Journal of Clinical Anesthesia最新文献

{"title":"Response to “The role positioning of AI in clinical decision-making”","authors":"Junyang Ma , Wenhao Bu , Mengjiao Wan , Liqin Deng , Jing Cheng","doi":"10.1016/j.jclinane.2025.111975","DOIUrl":"10.1016/j.jclinane.2025.111975","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111975"},"PeriodicalIF":5.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of short duration smoking cessation on post-operative complications: A systematic review and meta-analysis","authors":"Evan Tang MD ,&nbsp;Ray Martinez Rodriguez BScN BSc ,&nbsp;Ananya Srivastava MD ,&nbsp;Roshan Malhan MD ,&nbsp;Isabelle Laksono MD ,&nbsp;Ellene Yan ,&nbsp;Marina Englesakis MLIS ,&nbsp;Jean Wong MD ,&nbsp;Frances Chung MD","doi":"10.1016/j.jclinane.2025.111967","DOIUrl":"10.1016/j.jclinane.2025.111967","url":null,"abstract":"<div><h3>Background</h3><div>Use of tobacco poses significant health risks, particularly in surgical patients, where smoking is a well-established risk factor for postoperative complications. Patients are often seen in the pre-assessment clinic 2–4 weeks prior to surgery, presenting a window of opportunity to intervene. The objective of our systematic review and meta-analysis is to explore the impact of short-term smoking cessation on postoperative outcomes, focusing on the critical 2–4-week period preceding surgery.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting</h3><div>MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews.</div></div><div><h3>Patients</h3><div>Adults undergoing surgical procedures with a defined smoking cessation pre-operative smoking cessation interval.</div></div><div><h3>Measurement</h3><div>Post-operative complications including pulmonary complications, surgical site infection, wound complication, bleeding, mortality, and composite complications.</div></div><div><h3>Results</h3><div>Fifty-five studies were included in the systematic review and meta-analysis. Pulmonary complications were more prevalent in former smokers compared to non-smokers, even after cessation. Progressively longer smoking cessation periods showed improved outcomes. Compared to active smokers, preoperative cessation reduced pulmonary complications by 27 % at ≥2 weeks (RR 0.73, 95 % CI 0.60–0.89), 29 % at ≥4 weeks (RR 0.71, 95 % CI 0.61–0.82), and 37 % at ≥8 weeks (RR 0.63, 95 % CI 0.41–0.95). With ≥4 weeks of cessation, there was a 33 % lower risk of wound complications (RR 0.67, 95 % CI 0.47–0.94), 31 % lower risk of composite complications (RR 0.69, 95 %CI 0.63–0.76), and 14 % lower risk of mortality (RR 0.86, 95 % CI 0.77–0.97). Short term cessation did not seem to have a significant impact on surgical site infections or bleeding.</div></div><div><h3>Conclusions</h3><div>Short term cessation of at least 2–4 weeks demonstrates benefits in reducing post-operative complications.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111967"},"PeriodicalIF":5.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided external oblique intercostal plane block versus subcostal transversus abdominis plane block for postoperative analgesia in living liver donors: A prospective randomized trial","authors":"Taylan Sahin ,&nbsp;Ali Sait Kavakli ,&nbsp;Eryigit Eren ,&nbsp;Alaaddin Aydin ,&nbsp;Nese Kutluturk Sahin ,&nbsp;Mehmet Tokac ,&nbsp;Ayhan Dinckan","doi":"10.1016/j.jclinane.2025.111971","DOIUrl":"10.1016/j.jclinane.2025.111971","url":null,"abstract":"<div><h3>Introduction</h3><div>Pain relief provided by the transversus abdominis plane (TAP) block in individuals who have undergone living liver donation during the postoperative period has been demonstrated in previous studies. The external oblique intercostal plane (EOI) block is a recently introduced technique designed to provide analgesia for the anterolateral region of the upper abdominal wall.</div><div>This study aims to evaluate and compare the efficacy of the external oblique intercostal plane (EOI) block and the subcostal TAP block in individuals who have undergone living liver donation.</div></div><div><h3>Methods</h3><div>Patients were randomly assigned to one of two groups: EOI block group and subcostal TAP block group. In both groups, bilateral blocks were performed using a total of 40 ml of 0.25 % bupivacaine at the end of surgery and prior to extubation. Postoperatively, all patients were connected to an intravenous patient-controlled analgesia (PCA) device containing morphine. The primary outcome of the study was intravenous morphine consumption during the first 24 h postoperatively.