Journal of Burn Care & Research最新文献

{"title":"Elevated Cardiac Troponin I Level Associated to Cardiac Dysfunction in Burned Patients.","authors":"Carolina Segura, George Golovko, Isabel Obias, Suhaib Shah, Amina El Ayadi, Steven Wolf, Juquan Song","doi":"10.1093/jbcr/irae086","DOIUrl":"10.1093/jbcr/irae086","url":null,"abstract":"<p><p>Severely burned patients often develop cardiac dysfunction and heart failure. The purpose of this retrospective study is to evaluate the role of cardiac troponin I (cTI) and its association to patients with burns. Patients deidentified data were collected from a national database in May 2023. Adult patients with burns who had cTnI lab counted were enrolled in this study. Patients were grouped by the cTnI mean level within 72 h including patients with elevated cTnI levels at >0.3 ng/mL (n = 2188 patients) and patients with nonelevated cTnI level (<0.04 ng/mL) (n = 3200). The cohorts were further stratified by less than 20% TBSA mild burn population and >20% TBSA severe burn population to replicate the severity of burns. The 30-day incidences of acute myocardial infarction (MI), sepsis, and mortality were investigated after the cohorts were propensity-matching balanced. The odds ratios (ORs) with 95% CI for MI were (9.829/7.081-13.645), sepsis (1.527/1.269-1.959), and mortality (2.586/2.110-3.170), respectively (P < .05). The groups that were further stratified into mild burn and severe burn had the following results: The mild burn ORs and 95% CI for MI was (6.237/3.986-9.785), sepsis (1.603/1.132-2.270), and mortality was (2.298/1.629-3.242). The severe burn cohort had ORs and 95% CI for MI (3.145/1.469-6.732), sepsis (0.993/0.555-1.777), and mortality (2.934/1.924-4.475). In conclusion, the patients with earlier elevated cTnI levels had worse outcomes of MI and mortality in both severe and mild burns.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1139-1147"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing Consensus of Best Practice for CEA Use in Treatment of Severe Burns: A US Burn Provider Delphi Study.","authors":"Paul Glat, Lisa Quirk, Scott Hultman, Jennifer Kesey, Arpana Jain, John Griswald, Fitzgerald Natalie, Lucy Wibbenmeyer, Hamed Amani, Caryn Cramer, William L Hickerson","doi":"10.1093/jbcr/irae050","DOIUrl":"10.1093/jbcr/irae050","url":null,"abstract":"<p><p>The goal of this study was to inform standards of best practice in the use of cultured epidermal autograft (CEA), manufactured in the United States, for the treatment of patients with severe burns. The study was designed using the modified Delphi technique, a method for structuring group communication among experts to promote the development of consensus-based recommendations. Known areas of variability related to the stages of CEA treatment were identified by literature review prior to the study and were confirmed through qualitative interview with the experts. The areas included Preoperative Planning/Surgical Planning, Immediate Postoperative Care, and Rehabilitation and Long-Term Care. A list of 22 questions was developed based on interviews with the experts, and a 3-round Delphi technique was used to establish consensus (≥80% agreement). Following 3 rounds (quantitative, qualitative, and virtual roundtable meeting) of the Delphi study, important guidance for the use of CEA treatment in severely burned patients gained consensus. Final key recommendations included minimum burn limit for CEA treatment (30%-50% TBSA), ideal biopsy timing (1-2 days), number of grafts (enough to cover; adjust 72 hours before application), use of dermal substrates (recommended) and wide meshed autograft underlay (recommended), optimal CEA drying time per day (open air >6 hours), slings used if CEA placed on extremities (recommended), dressing changes (performed every day, all at once, with all layers removed down to bridal veil), CEA backing removal (10-14 days after placement), heat lamps (can be used to aid the wound in drying, depending on clinical judgment), initial activity restrictions lifted (beginning 10 days after backing removal), compression garments (introduced at approximately 2 months post-CEA surgery), and lasers (CO2 laser can be introduced between 3 and 6 months post-CEA surgery).</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1287-1293"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140174862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hematological Trends in Severe Burn Patients: A Comprehensive Study for Prognosis and Clinical Insights.","authors":"Amber Yousuf Khan, Faiza Waheed, Muhammad Rehan, Zunera Arshad, Tariq Iqbal, Saman Waqar, Usman Waheed","doi":"10.1093/jbcr/irae057","DOIUrl":"10.1093/jbcr/irae057","url":null,"abstract":"<p><p>Severe burn injuries pose diagnostic challenges, contributing to increased fatality rates with delayed diagnoses. This study aims to identify early risk factors and understand their impact on clinical outcomes by examining hematological dynamics in severe burn cases. The focus includes age-related patterns, total body surface area (TBSA) affected by burns, hospital stay duration, and changes in hematological markers during burn injuries. An analytical cross-sectional study at the burn care center involved 135 participants hospitalized between January 2018 and December 2021. Demographic data and hematological