Ukrainian Journal of Cardiovascular Surgery最新文献

{"title":"Catheter Ablation of Paroxysmal and Persistent Atrial Fibrillation in Patients with Secondary Atrial Septal Defect. Evaluation of the Results and Impact on the Quality of Life","authors":"M. Petkanych","doi":"10.30702/ujcvs/23.31(04)/pet061-8692","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/pet061-8692","url":null,"abstract":"Introduction. The presence of atrial fibrillation (AF) in patients with secondary atrial septal defect (ASD) has significant impact on their quality of life (QoL) and reduces life expectancy. Current guidelines recommend catheter ablation (CA) for patients with AF in case of medical treatment failure, however, its use in patients with AF and ASD is still poorly studied. The aim. To study the efficacy and safety of CA and its impact on the QoL in patients with AF and secondary ASD. Materials and methods. In 2003-2023, 1408 patients with secondary ASD were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Of these, 54 patients who had AF and underwent the CA procedure were included in group 1 of our study. There were 36 (66.7%) men and 18 (33.3%) women aged 24-76 years (mean age 61.4 ± 9.8 years). Four (9.3%) patients had persistent AF and 50 (90.7%) patients had paroxysmal AF. Fifty-six patients with paroxysmal or persistent AF and with the comparable age, duration of symptoms and associated pathology but without ASD were examined as group 2. The type and results of surgical interventions were analyzed according to surgical reports. The results of the treatment and QoL were assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire during the follow-up period 1, 2 and 3 months after the procedure. Results. Pulmonary vein isolation was performed in all 54 (100%) patients of the group 1, as well as cavotricuspid isthmus ablation in 26 (48.2%) cases, cavotricuspid isthmus ablation and left atrial linear ablation in 2 (3.6%) cases. Type, length and complication of the procedure were comparable to those in the group 2. Fourty-four (81.5%) patients with ASD were free from AF 3 months after procedure, and their results did not differ from those obtained in the group 2 (p > 0.05). Average QoL indicators according to AFEQT significantly improved in both groups of patients who underwent CA. The differences in post-treatment QoL between patients of both groups were insignificant (p > 0.05). Conclusions. CA was found to be safe and beneficial in patients with AF and secondary ASD. The rate of procedural complications and cure rate in patients with AF and secondary ASD (81.5%) were compatible to those in patients without ASD (80.5%). AF has negative effect on the main indicators of the patient’s life. In patients with secondary AF with ASD who underwent CA, a significant improvement in AF symptoms and QoL according to the AFEQT questionnaire (total score 56.1 ± 2.7 before the procedure vs. 78.7 ± 4.0 at follow-up) was noted.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"23 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative Pressure Wound Therapy in the Treatment of Sternal Infection after Cardiac Surgery: a Case Report and Literature Review","authors":"Yulia V. Ivanova, I. A. Kryvoruchko, Viktor M. Cheverda, D. Minukhin, S. Gramatiuk, Sergii I. Estrin, Andrii O. Kovalchuk","doi":"10.30702/ujcvs/23.31(04)/ik049-4956","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/ik049-4956","url":null,"abstract":"The aim. To assess the effectiveness of negative pressure wound therapy (NPWT) in the treatment of sternal infection following heart surgery. Materials and methods. During 2019-2022, six patients aged from 46 to 69 years underwent NPWT for sternal infection which occurred within 2 to 24 weeks after complete median sternotomy. For the purpose of temporary wound closure, standard dressing kits with sorption sponge were used. Negative pressure was created by electric vacuum pump with a constant vacuum mode at a range of -75 to -115 mm Hg and a duration of 4-5 days per session. In all cases determination of serum procalcitonin, bacteriological examination of wound discharge, computed tomography (CT) of the chest were performed in dynamics. Results. The study revealed that NPWT in all cases promoted wound cleansing, gradual closing of fistulas and non-grooving pockets, termination of inflammatory process, reduction of the wound cavity, thus accelerating complete wound healing. A significant reduction in the level of wound contamination was revealed after the first NPWT session (below the critical level of 103 CFU), compared to that before treatment (107-108 CFU). Normalization of the level of procalcitonin in the blood serum was determined by day 5-7 of NPWT. CT showed the signs of sternum stability and reduction of inflammatory process in surrounding tissues after treatment. Each treatment case required from 2 to 4 sessions. The duration of hospital stay ranged between 25 and 35 days. A treatment case of one of the 6 patients included in the study is described. Conclusions. NPWT has proven to have positive clinical effect in the local treatment of postoperative sternal infection and can be applied as an ultimate or a transitional option. Methodology of its clinical application needs further elaboration.