Journal of electrocardiology最新文献

{"title":"Nonparoxysmal junctional tachycardia associated with 3:2 Wenckebach exit block in the absence of digitalis therapy","authors":"S. Serge Barold ,&nbsp;Patrick Hermans ,&nbsp;Andreas Kucher ,&nbsp;Rik Willems","doi":"10.1016/j.jelectrocard.2024.153780","DOIUrl":"10.1016/j.jelectrocard.2024.153780","url":null,"abstract":"<div><div>Nonparoxysmal junctional tachycardia with Wenckebach exit block is known to be associated with digitalis toxicity. This report documents the occurrence of this arrhythmia in the absence of digitalis therapy in a patient with structural heart disease.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554642","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":"The ECG of a 6-year-old girl","authors":"Leonid Makarov MD, PhD,&nbsp;Anush Akopyan MD,&nbsp;Vera Komoliatova MD, PhD","doi":"10.1016/j.jelectrocard.2024.153819","DOIUrl":"10.1016/j.jelectrocard.2024.153819","url":null,"abstract":"<div><div>A 12-channel ECG and the ECG patterb from Holter monitoring of a 6-year-girl are presented.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568469","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":"Use of ST/HR hysteresis decreases false positive rate in exercise electrocardiography test of middle-aged asymptomatic women","authors":"Miro Enroth ,&nbsp;Harri Sievanen ,&nbsp;Tuikku Tuula-Maria Agnes Asikainen ,&nbsp;Jari Viik","doi":"10.1016/j.jelectrocard.2024.153820","DOIUrl":"10.1016/j.jelectrocard.2024.153820","url":null,"abstract":"<div><h3>Background</h3><div>Exercise electrocardiography (ECG) is a common diagnostic and prognostic method for the detection of coronary artery disease (CAD). However, its accuracy in asymptomatic women has not been comprehensively investigated and the diagnostic criteria may require refinements. This study evaluated the performance of ECG-derived ST/HR-index, ST/HR hysteresis and ST-segment depression parameters among asymptomatic middle-aged women.</div></div><div><h3>Methods</h3><div>108 women (mean age 56 ± 4 years) performed exercise ECG test on treadmill until exhaustion three times within a nine-month period. False-positive rates of maximum ST/HR-index, ST/HR hysteresis, and ST-segment depression values measured from 12 leads at peak exercise and after one-minute recovery were evaluated with recommended diagnostic partition values. Repeatability was assessed with intraclass correlation (ICC) and Bland-Altman plot analysis.</div></div><div><h3>Results</h3><div>False-positive rate was lower for all variables when a two‑lead configuration was used instead of a single‑lead configuration. Using a two‑lead configuration, ST/HR hysteresis (0–1.9 %) and ST-segment depression after one-minute recovery (0–2.8 %) had lower false-positive rates compared to ST/HR index (3.7–20.4 %) and ST-segment depression at peak exercise (9.3–27.8 %). ICC values indicated moderate repeatability for ST/HR hysteresis while ST/HR index, ST-segment at peak exercise, and ST-segment after one-minute recovery had moderate-to-good repeatability. Bland-Altman analysis indicated poor repeatability for all evaluated ECG variables.</div></div><div><h3>Conclusion</h3><div>In asymptomatic middle-aged women, practitioners should prefer the use of ST/HR hysteresis and ST-segment after one-minute recovery over the conventional ST-segment depression at peak exercise or ST/HR index, and evaluate the ECG data from a two‑lead configuration instead of single‑lead.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590628","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":"Study on the feasibility of distinguishing ventricular and pre-excited arrhythmia rhythms by a new algorithm","authors":"Honglin Ni ,&nbsp;Qingcheng Wang ,&nbsp;Zhiyong Wang ,&nbsp;Wenbo Xu ,&nbsp;Xiaowei Pan ,&nbsp;Jianfang Zhu ,&nbsp;Zhe Liu ,&nbsp;Weixun Cai","doi":"10.1016/j.jelectrocard.2024.153817","DOIUrl":"10.1016/j.jelectrocard.2024.153817","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The differentiation and diagnosis of ventricular tachycardia (VT) and pre-excited tachycardia (PXT) remains a challenging task, especially when typical AV dissociation is not present. The purpose of this article is to study the feasibility of a new theoretical algorithm for identifying ventricular arrhythmias (VA) and pre-excited arrhythmias (PA) rhythms (which can be used to distinguish VT from PXT, etc.).