSM analysis (♂ 81.1% [n=73] vs ♀ 68.9% [n=42]; p=0.056). However, females less frequently required RRT in both analyses (♂ 48.2% [n=126] vs ♀ 25.9% [n=25]; p=0.001; PSM: ♂ 49.1% [n=36] vs ♀ 23.3% [n=12]; p=0.007). All-cause mortality did not differ between the cohorts.</p><p><strong>Conclusions: </strong>This study showed no differences in all-cause mortality at 30 days between male and female patients receiving microaxial pLVAD in CS. Larger studies are required to confirm whether female sex is associated with reduced requirement of RRT in CS treated with microaxial pLVAD.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"1670-1679"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiogenic Shock and Percutaneous Left Ventricular Assist Devices-Investigating Gender-Specific Disparities.","authors":"Mohammad Sarraf, Saraschandra Vallabhajosula, Vinayak Nagaraja","doi":"10.1016/j.hlc.2024.11.005","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.11.005","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 12","pages":"1611-1613"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Massive Right Atrial Enlargement in an Adult.","authors":"Alexander Marschall, Inés Gómez Sánchez, Carmen Dejuán Bitriá, Blanca Coto Morales, Freddy Delgado Calva, David Martí Sánchez","doi":"10.1016/j.hlc.2024.06.1037","DOIUrl":"10.1016/j.hlc.2024.06.1037","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"e69-e70"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracoronary Versus Intravenous Low-Dose Tirofiban in Patients With ST-Elevation Myocardial Infarction: A Meta-Analysis of Randomised Controlled Trials","authors":"Liye Shi MD, PhD,&nbsp;Ling Chen MD, PhD,&nbsp;Wen Tian MD, PhD,&nbsp;Shijie Zhao MD, PhD","doi":"10.1016/j.hlc.2024.05.006","DOIUrl":"10.1016/j.hlc.2024.05.006","url":null,"abstract":"<div><h3>Background</h3><div>This meta-analysis aimed to evaluate the effects of intracoronary (IC) low-dose tirofiban versus intravenous (IV) administration on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).</div></div><div><h3>Methods</h3><div><span>All published randomised controlled trials (RCTs) comparing the effects of IC low-dose </span>tirofiban<span><span> (a bolus of ≤10 ug/kg) versus IV administration in patients with STEMI were identified by searching PubMed, EMBASE, </span>Cochrane Library, and ISI Web of Science from inception to June 2023, with no language restriction. The risk ratio (RR) with 95% confidence intervals (CI) and the weighted mean difference (WMD) with 95% CI were calculated.</span></div></div><div><h3>Results</h3><div><span><span>Eleven RCTs involving 1,802 patients were included. Compared with the IV group, IC low-dose tirofiban was associated with improved </span>major adverse cardiac events rate (RR 0.595, 95% CI 0.442–0.802; p=0.001), </span>left ventricular ejection fraction<span> (WMD 1.982, 95% CI 0.565–3.398; p=0.006), thrombolysis<span> in myocardial infarction (TIMI) flow grade (RR 1.065, 95% CI 1.004–1.131; p=0.037), and TIMI myocardial perfusion grade (RR 1.194, 95% CI 1.001–1.425; p=0.049). The two groups had no significant difference in bleeding events (RR 0.952, 95% CI 0.709–1.279; p=0.745).</span></span></div></div><div><h3>Conclusions</h3><div>Intracoronary low-dose tirofiban administration may be a safe and effective alternative to IV administration in STEMI patients.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1533-1542"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interplay of Age and Risk Factor Control Upon Coronary Atheroma Progression","authors":"Iryna Dykun MD ,&nbsp;Julie Carlo MS ,&nbsp;Steven E. Nissen MD ,&nbsp;Samir R. Kapadia MD ,&nbsp;Stephen J. Nicholls MBBS, PhD ,&nbsp;Rishi Puri MBBS, PhD","doi":"10.1016/j.hlc.2024.06.1031","DOIUrl":"10.1016/j.hlc.2024.06.1031","url":null,"abstract":"<div><h3>Background &amp; Aim</h3><div>The extent and composition of coronary plaque, and its progression differ with patients’ age. The interplay of patient’s age with respect to risk factor control, upon atheroma progression has not been evaluated. We tested the hypothesis that risk factor control modulates the association between age and coronary atheroma progression.