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"47 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139149891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualization of Left Ventricular Endocardium Activation Time during Cardiac Conduction System Pacing","authors":"E. O. Perepeka","doi":"10.30702/ujcvs/23.31(04)/per058-7985","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/per058-7985","url":null,"abstract":"Introduction. Right ventricular myocardial pacing leads to asynchronous contraction of the left ventricle (LV) and can impair its contractility over time. Stimulation of the conduction system of the heart ensures physiological activation of the ventricles. The aim. To visualize the pattern of propagation of the electrical front on the activation map of the LV endocardium during conduction system pacing and during right ventricular myocardial pacing. Materials and methods. In two patients with the conduction system pacing, who were operated at the National Amosov Institute of Cardiovascular Surgery, invasive LV activation mapping was performed on various options of cardiac pacing using the EnSite Precision TM navigation system. One patient with complete atrioventricular block had nonselective His bundle pacing. The second patient had dilated cardiomyopathy and indications for cardiac resynchronization therapy and ablation of the atrioventricular junction due to chronic tachyform of atrial fibrillation. After an unsuccessful attempt to place LV lead in coronary sinus, a lead for left bundle branch pacing was implanted. Different activation maps of the LV endocardium were built in two patients with two types of cardiac pacing: right ventricular myocardial pacing and cardiac conduction system pacing. Results. The total LV endocardial activation time was significantly different in the two studied patients with different pacing options. In a patient with non-selective stimulation of His bundle, the total LV endocardial activation time was 43 ms (QRS width 126 ms, the interval from the stimulus to the peak of the R wave in lead V6 78 ms). After switching to right ventricular myocardial pacing with a decrease in the pacing amplitude, the total LV endocardial activation time prolonged to 90 ms (QRS width 165 ms, the interval from the stimulus to the peak of the R wave in lead V6 117 ms). In a patient with left bundle branch pacing, total LV endocardial activation time was 51 ms (QRS width 160 ms, the interval from the stimulus to the peak of the R wave in lead V6 66 ms). With switching exclusively to right ventricular pacing the total LV endocardial activation time prolonged to 93 ms (stimulated QRS width 180 ms). At the same time, the activation pattern of the LV endocardium was significantly different, since the right ventricular lead was located closer to the apex. Conclusions. Conduction system pacing provides rapid physiological LV activation and potentially avoids the negative consequences of asynchronous slow ventricular activation during right ventricular pacing.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flechette Wounds of the Heart: Clinical Manifestations, Diagnostics, and Surgical Treatment","authors":"V. Lazoryshynets, R. M. Vitovskyi, Mykola L. Rudenko, N. O. Ioffe, A. R. Vitovskyi","doi":"10.30702/ujcvs/23.31(04)/lv069-100105","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/lv069-100105","url":null,"abstract":"Each case of fragment injury to the heart is unique and requires careful diagnosis and surgical intervention. In some cases, the diagnosis of fragment injury to the heart and mediastinum is delayed. This is due to the fact that some penetrating and non-penetrating injuries to the heart may go unnoticed, due to the poor clinical presentation and the absence of significant damage to the chest, which may not be noticed on examination. The aim. To present a case of a flechette wound of the heart and to explore the peculiarities of clinical manifestations, diagnostic findings of instrumental tests, and surgical treatment methods. Material and methods. The article provides an analysis of methods of diagnosis and surgical treatment of a patient diagnosed with mine-explosive fragment penetrating wound of the chest with the presence of a foreign body (flechette) in the heart. In addition to the medical history, such research methods as computed tomography, X-ray examination, echo-cardiography, as well as laboratory tests were used for the diagnosis. Median sternotomy was used to perform the opera-tion to remove the fragment. The operation was performed on the fibrillation heart with the cardiopulmonary bypass. Results. Due to the absence of a pronounced