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;This study involved the deduction of a new algorithm by combining knowledge of cardiac anatomy, vectorcardiography, and cardiac electrophysiology. The new algorithm evaluated the diagnostic value through intracardiac electrophysiology in 205 cases of VA and PA. The new algorithm diagnoses VA based on the following 4-step process:&lt;ul&gt;&lt;li&gt;&lt;span&gt;1.&lt;/span&gt;&lt;span&gt;&lt;div&gt;The QRS complex in leads II, III, and aVF shows a unidirectional R wave, and lead aVR shows a QS pattern.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;2.&lt;/span&gt;&lt;span&gt;&lt;div&gt;S waves are predominant in two or more of leads I, aVF, and V6.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;3.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Lead V2 shows ≥3 phase waves or returning branch notching (note: returning branch refers to the band of QRS complexes returning to the baseline).&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;4.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Lead V5 shows a negative wave in the initial portion or returning branch notching.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;/div&gt;&lt;div&gt;If none of these criteria are met, the diagnosis is PA. The diagnostic value of the new algorithm is compared with the Steurer algorithm and the Vereckei algorithm (diagnosed based on the QRS waveform characteristics of the two algorithms during electrophysiological verification, excluding the diagnosis of atrioventricular dissociation).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The new algorithm showed significant advantages in terms of AUC value (0.83 vs. 0.61 vs. 0.57), sensitivity (83.6 % vs. 23.3 % vs. 24.8 %), and accuracy (82.9 % vs. 48.3 % vs. 46.3 %) compared to the Steurer algorithm and Vereckei algorithm based on QRS waveform characteristics for diagnosing VA (137 cases) and PA (68 cases). This indicates that the new algorithm is more accurate in identifying idiopathic VA. While there was a significant difference in specificity between the New algorithm and Steurer algorithm (82.3 % vs. 98.5 %, &lt;em&gt;p&lt;/em&gt; &lt; 0.05), the difference with Vereckei algorithm (82.3 % vs. 89.7 %) was not significant.&lt;/div&gt;&lt;div&gt;In the New algorithm, the sensitivity and specificity for each step are as follows:&lt;ul&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;div&gt;Step 1: Sensitivity 34.3 %, Specificity 94.1 %.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;div&gt;Step 2: Sensitivity 24.1 %, Specificity 98.5 %.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;div&gt;Step 3: Sensitivity 18.3 %, Specificity 100 %.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;div&gt;Step 4: Sensitivity 6.6 %, Specificity 89.7 %.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;/div&gt;&lt;div&gt;Step 1 had the highest AUC value, indicating the best overall diagnostic performan","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561047","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":"Detailed association between adolescent obesity and ventricular repolarization.","authors":"Naoya Kataoka, Teruhiko Imamura","doi":"10.1016/j.jelectrocard.2024.153816","DOIUrl":"https://doi.org/10.1016/j.jelectrocard.2024.153816","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467183","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":"Variability of the PR intervals in Wenckebach atrioventricular block","authors":"S. Serge Barold MD ,&nbsp;Harry G. Mond MD","doi":"10.1016/j.jelectrocard.2024.153815","DOIUrl":"10.1016/j.jelectrocard.2024.153815","url":null,"abstract":"<div><div>The duration of the PR intervals in atypical Wenckebach atrioventricular block before and after a non-conducted P wave can exhibit a wide range of values and patterns. Understanding the different or at times puzzling manifestations of Wenckebach atrioventricular block in terms of its PR intervals can avoid diagnostic errors, especially the erroneous more serious diagnosis of Mobitz type II atrioventricular block.