</div></div><div><h3>Method</h3><div>We performed a <em>post</em> <em>hoc</em> pooled analysis of data from 10 prospective, randomised trials involving serial coronary intravascular ultrasonography (IVUS) (n=5,823). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque.</div></div><div><h3>Results</h3><div>Mean overall age was 58±9 years (28% women). In a fully adjusted multivariable analysis (following adjustment of sex, body mass index, systolic blood pressure [SBP], smoking, high-density lipoprotein and low-density lipoprotein [LDL]-cholesterol, triglyceride levels, peripheral vascular disease, diabetes mellitus, trial, region, and baseline PAV), an increase in age by one standard deviation was linked with PAV progression (β-estimate 0.097; 95% confidence interval 0.048–0.15; p&lt;0.001). In patients with good risk factor control (LDL-cholesterol &lt;1.8 mmol/L and SBP &lt;130 mmHg), increasing age remained associated with PAV progression (0.123; 0.014–0.23; p=0.027). Lower effect sizes for the association of age with PAV progression were observed for patients with partial control of LDL-cholesterol and SBP and were not significantly associated with PAV progression when both LDL-cholesterol and SBP were not controlled (0.099; 0.032–0.167; p=0.004 and 0.042; −0.056 to 0.14; p=0.40, respectively).</div></div><div><h3>Conclusions</h3><div>Patient age is directly associated with coronary atheroma progression independently of traditional cardiovascular risk factors. In the setting of poor risk factor control, the influence of age on coronary artery disease progression is attenuated.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1593-1599"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Withdrawal notice to: Impact of Provision of Abdominal Aortic Calcification Results on Cardiovascular Risk Reducing Behaviours: A 12-Week RCT [Heart, Lung and Circulation, Volume 33, Supplement 4, August 2024, Page S357]","authors":"S. Radavelli Bagatini ∗ ,&nbsp;C. Bondonno ,&nbsp;J. Dalla Via ,&nbsp;M. Sim ,&nbsp;A. Gebre ,&nbsp;L. Blekkenhorst ,&nbsp;E. Connolly ,&nbsp;N. Bondonno ,&nbsp;J. Schousboe ,&nbsp;R. Woodman ,&nbsp;K. Zhu ,&nbsp;S. Mullin ,&nbsp;P. Szulc ,&nbsp;B. Jackson ,&nbsp;J. Dimmock ,&nbsp;M. Schlaich ,&nbsp;K. Cox ,&nbsp;D. Kiel ,&nbsp;W. Lim ,&nbsp;M. Stanley ,&nbsp;J. Lewis","doi":"10.1016/j.hlc.2024.10.005","DOIUrl":"10.1016/j.hlc.2024.10.005","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Page R1"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine Green (ICG): A Versatile Tool in Enhancing Precision in Minimally Invasive Thoracic Surgery","authors":"Oscar Zhang MD ,&nbsp;Gavin Wright PhD ,&nbsp;Yin-Kai Chao PhD ,&nbsp;Christopher Cao PhD","doi":"10.1016/j.hlc.2024.04.310","DOIUrl":"10.1016/j.hlc.2024.04.310","url":null,"abstract":"<div><div>Intraoperative fluorescence imaging using indocyanine green (ICG) is an innovative and safe tool in minimally invasive thoracic surgery. It provides real-time imaging capabilities that can enhance surgical precision. We describe several clinical uses of ICG including intersegmental plane identification, thoracic duct injury localisation, anomalous systemic artery identification in pulmonary sequestration, phrenic nerve identification, and sentinel lymph node mapping. Successful visualisation of ICG was achieved to identify intra-thoracic anatomical structures and boundaries, allowing for safe and precise dissection.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1600-1604"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142285975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}