Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Comparing High-Flow Nasal Cannula Therapy and Conventional Oxygen Therapy in Adult Patients Post-Cardiac Surgery: A Systematic Review and Meta-Analysis.","authors":"Muhammad Mustafa Khan, Zaryab Bacha, Fatima Ajaz Khan, Hunain Shahbaz, Qazi Hassam Ur Rahman, Umme Habiba, Asmat Ali, Moiz Murad, Abbas Ali, Syed Umair Ahmed, Amir Hamza, Iqra Sami, Sofia Muryem, Izza Awais, Mujeeb Ur Rehman, Shoaib Ahmad, Bharat Kumar","doi":"10.1053/j.jvca.2026.09.009","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.009","url":null,"abstract":"<p><strong>Background: </strong>Cardiac surgery with cardiopulmonary bypass structurally alters respiratory mechanics and carries a substantial risk of postoperative morbidity. Historically, patients have routinely received conventional oxygen therapy (COT) following extubation. High- flow nasal cannula (HCNC) therapy has emerged as an innovative respiratory support system. By synthesizing all currently available high-quality randomized controlled trials (RCTs), this study aimed to rigorously evaluate the efficacy and safety of HFNC compared to COT, focusing primarily on determining the need for escalation of respiratory support.</p><p><strong>Methodology: </strong>A thorough electronic search was carried out in the PubMed, Embase, and Scopus databases from their inception to May 2026. Only RCTs were considered for analysis. A random-effects model was applied to compute pooled estimates and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 11 RCTs, comprising 2473 patients, were included in this systematic review and meta-analysis. HFNC had a statistically significant effect on reducing the requirement for escalation of respiratory support (risk ratio [RR] = 0.71; 95% CI, 0.55-0.93; p = 0.01). HFNC had a statistically significant effect on improving the arterial partial pressure of oxygen, as well as forced expiratory volume in 1 second, while also increasing delirium complications (RR = 3.63; 95% CI, 1.80-7.30; p = 0.0003). There were no statistically significant differences between the 2 approaches in the other secondary clinical and resource utilization outcomes, including intubation, overall mortality, hospital length of stay, intensive care unit length of stay, and postoperative atrial fibrillation.</p><p><strong>Conclusion: </strong>In adult patients recovering from cardiac surgery, HFNC therapy improves oxygenation and significantly curtails the need to escalate respiratory support compared to COT. However, these physiologic and intermediate clinical benefits do not translate into reductions in mortality, reintubation rate, or hospital length of stay and may come at the cost of increased postoperative delirium.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193795","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":"High-Frequency Low-Tidal Volume Ventilation and Procedural Efficiency in Atrial Fibrillation Catheter Ablation: A Single-Center Retrospective Study.","authors":"Gizem Özata Arslan, Hikmet Yorgun, Cem Çöteli, Huseyin Ulas Pinar, Kudret Aytemir, Ayşe Heves Karagöz","doi":"10.1053/j.jvca.2026.09.027","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.027","url":null,"abstract":"<p><strong>Objectives: </strong>To compare high-frequency low-tidal volume (HFLTV) ventilation with standard ventilation (SV) regarding procedural efficiency, airway mechanics, and clinical outcomes in atrial fibrillation (AF) catheter ablation.</p><p><strong>Design: </strong>Retrospective, observational, nonrandomized cohort study.</p><p><strong>Setting: </strong>Electrophysiology laboratory of a single tertiary-care university hospital.</p><p><strong>Participants: </strong>There were 160 consecutive eligible adults undergoing first-time AF radiofrequency ablation under general anesthesia between June 2023 and May 2024.</p><p><strong>Interventions: </strong>Patients received HFLTV (n = 80; respiratory rate 25-30 breaths/min, tidal volume 3-4 mL/kg, ETCO₂ maintained <50 mmHg) or SV (n = 80; tidal volume 6-8 mL/kg, respiratory rate 10-12 breaths/min) per attending anesthesiologist practice. All received propofol-remifentanil total intravenous anesthesia.