markers were recorded, and statistical analysis was performed using IBM SPSS 25.0. Nonsurvivors exhibited a greater mean TBSA, shorter hospital stay, and an enhanced early immune response indicated by white blood cell count on the first day. Hematological markers, including hemoglobin, red cell count (RCC), and platelet count, showed dynamic patterns over the study period. Marginal variations in platelet counts and intriguing patterns in RCC suggested potential consequences like disseminated intravascular coagulation. The study provides crucial insights into hematological responses to severe burn injuries. Early identification of risk factors, particularly age-related patterns and immune responses, informs clinicians about predicting outcomes and guiding therapeutic interventions. Despite limitations, this work underscores the need for further multicenter research to comprehensively understand the complex relationships between burn injuries, hematological responses, and clinical outcomes.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1315-1320"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863160","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":"Endoscopic Tissue Expander Implantation in Postburn Reconstruction: A Review of the Literature.","authors":"Artur Manasyan, Maxwell B Johnson","doi":"10.1093/jbcr/irae097","DOIUrl":"10.1093/jbcr/irae097","url":null,"abstract":"<p><strong>Background: </strong>Tissue expansion generates new tissue that can be used in postburn reconstruction. Expanders are placed through small incisions, requiring difficult and sometimes blind dissection to prepare an adequate pocket. Recently, the use of endoscopy to assist in expander placement has been described, which may improve intraoperative visualization and allow for a smaller incision. In this review, we summarize the existing literature on endoscopic tissue expander (TE) placement in postburn reconstruction and highlight areas for future research.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were utilized to conduct this review. The following databases were queried for the initial search of relevant articles: PubMed, Embase, Scopus, Cochrane, and Web of Science. The data were assessed qualitatively due to the heterogeneity in reporting between the studies.</p><p><strong>Results: </strong>Our literature query yielded 1023 studies. Sixteen manuscripts underwent full-text review, and 7 met inclusion criteria. All studies demonstrated that the endoscopic approach led to successful tissue expansion. Four articles performed a comparative analysis between the open and endoscopic approach, all of which found a significant reduction in complications like seroma, hematoma formation, and device exposure with endoscopic TE implantation. Two studies demonstrated that the use of endoscopy significantly reduced operative time and length of stay.</p><p><strong>Conclusion: </strong>Endoscopy is a safe and effective tool in tissue expansion for postburn reconstruction. Further prospective research should include evaluating the cost-benefit of this approach and long-term outcomes for patients who have undergone endoscopic-assisted TE placement.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1160-1164"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141186488","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":"Distance to Burn Center Does Not Impact Long-term Anxiety and Depression Risk Following Burn Injury.","authors":"William B Risinger, Crystal N Dye, Spencer K Thompson, Chinweotuto V Uma, David D Keeven, Nicholas A Nash, Jason W Smith, Matthew C Bozeman","doi":"10.1093/jbcr/irae042","DOIUrl":"10.1093/jbcr/irae042","url":null,"abstract":"<p><p>Burn injury predisposes patients to significant psychological morbidity, including anxiety, depression, and posttraumatic stress. Adding to the burden of injury, patients often require transfer to specialized burn centers located far from home. We hypothesized that greater distances between a patient's home address and the treating burn center would increase the rate of postinjury anxiety and depression. From January 2021 to June 2023, patients who were admitted to our American Burn Association verified center and seen for posthospitalization follow-up were identified. Demographics, burn characteristics, and follow-up anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-2) screening scores were reviewed. Comparisons between patients with positive and negative screens were performed using univariate analysis followed by logistic regression. Linear regression was used to evaluate the relationship between distance to the burn center and incremental screening scores. Of the 272 patients identified, 35.6% and 27.9% screened positive for anxiety and depression, respectively. The distance to burn center was not greater among patients with positive screens. Likewise, no statistically significant linear relationship was found between distance to the burn center and incremental screening scores. Morphine milligram equivalents on the last day of hospitalization (P = .04) and a prior psychiatric history (P < .001) all predicted postinjury anxiety. Total body surface area burned (P = .02) and a prior psychiatric history (P = .02) predicted postinjury depression. The distance between a patient's home and the treating burn center does not alter anxiety and depression rates following burn injury, further supporting the transfer of patients to specialized centers.