</div></div><div><h3>Results</h3><div>The median [interquartile range] morphine consumption at 24 h postoperatively was similar between EOI block and subcostal TAP block groups (23.5 [19.5 to 27.5] vs 26 [<span><span>[24]</span></span>, <span><span>[25]</span></span>, <span><span>[26]</span></span>, <span><span>[27]</span></span>, <span><span>[28]</span></span>], respectively). There were no significant differences in terms of numerical rating scale (NRS) scores at rest and during movement at 2, 6, 12 and 24 h. No block-related complications were observed in any patients.</div></div><div><h3>Conclusion</h3><div>The results of the study showed that there were no statistically significant differences in 24-h morphine consumption or pain scores at rest and during movement between the subcostal TAP and EOI block groups in living liver donors undergoing right hepatectomy. Either technique may be preferred depending on the clinician's experience and institutional practice.</div><div>Trial registration.</div><div><span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> identifier: <span><span>NCT05890079</span><svg><path></path></svg></span></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111971"},"PeriodicalIF":5.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to “overlooked clinical realities in ChatGPT vs. DeepSeek comparative studies: Barriers to translating dynamic decision support to practice”","authors":"Junyang Ma ,&nbsp;Wenhao Bu ,&nbsp;Mengjiao Wan ,&nbsp;Liqin Deng ,&nbsp;Jing Cheng","doi":"10.1016/j.jclinane.2025.111974","DOIUrl":"10.1016/j.jclinane.2025.111974","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111974"},"PeriodicalIF":5.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of thoracic paravertebral block with liposomal bupivacaine for postoperative analgesia in patients undergoing liver resection: A randomized controlled trial","authors":"Jiangling Wang ,&nbsp;Daoying Zhou ,&nbsp;Sunyuan Xu ,&nbsp;Zewu Ding ,&nbsp;Man Fang ,&nbsp;Ping Chen ,&nbsp;Pingbo Xu","doi":"10.1016/j.jclinane.2025.111968","DOIUrl":"10.1016/j.jclinane.2025.111968","url":null,"abstract":"<div><h3>Background</h3><div>Patients often suffer from moderate to severe acute postoperative pain after liver resection, and the use of liposomal bupivacaine (LB) for pain management is widespread. However, no studies have demonstrated the effect of postoperative analgesia with LB administered via a thoracic paravertebral block (TPVB). The aim of this study was to evaluate the effects of TPVB-administered LB and standard bupivacaine (SB) on opioid sparing and postoperative recovery following liver resection</div></div><div><h3>Methods</h3><div>In this randomized, prospective, single-blind study, 96 patients were randomly (1:1) assigned to two groups. The primary outcome was cumulative opioid consumption over the first 72 h. the secondary outcomes were the time to first opioid use after surgery, plasma bupivacaine concentration, quality of recovery 40 (QoR-40) score area under the curve (AUC) from 24 to 72 h, pain visual analog scale (VAS) score AUC from 6 h to 3 months, postoperative plasma inflammatory factor levels, and sleep quality at 3 months after surgery</div></div><div><h3>Results</h3><div>Ninety-three patients (age (SD), 59.8 (10.5) years; 74 males, 79.6 %) were included in the final analysis. The cumulative opioid consumption was lower in the LB group 63.0 (IQR: 10.5, 90.0) than in the SB group of patients receiving the (72.0 (IQR: 27.0, 135.0) mg oral morphine equivalent (<em>p</em> = 0.041). Compared to those in the SB group, the time to first opioid use was longer, and the plasma bupivacaine and TNF-α levels were greater postoperatively in the LB group. There was no difference in other outcomes between the two groups, and there were no adverse events in this study</div></div><div><h3>Conclusion</h3><div>TPVB-administered LB reduced total opioid consumption postoperatively in patients undergoing hepatectomy in the first 72 h.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111968"},"PeriodicalIF":5.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel comprehensive model of indicators reflecting the relative spatial position of the anterior cervical structures for predicting difficult laryngoscopy in patients with cervical spondylosis","authors":"Tianhao Zhang ,&nbsp;Yujie Wang ,&nbsp;Binlong Li,&nbsp;Rui Zhang,&nbsp;Wenxuan Liu,&nbsp;Bin Wei,&nbsp;Mao Xu","doi":"10.1016/j.jclinane.2025.111966","DOIUrl":"10.1016/j.jclinane.2025.111966","url":null,"abstract":"<div><h3>Background</h3><div>Accurate assessment of difficult airway (DA) is critical, as failure to identify DA may lead to life-threatening complications. This study aimed to develop a multiparameter predictive model for DA using a novel ultrasound reference line (XU-line).