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501626","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":"Electrocardiographic correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries","authors":"Mitchell Pleasure BA ,&nbsp;Vita N. Jaspan MD ,&nbsp;Olivia Liu BA ,&nbsp;Emilie Lin ,&nbsp;Raymond Y. Kwong MD MPH ,&nbsp;Julia Huang BS ,&nbsp;Anais Hausvater MD ,&nbsp;Tara Sedlak MD ,&nbsp;Hayder Hashim MD ,&nbsp;Caitlin Giesler MD ,&nbsp;Kevin R. Bainey MD ,&nbsp;Aun-Yeong Chong MD ,&nbsp;Bobak Heydari MD MPH ,&nbsp;Mobeen Ahmed MD ,&nbsp;Nathaniel R. Smilowitz MD MS ,&nbsp;Harmony R. Reynolds MD","doi":"10.1016/j.jelectrocard.2024.153813","DOIUrl":"10.1016/j.jelectrocard.2024.153813","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 6–15 % of MI patients. Cardiac magnetic resonance (CMR) imaging identifies MINOCA etiologies, but access may be limited.</div></div><div><h3>Methods</h3><div>We assessed associations between the index electrocardiogram (ECG) and CMR in MINOCA. Women with MI and &lt; 50 % angiographic stenosis in all vessels were prospectively enrolled at 16 sites. CMR (median 6d from MI) was analyzed for late gadolinium enhancement (LGE), myocardial edema, and wall motion. We assessed ECGs for T-wave inversions (TWI), Q-waves (QW), ST-elevations (STE), ST-depressions (STD), and fragmented QRS complexes (fQRS). We calculated the DETERMINE score (# leads TWI + # fQRS +2*[# QW], excluding aVR, V1).</div></div><div><h3>Results</h3><div>Among 112 women with interpretable ECG, 81.3 % (91/112) had abnormal ECG; 50 % (56/112) had ≥1 TWI. CMR was abnormal in 74.1 % (83/112), with LGE in 49.1 % (55/112) and myocardial edema in 61.6 % (69/112). DETERMINE score ≥ 3 was associated with abnormal CMR (adjusted odds ratio [aOR] aOR 6.06 [1.89, 24.6], <em>p</em> = 0.002) and LGE (aOR 3.10 [1.26, 8.00], <em>p</em> = 0.013), but not edema (aOR 1.86 [0.80, 4.43], <em>p</em> = 0.152). TWI was also associated with abnormal CMR and LGE after adjustment (aOR 3.13 [1.08, 10.1], <em>p</em> = 0.036, aOR 3.23 [1.27, 8.63], p = 0.013, respectively), but not edema (aOR 1.26 [0.54, 2.96], <em>p</em> = 0.589). Specificity for abnormal CMR was 0.83 for DETERMINE score ≥ 3 and 0.75 for TWI. No other ECG findings were associated with CMR abnormality.</div></div><div><h3>Conclusion</h3><div>DETERMINE score ≥ 3 and the presence of any TWI were associated with abnormal CMR and with LGE in MINOCA. Our findings demonstrate that the index ECG can provide insight on CMR findings but without sensitivity or specificity required to forgo the CMR. We reaffirm the central role of CMR in elucidating MINOCA pathophysiology.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501624","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":"Premature ventricular contraction patterns associated with nonsustained ventricular tachycardia","authors":"Juan F. Rodriguez-Riascos MD,&nbsp;Whilman G. Rodriguez MD,&nbsp;Carlos A. Porras-Meza MD","doi":"10.1016/j.jelectrocard.2024.153812","DOIUrl":"10.1016/j.jelectrocard.2024.153812","url":null,"abstract":"<div><h3>Background</h3><div>Occurrence of nonsustained ventricular tachycardia (NSVT) is associated with negative outcomes. It is not clear whether specific electrocardiographic characteristics of premature ventricular contractions (PVCs) are associated with the occurrence of NSVT. The aim of this study was to identify electrocardiographic patterns associated with the presence of NSVT during 24-h electrocardiographic monitoring in patients with &gt;10 PVCs per hour.</div></div><div><h3>Methods</h3><div>This was a retrospective, observational, cross-sectional study. We reviewed consecutive patients who received 24-h ECG monitoring performed at a single outpatient cardiology center. Patients who received 24-h electrocardiographic monitoring, with a PVC burden ≥10 PVCs/h were included. Occurrence of NSVT during 24-h electrocardiographic monitoring was the main outcome.