Journal of Emergency Medicine最新文献

{"title":"COMMENT ON: PEDIATRIC POISONINGS ASSOCIATED WITH INGESTION OF MARIJUANA PRODUCTS","authors":"Fizaa Rasool , Muhammad Ali Nouman , Satesh Kumar","doi":"10.1016/j.jemermed.2024.08.004","DOIUrl":"10.1016/j.jemermed.2024.08.004","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 109-110"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006710","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":"Empathy Unmasked: Patient Perception of Physician Empathy in an Oncologic Emergency Setting. A Randomized Controlled Trial Comparing Personal Protective Equipment Wear versus Unmasked Video Communication","authors":"Kathryn J. Burk MD ,&nbsp;John J. Stroh MD ,&nbsp;Kelly Larkin MD ,&nbsp;Patrick Chaftari MD ,&nbsp;Denise M. Langabeer PhD ,&nbsp;Jazmin R. Menendez BS ,&nbsp;Jeanie F. Woodruff BS ,&nbsp;Jan Hargrave EdS ,&nbsp;Hongxu Zhu MS ,&nbsp;James P. Long PhD ,&nbsp;Sai-Ching J. Yeung MD, PhD ,&nbsp;Kumar Alagappan MD ,&nbsp;Aiham Qdaisat MD, MS","doi":"10.1016/j.jemermed.2024.08.005","DOIUrl":"10.1016/j.jemermed.2024.08.005","url":null,"abstract":"<div><h3>Background</h3><div>Amidst the COVID-19 pandemic, telemedicine emerged as an important option that supports and facilitates clinical practice, however, its usefulness in emergency settings that treat patients with cancer is unclear.</div></div><div><h3>Objective</h3><div>To evaluate patient perception of physician empathy in an emergency oncology setting, comparing video interaction to an in-person with personal protective equipment (PPE) approach.</div></div><div><h3>Methods</h3><div>In this single-center, prospective, cross-sectional, survey-based randomized controlled trial, patients were randomized 1:1 for the concluding conversation done in-person which included either interacting with physicians wearing PPE or video interaction with physicians without PPE (virtual). Patients’ perceptions of the physicians’ relational empathy were assessed and compared for each group by using the Consultation and Relational Empathy (CARE) Measure and the Perception of Physician Compassion measure.</div></div><div><h3>Results</h3><div>Patients (n = 106) in both the PPE and virtual arms provided favorable responses to all questions. The mean overall CARE scores for the PPE and virtual arms were 45.02 and 44.43, respectively (difference, 0.58 [95% CI: -2.10, 3.30]). Regarding the linear physician compassion scores, patients in the virtual arm appeared to consider physicians to be warmer (difference, -0.42 [95% CI: -0.87, 0.04]) but less pleasant (difference, 0.33 [95% CI: -0.40, 1.10]) than did patients in the PPE arm.</div></div><div><h3>Conclusions</h3><div>Cancer patients presenting to the emergency department perceive empathy and compassion equally when approached by physicians virtually without PPE or in person while wearing PPE. Virtual services for specific aspects of clinical practice during emergency department visits in an oncology setting can be implemented to ensure safer interactions between patients and physicians without compromising the physician-patient relationship.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 43-53"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971175","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":"Gastric Ultrasound in the Management of Emergency Department Patients with Upper Gastrointestinal Bleeding: A Case Series and Sonographic Technique","authors":"Robert James Adrian MD ,&nbsp;Peter Alsharif MD ,&nbsp;Hamid Shokoohi MD, MPH ,&nbsp;Stephen Alerhand MD","doi":"10.1016/j.jemermed.2024.07.015","DOIUrl":"10.1016/j.jemermed.2024.07.015","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality.</div></div><div><h3>Objectives</h3><div>Very early risk stratification of GIB patients can sometimes be a challenge. The decision to intubate these patients is multifactorial and requires careful consideration.</div></div><div><h3>Discussion</h3><div>Gastric ultrasound (GUS) is an adjunct tool that may help make such decisions and is supported by anesthesiology society guidelines to assess aspiration risk.</div></div><div><h3>Conclusion</h3><div>In this manuscript, we present a case series of ED patients with upper GIB in whom emergency physicians (2 fellowship-trained attendings and 2 senior residents facile with point-of-care ultrasound) performed GUS. As a supplement to the clinical examination, this <em>sonographic \"lavage\"</em> (i.e., using GUS in patients with upper GIB) helped predict aspiration risk, support diagnostic reasoning, and expedite early goal-directed management and appropriate disposition. We also provide a step-by-step tutorial using high-quality media, as well as a novel algorithm for translation of this technique to the bedside for emergency physicians.