</div></div><div><h3>Methods</h3><div>In this prospective, observational, single-blinded study, patients scheduled for elective cervical spondylosis surgery at Peking University Third Hospital underwent preoperative airway evaluation via physical indices and ultrasonography. Distances from the XU-line to six anatomical landmarks (hyoid bone, cricoid cartilage, epiglottis, vocal cords, thyroid isthmus, and suprasternal notch) were measured both in supine and sniffing positions. Participants were stratified into “easy laryngoscopy” and “difficult laryngoscopy” groups based on Cormack–Lehane (C-L) grades. Multivariate logistic regression identified independent predictors of difficult laryngoscopy.</div></div><div><h3>Results</h3><div>There were significant differences in the thirteen clinical factors between the two groups. Sex, modified Mallampati test, skin-to-epiglottis distance (neutral position), XU-line-to-vocal-cords distance (sniffing position), and spatial distances from XU-line to cricoid cartilage were found to be independent risk factors for difficult laryngoscopy. A combined model incorporating these five factors demonstrated superior predictive performance (sensitivity: 82.0 %; specificity: 61 %) compared to individual clinical predictors or traditional clinical models.</div></div><div><h3>Conclusion</h3><div>The spatial relationship between cervical airway structures and the XU-line may serve as a novel predictive index in a comprehensive DA assessment model.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111966"},"PeriodicalIF":5.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging current evidence: Peripheral perfusion index fails as a predictor of postinduction hypotension – Findings from a large diverse surgical population","authors":"Karam Azem M.D ,&nbsp;Roussana Aranbitski M.D ,&nbsp;Alexander Peres M.D ,&nbsp;Daniel Iluz-Freundlich M.D., B.Sc ,&nbsp;Vincent Gliesche M.D ,&nbsp;Olga Ciobanu-Caraus M.D ,&nbsp;Sharon Orbach-Zinger M.D ,&nbsp;Benjamin Zribi M.D ,&nbsp;Shai Fein M.D ,&nbsp;Philip Heesen B.Sc","doi":"10.1016/j.jclinane.2025.111969","DOIUrl":"10.1016/j.jclinane.2025.111969","url":null,"abstract":"<div><h3>Background</h3><div>Postinduction hypotension (PIH) is a common complication of general anesthesia with potential clinical consequences. A recent meta-analysis suggested that the peripheral perfusion index (PPI) has a high predictive value for PIH. However, this was limited by small sample sizes and significant heterogeneity. We aimed to evaluate the predictive performance of preinduction PPI for PIH in a large surgical cohort.</div></div><div><h3>Methods</h3><div>In this retrospective single-center study, we analyzed 6653 adult patients who had general anesthesia between May 2022 and May 2023. PIH was defined as mean arterial pressure &lt; 65 mmHg within 20 min after induction. We assessed the predictive performance of preinduction PPI for estimating PIH using the area under the receiver operating characteristic curve (AUC). A multivariable logistic regression was conducted to identify independent predictors of PIH.</div></div><div><h3>Results</h3><div>The overall incidence of PIH was 51.5 %. Preinduction PPI values were similar between patients who developed PIH and those who did not (1.22 [0.69–2.23] vs. 1.23 [0.75–2.13], <em>P</em> = 0.284). PPI demonstrated poor predictive performance for PIH (AUC 0.51, 95 % CI 0.49–0.52), with low sensitivity (31 %) and modest specificity (72 %) at the optimal cutoff (0.81). This poor discrimination persisted across all postinduction time intervals and patient subgroups. In contrast, independent predictors of PIH included preinduction mean arterial pressure, advanced age, higher ASA physical status, and emergency surgery.</div></div><div><h3>Conclusion</h3><div>Despite promising results from smaller studies, we found that preinduction PPI had no significant predictive value for PIH in a large, diverse surgical population. Anesthesiologists should focus on established risk factors rather than PPI when assessing PIH risk.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111969"},"PeriodicalIF":5.