</div></div><div><h3>Results</h3><div>A total of 343 patients were analyzed (mean [SD] age, 69.7 [12.5] years; 177 men [51.6 %]). NSVT occurred in 72 patients who were compared with 271 patients without NSVT. The novel term “premature beat ratio”, which aims to correlate the coupling interval and compensatory pause, was introduced; a value &gt;0.5 was independently associated with NSVT according to the multivariate model (OR = 3.73, 95 % CI = 1.57–8.82; <em>P</em> = 0.002). PVC burden (OR = 1.09, 95 % CI = 1.02–1.17; <em>P</em> = 0.006), and triplets (OR = 18.19, 95 % CI = 7.32–45.18 P = 0.0) were also associated with NSVT in the multivariate model.</div></div><div><h3>Conclusion</h3><div>These findings suggest that patients with a high PVC burden, triplets, and a premature beat ratio greater than 0.5 have an increased probability of presenting with NSVT and may benefit from more rigorous follow-up.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400456","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":"A change in QT interval and ST-segment after radiofrequency catheter ablation in pediatric patients with Wolff–Parkinson–White syndrome","authors":"Shuhei Fujita M.D., Ph.D ,&nbsp;Eriko Kabata M.D ,&nbsp;Shinichiro Mizutomi M.D ,&nbsp;Kazuo Usuda M.D., Ph.D ,&nbsp;Akio Chikata M.D., Ph.D ,&nbsp;Takeshi Futatani M.D., Ph.D ,&nbsp;Kiyoshi Hatasaki M.D., Ph.D","doi":"10.1016/j.jelectrocard.2024.153814","DOIUrl":"10.1016/j.jelectrocard.2024.153814","url":null,"abstract":"<div><h3>Background</h3><div>Few studies have examined QT, JT interval, and ST-segment changes due to radiofrequency catheter ablation (RFA) in manifest Wolff–Parkinson–White (WPW) syndrome in pediatric patients.</div></div><div><h3>Methods</h3><div>The study involved 27 patients (male-to-female, 13:14; age, 12 (5–16) years) who were diagnosed with WPW syndrome and underwent RFA in our hospital between 2009 and 2022. Electrocardiographic (ECG) changes were compared between the group with ventricular preexcitation due to an accessory pathway (manifest group, <em>n</em> = 16) and those without it (concealed group, <em>n</em> = 11).</div></div><div><h3>Results</h3><div>The QT interval before RFA was significantly longer in the manifest group than in the concealed group (402 [362–482] vs. 344 [323–427]; <em>p</em> = 0.001). The QT interval was significantly shortened in the manifest group before and after RFA (402 [362–482] vs. 360 [298–422] msec; <em>p</em> = 0.01). At 1 month, the QT interval difference between the manifest and concealed groups disappeared (366 [305–437] vs. 335 [301–436] msec; <em>p</em> = 0.001). ST-segment changes were found after RFA in 56 % (9/16) of the patients in the manifest group but not in the concealed group. ECG changes presenting the Brugada-pattern was found in one patient. One month later, ECG abnormalities persisted in only one patient.</div></div><div><h3>Conclusions</h3><div>In pediatric patients, the QT interval was prolonged in manifest WPW syndrome but shortened after RFA. In the manifest group, transient ST-segment change and T-wave abnormalities were often observed after RFA; however, the ECG normalized in approximately 1 month.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400455","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":"What is Chapman's sign?","authors":"S. Serge Barold","doi":"10.1016/j.jelectrocard.2024.153811","DOIUrl":"10.1016/j.jelectrocard.2024.153811","url":null,"abstract":"<div><div>Chapman's (electrographic) sign is of a notch on the ascending limb of the R wave in leads I, aVL and V6. It has been used in the diagnosis of myocardial infarction (MI) during left bundle branch block (LBBB) and cardiac pacing. A number of studies have yielded divergent results about its diagnostic usefulness. However, the sign can be helpful in the diagnosis of MI during LBBB or pacing in the absence of other manifestations of MI.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521970","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}