</p><p><strong>Measurements and main results: </strong>Primary outcomes were total procedure time and radiofrequency ablation time; secondary outcomes were airway pressures, oxygenation, AF recurrence at 1 and 6 months, AF-related hospitalization, and complications. HFLTV was associated with lower median procedure time (110 v 128 minutes; p < .001) and ablation time (23 v 28 minutes; p < .001). Peak (14 v 18 cmH₂O) and minimum (13 v 15 cmH₂O) airway pressures were lower with HFLTV (both p < .001), whereas ETCO₂ and SpO₂ nadir were comparable. Multivariable regression identified HFLTV as an independent predictor of shorter ablation time (nonstandardized β=-5.48 minutes; 95% CI -7.05 to -3.91; p < .001). In exploratory analyses, recurrence at 1 month (7.5% v 15.0%; p = .211) and 6 months (13.8% v 18.8%; p = .520) and 6-month AF-related hospitalization (12.5% v 18.8%; p = .384) were numerically lower with HFLTV but confidence intervals were wide and included no difference.</p><p><strong>Conclusion: </strong>In a consecutive cohort including paroxysmal and persistent AF, HFLTV was associated with shorter procedure and ablation times and lower measured airway pressures without compromising gas exchange. Clinical outcome analyses were exploratory and hypothesis-generating, warranting prospective randomized evaluation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182135","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":"Interpreting pMax-Derived Driving Pressure Warning Thresholds During Prolonged One-Lung Ventilation.","authors":"Cheng Dong, Shenghan Zhang, Fei Gao","doi":"10.1053/j.jvca.2026.09.019","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.019","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206822","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":"Anesthetic Management of Open and Endovascular Thoracoabdominal Aortic Aneurysm Repair: When, How, and Why to Use Intraoperative Transesophageal Echocardiography. A Narrative Review and Practical Framework.","authors":"Letizia Perinati, Alice Bottussi, Jacopo D'Andria Ursoleo, Juan Ripoll, Elisa Cerchierini, Valentina Roncarati, Daniela Di Luca, Michael P Merren, Omar Elmadhoun, Mauro Gargiulo, Enrico Gallitto, Patrick M Wieruszewski, Fabrizio Monaco","doi":"10.1053/j.jvca.2026.09.033","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.033","url":null,"abstract":"<p><p>Open surgical or endovascular thoracoabdominal aortic aneurysm (TAAA) repair induces abrupt and competing hemodynamic shifts, exposing patients to significant hemodynamic instability and procedure-specific complications. Although intraoperative transesophageal echocardiography (TEE) is a well-established adjunct for intraprocedural diagnostic and anatomic assessment, its role as a structured decision-making tool to support physiologic interpretation in the dynamic perioperative setting of aortic surgery remains insufficiently explored. This narrative review synthesizes current evidence and proposes a unified, stepwise, pragmatic algorithm for using TEE as a real-time intraoperative decision interface to support anesthetic management in both the open and endovascular settings. Following standardized baseline image acquisition, echocardiographic findings are subsequently interpreted dynamically (ie, linking specific patterns of ventricular loading, contractility, and flow to their clinical relevance and potential therapeutic implications). Within this framework, TEE may help translate hemodynamic data into clinical decisions by distinguishing preload depletion from contractile dysfunction, determining afterload excess or vasoplegia, and guiding fluid therapy, vasoactive modulation, bypass flow adjustment, and inotropic support. Likewise, in the setting of endovascular TAAA repair, TEE may further refine landing-zone optimization, confirm true-lumen wire positioning, and help detect endoleaks and raise suspicion of retrograde dissection. The proposed algorithm combines TEE imaging with real-time hemodynamic assessment to support intraoperative decision-making during open and endovascular TAAA repair.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193870","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":"Serratus Posterior Superior Intercostal Plane Block Versus Superficial Parasternal Intercostal Plane Block With Local Infiltration for Postoperative Analgesia in Open Cardiac Surgery: A Randomized Controlled Trial.","authors":"Eralp Çevikkalp, Emre Ulusoy, Mürsel Ekinci, Alper Kaan Oğur, Canan Yılmaz","doi":"10.1053/j.jvca.2026.09.035","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.035","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative pain after open cardiac surgery arises from both sternotomy and chest drains and is often inadequately controlled by anatomically limited techniques. This study compared the serratus posterior superior intercostal plane block (SPSIPB, C3-T10 spread) with superficial parasternal intercostal plane block (PSIPB) plus chest drain-site infiltration.