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A simple and effective technique for managing misplacement of left-sided visual double-lumen bronchial tube: Cervical tracheal traction method","authors":"Bing Li M.D.,&nbsp;Xinmin Liu M.D.,&nbsp;Jiaqiang Zhang M.D., Ph.D.,&nbsp;Wei Zhang M.D., Ph.D.","doi":"10.1016/j.jclinane.2025.111970","DOIUrl":"10.1016/j.jclinane.2025.111970","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111970"},"PeriodicalIF":5.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"The usefulness of the modified steep ramp test as a practical exercise test for preoperative risk assessment in patients scheduled for pancreatic surgery\".","authors":"Longsheng Zhang, Zitian Luo, Renzhe Lin","doi":"10.1016/j.jclinane.2025.111964","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.111964","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111964"},"PeriodicalIF":5.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of postoperative delirium by family and caregivers: Evaluation of the family confusion assessment method (FAM-CAM)","authors":"Angela M. Mickle MS ,&nbsp;Bethany R. Tellor Pennington ,&nbsp;Arbi Ben Abdallah PhD ,&nbsp;Wei Wang PhD ,&nbsp;Nan Lin PhD ,&nbsp;Jordan Oberhaus BS ,&nbsp;Thaddeus P. Budelier MD ,&nbsp;Daniel Park BS ,&nbsp;Ben J. Palanca MD, PhD ,&nbsp;Troy S. Wildes MD ,&nbsp;Eva M. Schmitt PhD ,&nbsp;Sharon K. Inouye MD, MPH ,&nbsp;Michael S. Avidan MBBCh","doi":"10.1016/j.jclinane.2025.111963","DOIUrl":"10.1016/j.jclinane.2025.111963","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;The primary objective was to evaluate agreement between researchers' and family members' postoperative delirium assessment. The secondary objective was to assess the incidence of positive FAM-CAM after hospital discharge up to 30-days postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This was a pre-specified sub-study of two multicenter randomized controlled trials that evaluated interventions to prevent postoperative delirium in older adults undergoing major elective surgery. In the hospital, delirium was ascertained using the Confusion Assessment Method (CAM) long-form or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), and structured chart review. Family members completed a Family Confusion Assessment Method (FAM-CAM) concurrent with researchers' assessments in the afternoons on postoperative days 1–3. At the time of hospital discharge, a booklet of FAM-CAM surveys was provided to complete daily until postoperative day 30. Agreement between researcher-rated CAM/CAM-ICU and family-rated FAM-CAM was analyzed using Generalized Linear Mixed Model with repeated measures, and Bland-Altman analysis. Inter-rater reliability for each instrument was modeled using intraclass correlation coefficient (ICC). Overall agreement beyond chance between researcher's assessment and the FAM-CAM was evaluated using repeated measure Cohen's Kappa and sensitivity, specificity, and positive and negative predicted values. Post-discharge FAM-CAM data were summarized descriptively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 817 patients had 1349 concurrent delirium assessments. Postoperative delirium incidence by researchers' assessment was 18.8 % and detection of delirium symptoms by FAM-CAM was 22.4 %. Analysis comparing delirium assessments showed there is an observed agreement beyond chance of 79.7 % with a kappa of 0.33 between the assessments by Generalized Linear Mixed Modeling with repeated measures, treating patients and raters as random effects, with FAM-CAM being more likely to report a positive delirium outcome. Assessment by features showed similar results. Both methods had an excellent degree of internal validity (CAM/CAM-ICU intraclass correlation =0.938, FAM-CAM intraclass correlation = 0.985). Repeated measures Cohen's kappa indicated good overall agreement (kappa = 0.72 [95 % confidence interval, 0.63 to 0.81]). Of the 330 booklets, 133 (40.3 %) were returned. A total of 18 patients exhibited symptoms indicative of delirium based on the FAM-CAM assessment between hospital discharge and 30 days postoperatively. Out of these, 9 (50 %) had also been diagnosed with postoperative delirium during their hospitalization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This study demonstrated that family member completed FAM-CAM had acceptable agreement with researchers' delirium assessments. Postoperative delirium symptoms were detected more frequently by family-administered FAM-CAM compared to delirium incidenc","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111963"},"PeriodicalIF":5.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}