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1089-1094"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851921","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":"Burn Care Funding in the Era of Price Transparency-Does Verification Signal Bargaining Power?","authors":"Eloise Wood Stanton, Rachel Pedreira, Nada Rizk, Akshay Swaminathan, Clifford Sheckter","doi":"10.1093/jbcr/irae078","DOIUrl":"10.1093/jbcr/irae078","url":null,"abstract":"<p><p>The Price Transparency Rule of 2021 forced payors and hospitals to publicly disclose negotiated prices to foster competition and reduce the cost. Burn care is costly and concentrated at less than 130 centers in the US. We aimed to analyze geographic price variations for inpatient burn care and measure the effects of American Burn Association (ABA) verification status and market concentration on prices. All available commercial rates for 2021-2022 for burn-related diagnosis-related groups (DRGs) 927, 928, 929, 933, 934, and 935 were merged with hospital-level variables, ABA verification status, and Herfindahl-Hirschman Index (HHI) data. For the DRG 927 (most intensive burn admission), a linear mixed effects model was fit with cost as the outcome and the following variables as covariates: HHI, plan type, safety net status, profit status, verification status, rural status, and teaching hospital status. Random intercepts allowed for individual burn centers. There were 170,738 rates published from 1541 unique hospitals. Commercial reimbursement rates for the same DRG varied by a factor of approximately three within hospitals for all DRGs. Similarly, rates across different hospitals varied by a factor of 3 for all DRGs, with DRG 927 having the most variation. Burn center status was independently associated with higher reimbursement rates adjusting for facility-level factors for all DRGs except for 935. Notably, HHI was the largest predictor of commercial rates (P < .001). Negotiated prices for inpatient burn care vary widely. ABA-verified centers garner higher rates along with burn centers in more concentrated/monopolistic markets.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1117-1123"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140908688","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":"Pediatric Postburn Flexion Contracture Release: Early Outcomes Using 2 Bloodless Techniques.","authors":"Oluwatobi Abass, Afieharo I Michael, Mohammad L Abubakar, Wasiu O Adebayo, Mohammed A Kabir, Abdulrasheed Ibrahim","doi":"10.1093/jbcr/irae035","DOIUrl":"10.1093/jbcr/irae035","url":null,"abstract":"<p><p>Postburn flexion contracture of the hand in children constitutes a significant proportion of postburn complications. We compared the early clinical outcomes of reconstruction of pediatric postburn flexion contracture of the digits of the hand using tourniquet or tumescent technique. A prospective randomized study of pediatric patients requiring contracture release and wound resurfacing with full-thickness skin graft between September 2020 and August 2021. Patients were randomized into groups of either tourniquet or tumescent technique for contracture release. The surface area of graft take and total active motion across joints were the outcome measures. Student t test and chi-square test were performed. Twenty-two patients were randomized into either group. The mean age of the participants was 6.09 ± 2.41 years, mostly males 31 (72.1%). A grade 3 flexion contracture was the most common (72.1%). Ninety-four digits and 178 joints were operated on, with the proximal interphalangeal joint being the most common (48.9%). The mean surface area of graft take on postoperative day 10 was significantly higher for the tumescent group than the tourniquet group, P = .001. The total active motion across the joints at 6 and 9 weeks postoperative showed a strong correlation between the total active motion across joints and the technique of release, P = .004 and .001, respectively. Tumescent technique is a feasible alternative to the tourniquet method for postburn flexion contracture release of the digits in the pediatric burned hand.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1250-1256"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140039446","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":"Mental Health Support Is an Unmet Need for Long-term Burn Survivors: A Web-based Survey.","authors":"Walter A Ramsey, Michael D Cobler-Lichter, Christopher F O'Neil, Mary Ishii, Shevonne S Satahoo, Joyce I Kaufman, Louis R Pizano, Tulay Koru-Sengul, Jose Szapocznik, Carl I Schulman","doi":"10.1093/jbcr/irae085","DOIUrl":"10.1093/jbcr/irae085","url":null,"abstract":"<p><p>A National Trauma Research Action Plan identified the involvement of burn survivors as critical informants to determine the direction of research. This study employed a web-based survey to identify care gaps in a sample of burn survivors. We surveyed burn survivors from around the United States through social media and email contact with the Phoenix Society for Burn Survivors. We elicited demographic info, burn history, and unmet needs. Statistical analysis was performed to test our hypothesis that lack of access to mental health