</p><p><strong>Design: </strong>Prospective, randomized, controlled trial with blinded outcome assessment.</p><p><strong>Setting: </strong>Single-center tertiary referral cardiac surgery center.</p><p><strong>Participants: </strong>Adults undergoing elective open cardiac surgery via median sternotomy; 80 assessed for eligibility, 76 randomized.</p><p><strong>Interventions: </strong>Bilateral SPSIPB (n = 35) or bilateral PSIPB plus local anesthetic infiltration at mediastinal and pleural chest drain sites (n = 41), performed preoperatively under ultrasound guidance.</p><p><strong>Measurements and main results: </strong>The primary outcome was cumulative 24-hour opioid consumption (morphine milligram equivalents, MME); the registered secondary outcomes were Numerical Rating Scale (NRS) pain scores at rest and on coughing and the Quality of Recovery-15 (QoR-15) at 24 hours. All other comparisons were exploratory. Twelve patients were excluded after randomization (2 SPSIPB, 10 control), leaving 33 and 31 for analysis. Opioid consumption was significantly lower in the SPSIPB group (36.6 ± 17.5 v 56.7 ± 16.1 mg of MME; mean difference 20.1 mg of MME; 95% CI, 11.7-28.5; p < 0.001). NRS scores were comparable during the first postoperative hour but lower in the SPSIPB group from 2 hours onward during coughing and at 4, 8, and 24 hours at rest (all p ≤ 0.019). QoR-15 scores were higher in the SPSIPB group (119 [112-126] v 108 [105-111.5]; median difference 10 points; 95% CI, 6-15; p < 0.001), exceeding the minimal clinically important difference of 6 points. Adverse events, including postoperative nausea and vomiting, did not differ between the groups.</p><p><strong>Conclusions: </strong>Compared with PSIPB plus drain-site infiltration-an active comparator targeting both the sternal and drain regions-SPSIPB reduced opioid consumption and improved quality of recovery and may be a valuable component of multimodal analgesia within Enhanced Recovery After Cardiac Surgery (ERACS) protocols.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182177","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":"Continuous Bilateral Lower-Limb Near-Infrared Spectroscopy Monitoring in Patients on Intra-aortic Balloon Pump Support: A Prospective Feasibility and Physiology Study.","authors":"Wong Shiun Woei, Huang Wenjie, Jiang Yan, Chia Yew Woon","doi":"10.1053/j.jvca.2026.09.018","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.018","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility of continuous bilateral lower-limb near-infrared spectroscopy (NIRS) monitoring as an adjunct to standard hourly neurovascular assessment (NVA) in patients receiving intra-aortic balloon pump (IABP) support, and to characterize the relationship between regional oxygen saturation (rSO₂) and in-hospital mortality.</p><p><strong>Design: </strong>Prospective observational cohort study.</p><p><strong>Setting: </strong>Cardiac care unit of a tertiary cardiac center (Tan Tock Seng Hospital, Singapore).</p><p><strong>Participants: </strong>Fifty consecutive adult patients receiving IABP support via femoral arterial access.</p><p><strong>Interventions: </strong>Continuous bilateral lower-limb rSO₂ monitoring using NIRS was performed throughout IABP support, alongside standardized hourly NVA of both limbs (capillary refill time, skin color, temperature, pulse quality, and Doppler signal).</p><p><strong>Measurements and main results: </strong>Right femoral access was used in 94% of patients (47 of 50). Minimum contralateral (left) rSO₂ was significantly lower in nonsurvivors than survivors (29.3% ± 17.6% v 43.3% ± 14.4%, p = 0.024), with a directionally similar but nonsignificant trend on the ipsilateral (right) side (p = 0.083). Regional oxygen saturation correlated moderately with capillary refill time (Spearman rank correlation [r_s] ≈ 0.50) and pulse quality (r_s ≈ 0.38) bilaterally but not with temperature change, which deteriorated in >92% of limbs. Low rSO₂ (<40%) in either limb was associated with a nonsignificant 3.16-fold increase in mortality odds (95% confidence interval, 0.55-18.11; p = 0.197). No patient developed acute limb ischemia. Sepsis (odds ratio [OR], 13.0) and renal replacement therapy (OR, 7.1) were the only statistically significant predictors of mortality.</p><p><strong>Conclusions: </strong>Continuous bilateral lower-limb rSO₂ monitoring is feasible throughout IABP support and produces a physiologically coherent signal that correlates moderately with objective NVA parameters and is lower in patients who do not survive to discharge. No limb ischemic events occurred; these findings are best regarded as feasibility and physiology data rather than evidence that continuous monitoring improves limb outcomes, and they warrant confirmation in a larger, multicenter study.