Infection Control & Hospital Epidemiology最新文献

{"title":"Comparative epidemiology of hospital-onset bloodstream infections (HOBSIs) and central line-associated bloodstream infections (CLABSIs) across a three-hospital health system","authors":"Jay Krishnan, Erin B. Gettler, Melissa Campbell, Ibukunoluwa C. Kalu, Jessica Seidelman, Becky Smith, Sarah Lewis","doi":"10.1017/ice.2024.38","DOIUrl":"https://doi.org/10.1017/ice.2024.38","url":null,"abstract":"<span>Objective:</span><p>To evaluate the comparative epidemiology of hospital-onset bloodstream infection (HOBSI) and central line-associated bloodstream infection (CLABSI)</p><span>Design and Setting:</span><p>Retrospective observational study of HOBSI and CLABSI across a three-hospital healthcare system from 01/01/2017 to 12/31/2021</p><span>Methods:</span><p>HOBSIs were identified as any non-commensal positive blood culture event on or after hospital day 3. CLABSIs were identified based on National Healthcare Safety Network (NHSN) criteria. We performed a time-series analysis to assess comparative temporal trends among HOBSI and CLABSI incidence. Using univariable and multivariable regression analyses, we compared demographics, risk factors, and outcomes between non-CLABSI HOBSI and CLABSI, as HOBSI and CLABSI are not exclusive entities.</p><span>Results:</span><p>HOBSI incidence increased over the study period (IRR 1.006 HOBSI/1,000 patient days; 95% CI 1.001–1.012; <span>P</span> = .03), while no change in CLABSI incidence was observed (IRR .997 CLABSIs/1,000 central line days, 95% CI .992–1.002, <span>P</span> = .22). Differing demographic, microbiologic, and risk factor profiles were observed between CLABSIs and non-CLABSI HOBSIs. Multivariable analysis found lower odds of mortality among patients with CLABSIs when adjusted for covariates that approximate severity of illness (OR .27; 95% CI .11–.64; <span>P</span> &lt; .01).</p><span>Conclusions:</span><p>HOBSI incidence increased over the study period without a concurrent increase in CLABSI in our study population. Furthermore, risk factor and outcome profiles varied between CLABSI and non-CLABSI HOBSI, which suggest that these metrics differ in important ways worth considering if HOBSI is adopted as a quality metric.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140169875","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":"Control of SARS-CoV-2 infection in skilled nursing facilities in Detroit, Michigan: a model for emerging infectious diseases","authors":"Seema Joshi, Samia Arshad, Abigail Lindsay, Jessica Heinonen, Helina Misikir, John Zervos, Tyler Prentiss, Jelena Verkler, Mariia Numi, Bonnie Czander, Randy E. David, Michael Mossing, Paul E. Kilgore, Najibah Rehman, Marcus Zervos","doi":"10.1017/ice.2024.35","DOIUrl":"https://doi.org/10.1017/ice.2024.35","url":null,"abstract":"<p>An infection prevention bundle that consisted of the development of a response team, public–academic partnership, daily assessment, regular testing, isolation, and environmental controls was implemented in 26 skilled nursing facilities in Detroit, Michigan (March 2020–April 2021). This intervention was associated with sustained control of severe acute respiratory coronavirus virus 2 infection among residents and staff.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"27 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140169355","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":"Modeling relaxed policies for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions","authors":"Jiaming Cui, Jack Heavey, Leo Lin, Eili Y. Klein, Gregory R. Madden, Costi D. Sifri, Bryan Lewis, Anil K. Vullikanti, B. Aditya Prakash","doi":"10.1017/ice.2024.23","DOIUrl":"https://doi.org/10.1017/ice.2024.23","url":null,"abstract":"<span>Objective:</span><p>To evaluate the economic costs of reducing the University of Virginia Hospital’s present “3-negative” policy, which continues methicillin-resistant <span>Staphylococcus aureus</span> (MRSA) contact precautions until patients receive 3 consecutive negative test results, to either 2 or 1 negative.</p><span>Design:</span><p>Cost-effective analysis.</p><span>Settings:</span><p>The University of Virginia Hospital.</p><span>Patients:</span><p>The study included data from 41,216 patients from 2015 to 2019.