support/professionals would be identified as an unmet need in long-term burn survivors. Of 178 survey respondents, most were at least 10 years removed from the date of their burn injury (n = 94, 53%). Compared with those less than 3 years from their burn injury, individuals greater than 10 years were at least 5 times more likely to note a lack of access to mental health support [11-20 years OR 8.7, P < .001; >20 years OR 5.7, P = .001]. About 60% of Spanish speakers reported lack of support group access was among their greatest unmet needs, compared with 37% of English speakers (P = .184). This study highlights the need for ongoing access to mental health resources in burn survivors. Our findings emphasize that burn injury is not just an acute ailment, but a complex condition that evolves into a chronic disease. Additional studies should focus on the experiences of Spanish-speaking burn survivors, given small sample size leading to a likely clinically significant but not statistically different lack of access to support groups.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1130-1138"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957642","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":"Riding Toward Danger: A Scoping Review of Burns Associated With Personal Mobility Devices, Including Electric Bikes (E-Bikes) and Electric Scooters (E-Scooters).","authors":"John Warner-Levy, Mohammed Herieka, Zeeshan Sheikh","doi":"10.1093/jbcr/irae115","DOIUrl":"10.1093/jbcr/irae115","url":null,"abstract":"<p><p>Burn injuries related to lithium-ion batteries from personal mobility devices, such as electric bikes and electric scooters, have emerged as a global concern. By examining the literature, this study aims to provide an overview of the demographics, patterns, and outcomes of personal mobility device-associated burns. A Singaporean cohort revealed burns resulting predominantly from fires occurring due to the combustion of unattended personal mobility device batteries during charging. In contrast, an Israeli cohort showed a higher total body surface area and highlighted the vulnerability of limbs to burn injuries in such incidents. A Beijing cohort, consisting of pediatric patients indicated potential child safety concerns regarding personal mobility device usage. Finally, a Shanghai cohort demonstrated the potential dangers of personal mobility device battery chargers. The observed differences between those experiencing burn injuries and the broader population of personal mobility device riders in terms of age and gender suggest that younger males may be at higher risk, perhaps due to risky practices such as leaving personal mobility devices unattended while charging. This review emphasizes the need for safety education, adherence to regulations, and responsible consumer choices to mitigate burn injuries. Recommendations include promoting child safety measures, using certified personal mobility devices, and cautious handling of DIY conversion kits. Further large-scale studies are essential to gain comprehensive insights and develop effective safety strategies to protect personal mobility device riders from burn injuries.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1154-1159"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Postburn Pruritus Treatment and Improvement of Insomnia-A Randomized Trial.","authors":"Elliott Arko-Boham, Albert Bedford Paintsil, Benjamin Arko-Boham, George Obeng Adjei","doi":"10.1093/jbcr/irae083","DOIUrl":"10.1093/jbcr/irae083","url":null,"abstract":"<p><p>Postburn pruritus is difficult to assess and treat. Antihistamines used in its treatment provide little relief. Identification of the itch neuronal pathway has inspired new alternatives, including gabapentin, for its management. The study compared the effectiveness of cetirizine, gabapentin, and a combination of gabapentin and cetirizine in treating postburn pruritus. Burn patients were randomly assigned to treatment with Cetirizine (n = 23), Gabapentin (n = 23), or Cetirizine plus Gabapentin (n = 23). A baseline assessment of the intensity or the severity of pruritus was evaluated, after which treatment commenced with standard doses of the 3 study regimens. Quality of sleep was assessed at baseline (day 0) and repeated on day 3, day 7, and day 14. Approximately 97% of participants presented with moderate or severe itch; 69% with acute itch; and the majority (94.2%) experienced pruritus between the first and fourth weeks. Gabapentin reduced itch by 92.9% in 14 days compared to cetirizine's 61.8%. The combined effect of cetirizine and gabapentin was comparable using gabapentin alone. When the itch became protracted over 6 weeks, the effectiveness of cetirizine in controlling itch worsened. It reduced itch intensity by only 37.7%, whilst gabapentin did so at 89.4%. Itch intensity correlated positively with insomnia, and controlling itch intensity improved sleep. Gabapentin was more effective for the treatment of postburn pruritus than cetirizine. Controlling itch intensity improved sleep. In acute and moderate itch, low-dose gabapentin could be added if cetirizine is the drug intended for its treatment.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"1165-1174"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080533","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}