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216349","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":"EACTS/STS/AATS Guidelines on Temporary Mechanical Circulatory Support in Adult Cardiac Surgery: An Expert Analysis for Cardiothoracic Anesthesia and Critical Care.","authors":"Harrison R Herrera, Daniel Brodie, Patrick M Wieruszewski, Jacopo D'Andria Ursoleo, Dominic Pisano, Jamel Ortoleva, Nathaniel Martin, Stepan Maruniak, German J Medina-Rincon, Edward A Bittner, Harish Ramakrishna, Juan G Ripoll","doi":"10.1053/j.jvca.2026.09.028","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.028","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182157","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":"Mechanical Circulatory Support and Heart Transplant Trends in Medicare Part B Beneficiaries, 2015-2024.","authors":"Alexander E Jacobs, Yosef A Cohen, Derek R Soled, Eddy Fan, David W Miranda, Andrew J Einstein, Jonah Rubin","doi":"10.1053/j.jvca.2026.09.026","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.026","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216272","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":"Angiotensin II in Refractory Shock Secondary to Amlodipine Overdose with Co-Ingestions.","authors":"Abigail J B Poindexter, Jack Pluenneke, Timothy P Berry, Aaron Douglas, Michelle M Haines, Adham Mohamed","doi":"10.1053/j.jvca.2026.09.029","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.029","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165838","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":"ChatGPT Versus MediSearch: A Comparative Analysis of Artificial Intelligence Platforms for Patient Education in Cardiac Surgery and Cardiac Anesthesia.","authors":"Akshar P Patel, Ishan Aggarwal, Stanley Joseph, Cheng-Hao Chen, Jahnavi Kakuturu, Caryl F Bailey","doi":"10.1053/j.jvca.2026.09.032","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.032","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the reliability and readability of responses generated by two artificial intelligence (AI) platforms-ChatGPT and MediSearch-to common patient-focused questions about cardiac surgery and its anesthetic implications.</p><p><strong>Design: </strong>Prospective, comparative, cross-sectional evaluation.</p><p><strong>Setting: </strong>Single-institution academic study; no direct patient involvement. Questions were sourced from publicly available online data (Google \"People Also Ask\" feature).</p><p><strong>Participants: </strong>One hundred unique patient-focused questions about cardiac surgery and anesthesia, categorized using the Rothwell classification system (80 fact, 14 policy, 6 value).</p><p><strong>Interventions: </strong>Each question was submitted individually to the free versions of ChatGPT (version 4.0) and MediSearch. Responses were evaluated using three validated metrics: reliability, assessed using the modified DISCERN tool; readability, assessed using the Flesch-Kincaid grade level (FK) and Coleman-Liau index (CL); and clinical accuracy, assessed by a board-certified cardiothoracic anesthesiologist and a board-certified cardiothoracic surgeon using a 3-point Likert scale.</p><p><strong>Measurements and main results: </strong>MediSearch demonstrated significantly higher reliability (mean DISCERN score, 4.64 v 2.47; p < 0.001). ChatGPT generated significantly more readable responses (mean FK score, 10.33 v 11.34 [p < 0.01]; mean CL score, 15.72 v 17.30 [p < 0.001]) and significantly higher clinical accuracy (mean, 0.82 v 0.71; p < 0.01). Subgroup analysis by Rothwell category confirmed MediSearch's reliability advantage across all question types, while ChatGPT's readability advantage was most pronounced for fact-based questions.</p><p><strong>Conclusions: </strong>This study reveals a critical trade-off between evidence-based reliability and linguistic accessibility in AI-generated cardiac surgery patient education content. MediSearch offers superior reliability, while ChatGPT provides more readable and accurate responses. Neither platform achieves the sixth-grade readability level recommended for broad public accessibility. These findings underscore the need for AI platforms to balance clinical accuracy with health literacy standards before being endorsed as patient education tools in high-stakes settings.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193831","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}