</p><span>Methods:</span><p>We developed a model for MRSA transmission in the University of Virginia Hospital, accounting for both environmental contamination and interactions between patients and providers, which were derived from electronic health record (EHR) data. The model was fit to MRSA incidence over the study period under the current 3-negative clearance policy. A counterfactual simulation was used to estimate outcomes and costs for 2- and 1-negative policies compared with the current 3-negative policy.</p><span>Results:</span><p>Our findings suggest that 2-negative and 1-negative policies would have led to 6 (95% CI, −30 to 44; <span>P</span> &lt; .001) and 17 (95% CI, −23 to 59; −10.1% to 25.8%; <span>P</span> &lt; .001) more MRSA cases, respectively, at the hospital over the study period. Overall, the 1-negative policy has statistically significantly lower costs ($628,452; 95% CI, $513,592–$752,148) annually (<span>P</span> &lt; .001) in US dollars, inflation-adjusted for 2023) than the 2-negative policy ($687,946; 95% CI, $562,522–$812,662) and 3-negative ($702,823; 95% CI, $577,277–$846,605).</p><span>Conclusions:</span><p>A single negative MRSA nares PCR test may provide sufficient evidence to discontinue MRSA contact precautions, and it may be the most cost-effective option.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139968247","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 impact of an intervention to reduce dispersal from wastewater drain sites on carbapenem-resistant Pseudomonas aeruginosa colonization and bloodstream infection on a hematopoietic cell transplant and hematologic malignancy unit","authors":"Lauren Fontana, Morgan Hakki, Egon A. Ozer, Amy Laird, Lynne Strasfeld","doi":"10.1017/ice.2023.288","DOIUrl":"https://doi.org/10.1017/ice.2023.288","url":null,"abstract":"<span>Objective:</span><p>To evaluate the impact of an intervention to limit dispersal from wastewater drain (WWD) sites on meropenem-nonsusceptible <span>Pseudomonas aeruginosa</span> patient and environmental colonization and bloodstream infection (BSI) on a hematopoietic cell transplant (HCT) and hematologic malignancy (HM) unit.</p><span>Design:</span><p>This quasi-experimental study included pre/postintervention point-prevalence surveys in July 2019 and June 2020, respectively. The retrospective cohort included HCT/HM patients with <span>P. aeruginosa</span> BSI between 2012 and 2022.</p><span>Setting:</span><p>Adult HCT/HM unit at an academic center.</p><span>Participants:</span><p>This study included consenting HCT/HM patients on the unit at the time of the point-prevalence surveys. HCT/HM patients with <span>P. aeruginosa</span> BSI between 2012 and 2022.</p><span>Methods:</span><p>A quality improvement intervention targeting WWD sites was conceived and implemented on a HCT/HM unit. Pre and postintervention colonization samples were obtained from patients and environmental sites, cultivated on selective media, then characterized by susceptibility testing. Whole-genome sequencing and phylogenetic analysis were performed on select isolates. The impact of the intervention on colonization and BSI was evaluated, as was relatedness among isolates.</p><span>Results:</span><p>Although colonization of WWD sites with meropenem-nonsusceptible <span>P. aeruginosa</span> was widespread before and after this intervention, we observed a substantial decline in patient colonization (prevalence rate ratio, 0.35; 95% confidence interval [CI], 0.04–3.12) and BSI (incidence rate ratio, 0.67; 95% CI, 0.31–1.42) after the intervention. Among 3 predominant sequence types (ST-111, ST-446, and ST-308), there was striking genetic conservation within groups and among environmental colonization, patient colonization, and BSI isolates.</p><span>Conclusions:</span><p>An intervention targeting WWD sites on a HCT/HM unit had a meaningful impact on meropenem-nonsusceptible <span>P. aeruginosa</span> patient colonization and BSI.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139926715","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 impact of minimally invasive surgical approaches on surgical-site infections","authors":"Stephanie F. Sweitzer, Emily E. Sickbert-Bennett, Jessica Seidelman, Deverick J. Anderson, Moe R. Lim, David J. Weber","doi":"10.1017/ice.2023.277","DOIUrl":"https://doi.org/10.1017/ice.2023.277","url":null,"abstract":"<p>We performed a literature review to describe the risk of surgical-site infection (SSI) in minimally invasive surgery (MIS) compared to standard open surgery. Most studies reported decreased SSI rates among patients undergoing MIS compared to open procedures. However, many were observational studies and may have been affected by selection bias. MIS is associated with reduced risk of surgical-site infection compared to standard open surgery and should be considered when feasible.