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 66-72"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983705","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":"End-Tidal Oxygen as an Effective Noninvasive Measure of Preoxygenation during Rapid Sequence Intubation in the Emergency Department","authors":"Eric Boccio MD, MPH ,&nbsp;Justin Belsky MD, MPH ,&nbsp;Sandra Lopez MD ,&nbsp;Brian Kohen MD ,&nbsp;James Bonz MD","doi":"10.1016/j.jemermed.2024.07.006","DOIUrl":"10.1016/j.jemermed.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Preoxygenation is intended to extend the duration of apnea until desaturation occurs. End-tidal oxygen (ETO₂) is the standard for measuring preoxygenation, however, peripheral capillary oxygen saturation (SpO₂) is used more commonly within the emergency department.</div></div><div><h3>Objective</h3><div>The primary aim was to determine whether patients were optimally preoxygenated as measured by ETO₂ vs. SpO₂ during rapid sequence intubation. Secondary aims investigated changes in these measurements before and after intubation and whether patient characteristics influenced the likelihood of preoxygenation success as measured by each of the modalities.</div></div><div><h3>Methods</h3><div>A multicenter, prospective observational study of a convenience sample of patients undergoing rapid sequence intubation was performed. ETO₂ and SpO₂ were recorded at the cessation of preoxygenation (T₁) and intubation completion (T₂). Optimal preoxygenation was defined by an observed ETO₂ level ≥ 90% and SpO₂ level equal to 100% at T₁.</div></div><div><h3>Results</h3><div>Thirty patients were intubated and included in the analysis. Median ETO₂ and SpO₂ at T₁ were 90.5% (interquartile range 86–93%) and 100% (interquartile range 97–100%), respectively. Preoxygenation success rates as measured by ETO₂ and SpO₂ were 56.7% and 53.3%, respectively (<em>p</em> = 0.431). The mean (SD) decrease in ETO₂ during the intubation attempt was larger and more variable than that for SpO₂ (25.8% [22.5%] vs. 2.1% [3.3%]; <em>p</em> &lt; 0.001). Patient age, sex, and body mass index were not associated with likelihood of preoxygenation success for either modality.</div></div><div><h3>Conclusions</h3><div>Preoxygenation success was similar when measured by strict ETO₂ and SpO₂ criteria. ETO₂ is more sensitive to periods of apnea than SpO₂ and may serve as an early indicator of an imminent desaturation event.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 34-42"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785969","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":"Intermittent High-Degree AV Block, Rash, and Facial Droop with Negative Lyme PCR","authors":"Amber N. Brooks DO","doi":"10.1016/j.jemermed.2024.08.006","DOIUrl":"10.1016/j.jemermed.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Lyme disease is the most common tick-borne illness in the United States, and cases of Lyme disease have nearly doubled since the early 2000s. Symptoms and presentation vary based on severity of illness, with more serious complications of disease consisting of neurologic and cardiac dysfunction. Testing is often unreliable, which can lead to delayed diagnosis and management.</div></div><div><h3>Case Report</h3><div>A 38-year-old woman presented to the Emergency Department with left-sided facial droop and was subsequently diagnosed with Lyme carditis. This case depicts a classic but unique triad of symptoms caused by Lyme disease: high-degree atrioventricular (AV) blockade, Bell's palsy, and erythema migrans. The patient was promptly treated with empiric i.v. antibiotics pending serology testing for Lyme disease, and her high-degree AV block improved. Initial polymerase chain reaction testing for this patient was negative, but diagnosis was later confirmed with a positive two-tiered test. Intravenous ceftriaxone therapy improved this patient's heart block, allowing for discharge on oral antibiotics.</div><div>Why Should an Emergency Physician Be Aware of This? It is important to recognize potential cases of Lyme disease early so that appropriate treatment can be initiated. Lyme disease is difficult to diagnose given the wide variety of symptoms and clinical presentations coupled with routine testing that has relatively low sensitivity. Lyme cases have been increasing over the last several years, even in areas in which Lyme disease is not generally endemic. Testing limitations make obtaining a definitive diagnosis difficult, which the emergency physician should be aware of.