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139083916","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":"ICE volume 45 issue 1 Cover and Front matter","authors":"D. Yokoe, Patricia Jackson, David C. Classen, C. Rhee, Ray Dantes, A. Benin, Julie Tsu-Yu, Tsu-Yu Wu, Erica S. Shenoy, Evan P. Carey, Gil Alterovitz, Michael J. Kim, W. Branch-Elliman, Carissa M. Windish, Priya Nori, Kimberly C. Dukes, Heather R S Reisinger, Marin L. Schweizer, M. Ward, Laura Chapin, T. Ryken, T. Perl, L. Herwaldt, Mary Fornek, Subhan Ata, Edwin Jimenez, M. Abdallah, S. Sunny, Jennifer Lee, Briana Episcopia, Valery Roudnitsky, John Quale, Jérémy Picard, B. Nkoumazok, Isabelle Arnaud, D. Verjat-trannoy, Pascal Astagneau, Kelsey M. Fillman, Jonathan H. Ryder, Daniel M. Brailita, Mark E. Rupp, R. Cavalieri, Paul D. Fey, Elizabeth R. Lyden, Richard J Hankins, Karen M. Jones, Sarah L. Krein, J. Mantey, M. Harrod, L. Mody, Gang Ye Kalvin C. Yu, Jonathan R. Edwards, Vikas Gupta, ChinEn Ai, Kristina Betz, Andrew S. Crone, Lorinda M. Wright, Adam K Cheknis, Stuart Johnson, S. Pacheco, Andrew M. Skinner, Hao-Hsin Wu, Chiu-Hsia Su, Li-Jung Chien, S. Tseng, Shan-Chwen Chang, L. S. Ocampo, Eric Hall, ","doi":"10.1017/ice.2023.290","DOIUrl":"https://doi.org/10.1017/ice.2023.290","url":null,"abstract":"","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"9 10","pages":"f1 - f7"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457855","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":"ICE volume 45 issue 1 Cover and Back matter","authors":"","doi":"10.1017/ice.2023.291","DOIUrl":"https://doi.org/10.1017/ice.2023.291","url":null,"abstract":"","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"5 2","pages":"b1 - b2"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457778","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 cluster of three extrapulmonary Mycobacterium abscessus infections linked to well-maintained water-based heater-cooler devices","authors":"Jessica L. Seidelman, Arthur W. Baker, Sarah S. Lewis, Bobby G. Warren, Aaron Barrett, Amanda Graves, Carly King, Bonnie Taylor, Jill Engel, Desiree Bonnadonna, Carmelo Milano, Richard J. Wallace, Matthew Stiegel, Deverick J. Anderson, Becky A. Smith","doi":"10.1017/ice.2023.273","DOIUrl":"https://doi.org/10.1017/ice.2023.273","url":null,"abstract":"<span>Background:</span><p>Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated <span>M. abscessus</span> (HA-Mab) put in place following a prior institutional outbreak of <span>M. abscessus</span> alerted investigators to a cluster of 3 extrapulmonary <span>M. abscessus</span> infections among patients who had undergone cardiothoracic surgery.</p><span>Methods:</span><p>Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of <span>M. abscessus</span> in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental <span>M. abscessus</span> isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.</p><span>Results:</span><p>Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. <span>M. abscessus</span> was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of <span>M. abscessus</span> from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.</p><span>Conclusions:</span><p>Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted <span>M. abscessus</span> to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138825571","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":"Bronchoscopy-related outbreaks and pseudo-outbreaks: A systematic review","authors":"Loukas Kakoullis, Sofia Economidou, Preeti Mehrotra, George Panos, Theodoros Karampitsakos, Grigorios Stratakos, Argyrios Tzouvelekis, Fotios Sampsonas","doi":"10.1017/ice.2023.250","DOIUrl":"https://doi.org/10.1017/ice.2023.250","url":null,"abstract":"Objective: To identify and report the pathogens and sources of contamination associated with bronchoscopy-related outbreaks and pseudo-outbreaks. Design: Systematic review. Setting: Inpatient and outpatient outbreaks and pseudo-outbreaks after bronchoscopy. Methods: PubMed/Medline databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the search terms “bronchoscopy,” “outbreak,” and “pseudo-outbreak” from inception until December 31, 