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 84-88"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971176","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":"Ultrasound-guided thoracic nerve blocks for emergency department patients with rib fractures: A review","authors":"Bushra Hussein MD ,&nbsp;Daniel Mercader MD ,&nbsp;Rebecca G. Theophanous MD MHSc","doi":"10.1016/j.jemermed.2024.07.016","DOIUrl":"10.1016/j.jemermed.2024.07.016","url":null,"abstract":"<div><h3>Background</h3><div>Rib fractures are frequently diagnosed and treated in the emergency department (ED). Thoracic trauma has serious morbidity and mortality, particularly in older adults, with complications including pulmonary contusions, hemorrhage, pneumonia, or death. Bedside ED-performed ultrasound-guided anesthesia is gaining in popularity, and early and adequate pain control has shown improved patient outcomes with rare complications.</div></div><div><h3>Objective of the Review</h3><div>We describe thoracic nerve block options that can be used clinically for rib fractures or other thoracic pain or trauma. We identify the pros and cons of each type of block, describe their risk profile and advantages, and summarize the steps on how each is performed.</div></div><div><h3>Discussion</h3><div>Thoracic epidural and paravertebral blocks are more invasive, targeting the nerves closer to the spinal cord, thus they are primarily used in the operating room or by anesthesiology for surgical cases. However, newer blocks are gaining in popularity, particularly the erector spinae block (ESP), serratus anterior plane nerve block (SANB), and intercostal nerve block (ICNB). These blocks provide adequate anesthesia and can be performed in an ED setting.</div></div><div><h3>Conclusions</h3><div>Thoracic nerve blocks (e.g., ESP, SANB, ICNB) can be performed safely by appropriately trained emergency physicians, provide excellent anesthesia for rib fractures and thoracic trauma, and should be strongly considered for improved patient-centered outcomes. Furthermore, performing regional nerve blocks in the emergency department can reduce complications including adverse effects from opioids or other delirium-inducing medications.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 1-14"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983725","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":"Cardiopulmonary Ultrasound to Predict Care Escalation in Early Sepsis: A Pilot Study","authors":"Hani I. Kuttab MD ,&nbsp;Sara C. Damewood MD ,&nbsp;Jessica Schmidt MD, MPH ,&nbsp;Amber Lin MS ,&nbsp;Kevin Emmerich MD ,&nbsp;Nikolai Schnittke MD, PhD","doi":"10.1016/j.jemermed.2024.07.009","DOIUrl":"10.1016/j.jemermed.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>It is challenging to identify emergency department (ED) patients with sepsis who will require resources such as positive-pressure ventilation, vasopressors, or intensive care unit (ICU) admission.</div></div><div><h3>Objectives</h3><div>Describe the correlation of cardiopulmonary ultrasound (CPUS) with need for care escalation.</div></div><div><h3>Methods</h3><div>Single center, prospective, observational study of adult patients with suspected sepsis. CPUS assessed left ventricular systolic function (LVF), right ventricular (RV) size and function, inferior vena cava (IVC) collapsibility, and thoracic B lines. The primary composite outcome was need for care escalation within 12 hours of ED presentation defined as: ICU admission or positive-pressure ventilation or vasopressor infusion.</div></div><div><h3>Results</h3><div>A total of 92 patients were enrolled; 18 (19.6%) required care escalation. A logistic regression model identified the presence of ≥4 thoracic B-lines as a statistically significant predictor of care escalation (OR 7.8, 95% CI [1.3–26.4], <em>p =</em> 0.002). Other features positively correlated with care escalation were: reduced LVF (OR 4.26, 95% CI [0.06–12.9], <em>p =</em> 0.14), and dilated RV size (OR 2.8, 95% CI [0.4–11.8], <em>p =</em> 0.16). A retrospective stepwise regression model incorporating these three variables to predict care escalation showed an AUROC = 0.75 (95% CI [0.63–0.88]). When 2 or more variables were abnormal the model showed excellent specificity of 95% (LR+ 6.2), but low sensitivity of 33% (LR- 0.7).</div></div><div><h3>Conclusions</h3><div>In patients with concern for sepsis early findings of ≥4 B-lines is associated with care escalation. Combining this finding with LVF and RV size assessment improves the positive predictive power and may be useful in rapid identification of patients likely to require care escalation.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 54-65"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785967","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":"Respecting autonomy and capacity in patients with opioid use disorder","authors":"Michael E. Mullins MD ,&nbsp;Melissa R. Kroll MD ,&nbsp;David B. Liss MD","doi":"10.1016/j.jemermed.2024.08.003","DOIUrl":"10.1016/j.jemermed.2024.08.003","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 111-112"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006717","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":"External Validation of Vision, Aphasia and Neglect, Ventura Emergent Large Vessel Occlusion and Large Artery Intracranial Occlusion Screening Tools for Emergent Large Vessel Occlusion Stroke: A Multicenter, Prospective, Cross-Sectional Study","authors":"İbrahim Ulaş Özturan MD ,&nbsp;Duygu Ferek Emir MD ,&nbsp;Adnan Karadaş MD ,&nbsp;Cansu Alyeşil Özturan MD ,&nbsp;Uğur Durmuş MD ,&nbsp;Nurettin Özgür Doğan MD ,&nbsp;Elif Yaka MD ,&nbsp;Serkan Yılmaz MD ,&nbsp;Murat Pekdemir MD","doi":"10.1016/j.jemermed.2024.07.004","DOIUrl":"10.1016/j.jemermed.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Vision, Aphasia, and Neglect (VAN), Ventura Emergent Large Vessel Occlusion (VES), and Large Artery Intracranial Occlusion (LARIO) are promising stroke screening tools that were shown to have high diagnostic performance to detect Emergent Large Vessel Occlusion (ELVO) in their derivation studies.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the validation of VAN, VES, and LARIO in predicting ELVO among patients presenting at emergency department (ED) triage with suspected acute ischemic stroke.</div></div><div><h3>Methods</h3><div>This is a prospective multicenter study conducted in five EDs of tertiary stroke centers between June and October 2023. Patients with suspected stroke admitted to ED for triage were evaluated using the VAN, VES, and LARIO stroke screening tools. Diagnostic performances of these tools for predicting ELVO were determined and compared with the National Institute of Health Stroke Scale (NIHSS).</div></div><div><h3>Results</h3><div>A total of 614 patients were included. The prevalence of ELVO was found to be 23.5% in the study population. VAN exhibited a sensitivity of 70.1% and specificity of 78.7%, VES showed a higher sensitivity (79.1%) with lower specificity (63.4%), while LARIO displayed high specificity (86%) with lower sensitivity (56.3%). Receiver operating characteristic curve analysis showed that LARIO and NIHSS had similar diagnostic performance (areas under the curve [AUC] 0.801 and 0.805, <em>p</em> = 0.7, respectively), while VES showed a modestly poorer performance (AUC 0.746, <em>p</em> &lt; 0.001 and <em>p</em> = 0.003).</div></div><div><h3>Conclusion</h3><div>The comparable diagnostic performance of VAN, VES, and LARIO to the NIHSS, in addition to their straightforwardness and rapid evaluation time, can facilitate optimal care for patients with ELVO in prehospital or ED triage settings.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 15-24"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785971","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":"Differentiating Vestibular Migraine and Posterior Circulation Transient Ischemic Attack in the Emergency Department: An Expert Practice Review","authors":"Sameer Sharif MD MSc ,&nbsp;Susrutha Kotwal MBBS MD ,&nbsp;Jonathan A. Edlow MD","doi":"10.1016/j.jemermed.2024.07.002","DOIUrl":"10.1016/j.jemermed.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Vestibular migraine (VM) is a subset of migraine and, as its name suggests, presents with both migrainous and vestibular symptoms. However, a more worrisome diagnosis that can present with similar features is posterior circulation transient ischemic attack (pc-TIA) presenting as episodes of isolated dizziness.</div></div><div><h3>Objectives</h3><div>The purpose of this article is to introduce emergency physicians to the diagnostic features of VM focusing on epidemiological context, timing and quality of symptoms that help differentiate vestibular migraine from pc-TIA.</div></div><div><h3>Discussion</h3><div>Our comprehensive search of epidemiologic data of VM patients found that they are more likely to be younger and female than patients with pc-TIA. Traditional vascular risk factors and a recent history of head or neck trauma are more common in pc-TIA patients. The onset of dizziness is sudden in pc-TIA with symptoms often lasting less than one hour. Moreover, symptoms tend to be positive in VM versus negative in pc-TIA.</div></div><div><h3>Conclusions</h3><div>Medical decision making should be individualized. A new nontriggered episode of isolated dizziness or those with new transient neurological findings should be evaluated for pc-TIA. VM should be considered in younger patients who have had multiple episodes over a greater time period with other migraine-related symptoms.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 113-121"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780391","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}