2022. From eligible publications, data were extracted regarding the type of event, pathogen involved, and source of contamination. Pearson correlation was used to identify correlations between variables. Results: In total, 74 studies describing 23 outbreaks and 52 pseudo-outbreaks were included in this review. The major pathogens identified in these studies were <jats:italic>Pseudomonas aeruginosa</jats:italic>, <jats:italic>Mycobacterium tuberculosis</jats:italic>, nontuberculous mycobacteria (NTM), <jats:italic>Klebsiella pneumoniae</jats:italic>, <jats:italic>Serratia marcescens</jats:italic>, <jats:italic>Stenotrophomonas maltophilia</jats:italic>, <jats:italic>Legionella pneumophila</jats:italic>, and fungi. The primary sources of contamination were the use of contaminated water or contaminated topical anesthetics, dysfunction and contamination of bronchoscopes or automatic endoscope reprocessors, and inadequate disinfection of the bronchoscopes following procedures. Correlations were identified between primary bronchoscope defects and the identification of <jats:italic>P. aeruginosa</jats:italic> (r = 0.351; <jats:italic>P</jats:italic> = .002) and <jats:italic>K. pneumoniae</jats:italic> (r = 0.346; <jats:italic>P</jats:italic> = .002), and between the presence of a contaminated water source and NTM (r = 0.331; <jats:italic>P</jats:italic> = .004) or <jats:italic>L. pneumophila</jats:italic> (r = 0.280; <jats:italic>P</jats:italic> = .015). Conclusions: Continued vigilance in bronchoscopy disinfection practices remains essential because outbreaks and pseudo-outbreaks continue to pose a significant risk to patient care, emphasizing the importance of stringent disinfection and quality control measures.","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138686341","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":"Staphylococcus epidermidis joint isolates: Whole-genome sequencing demonstrates evidence of hospital transmission and common antimicrobial resistance","authors":"Samantha J. Simon, Mohamad Sater, Ian Herriott, Miriam Huntley, Emma Briars, Brian L. Hollenbeck","doi":"10.1017/ice.2023.253","DOIUrl":"https://doi.org/10.1017/ice.2023.253","url":null,"abstract":"Objective: We investigated genetic, epidemiologic, and environmental factors contributing to positive <jats:italic>Staphylococcus epidermidis</jats:italic> joint cultures. Design: Retrospective cohort study with whole-genome sequencing (WGS). Patients: We identified <jats:italic>S. epidermidis</jats:italic> isolates from hip or knee cultures in patients with 1 or more prior corresponding intra-articular procedure at our hospital. Methods: WGS and single-nucleotide polymorphism–based clonality analyses were performed, including species identification, in silico multilocus sequence typing (MLST), phylogenomic analysis, and genotypic assessment of the prevalence of specific antibiotic resistance and virulence genes. Epidemiologic review was performed to compare cluster and noncluster cases. Results: In total, 60 phenotypically distinct <jats:italic>S. epidermidis</jats:italic> isolates were identified. After removal of duplicates and impure samples, 48 isolates were used for the phylogenomic analysis, and 45 (93.7%) isolates were included in the clonality analysis. Notably, 5 <jats:italic>S. epidermidis</jats:italic> strains (10.4%) showed phenotypic susceptibility to oxacillin yet harbored <jats:italic>mecA</jats:italic>, and 3 (6.2%) strains showed phenotypic resistance despite not having <jats:italic>mecA</jats:italic>. <jats:italic>Smr</jats:italic> was found in all isolates, and <jats:italic>mupA</jats:italic> positivity was not observed. We also identified 6 clonal clusters from the clonality analysis, which accounted for 14 (31.1%) of the 45 <jats:italic>S. epidermidis</jats:italic> isolates. Our epidemiologic investigation revealed ties to common aspirations or operative procedures, although no specific common source was identified. Conclusions: Most <jats:italic>S. epidermidis</jats:italic> isolates from clinical joint samples are diverse in origin, but we identified an important subset of 31.1% that belonged to subclinical healthcare–associated clusters. Clusters appeared to resolve spontaneously over time, suggesting the benefit of routine hospital infection control and disinfection practices.","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138686203","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}