pain syndrome, significant damage of the skin, and signs of intense bleeding as a result of an explosive injury, doctors did not suspect a heart injury. Discomfort and tingling sensation in the area of the apex of the heart required computed tomography of the chest. As a result, an oblong metallic fragment was found in the wall of the right ventricle of the heart. Surgical treatment with the cardiopulmonary bypass enabled to remove the fragment, which turned out to be a flechette. Conclusions. The external signs of a mine-explosive injury may not always correspond to the danger to the human body that may be caused by modern damaging agents. Only a carefully collected medical history, alertness of medical staff and proper use of radiological investigative methods can promptly identify the consequences of a mine-explosive damage, including the detection of potentially dangerous fragment locations, and provide the necessary medical assistance to the injured soldier.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"41 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Results of Stenting in Patients with Hemodynamically Significant Lesions of the Left Main Coronary Artery","authors":"O. V. Levchyshyna, S. V. Salo, Yevhenii V. Aksonov, Mykola S. Kyba","doi":"10.30702/ujcvs/23.31(04)/ls066-2633","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/ls066-2633","url":null,"abstract":"The aim. To study the long-term results of stenting in patients with coronary artery disease with hemodynamically significant left main coronary artery (LMCA) stenoses. Materials and methods. The study included 67 patients (56 men, 11 women) with a mean age of 63 ± 2.1 years. Results. Among the 67 patients included in the study, 29 patients (43.3%) underwent percutaneous coronary inter-vention using a single-stent technique. These were patients with ostial LMCA lesions, lesions of the middle third of the LMCA and some patients with Medina 1.1.0; 1.0.1; 1.0.0; 0.1.0; 0.0.1 lesions of the distal part of the LMCA. The median follow-up was 2 years. Using a questionnaire, we managed to establish contact with 25 patients (86.2%). Among these, 1 patient (3.4%) died of non-cardiac causes and 7 patients (24.1%) had a recurrence of angina within 2 years. The causes of angina recurrence in 2 cases (6.9%) were restenosis in the stent with transition to the mouth of the side branch, which required repeated stenting of the LMCA with transition to the left circumflex artery. In 5 patients (17.2%), angina recur-rence was associated with progression of coronary atherosclerosis of another localization. Among 67 patients with LMCA stenting, the two-stent technique was used in 38 patients (56.7%). These were pa-tients with Medina 1.1.0; 1.0.1; 1.0.0; 0.1.0; 0.0.1 lesions of the distal part of the LMCA. The median follow-up was 2 years. Using a questionnaire, we managed to contact 35 patients (92.1%). Among these, 4 patients (10.5%) died, but only one of them due to cardiac causes (2.6%), and 3 patients (7.9%) had recurrent angina within 2 years, two of whom underwent stenting by the T and protrusion (TAP) technique and one by culotte. The first two patients underwent angioplasty of restenosis in stents using balloons with a therapeutic coating. In the last patient, stent recoil in the left circumflex artery mouth was observed due to severe calcification, so this patient underwent re-implantation of the stent system in the recoil zone. Conclusions. The problem of choosing a method of revascularization for patients with hemodynamically significant LMCA lesions remains controversial to this day, despite the wide range of evidence. Doctors should jointly decide on the choice of treatment methodology solely in the interests of the patient, taking into account all the factors that may affect the patient’s quality of life in the long term.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"28 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Changes in the Quality of Life Using the U22 Questionnaire after Cavotricuspid Isthmus Ablation","authors":"Andriy V. Yakushev, Mykhaylo S. Podluzhny","doi":"10.30702/ujcvs/23.31(04)/yap048-9399","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/yap048-9399","url":null,"abstract":"Abstract. Atrial tachyarrhythmias are the most common forms of heart rhythm disorders. According to literature sources, isolated atrial flutter (AFL) is observed in 88 people per 100,000 population. Most quality-of-life assessment methods have been developed and used primarily to assess atrial fibrillation. In this context, the U22 questionnaire becomes a significant protocol aimed at quantifying paroxysmal symptoms associated with tachyarrhythmias. The aim. To evaluate changes in the quality of life in patients with typical AFL after radiofrequency ablation (RFA) and bidirectional conduction block through the cavotricuspid isthmus. Materials and methods. The study is based on the analysis of the results of the treatment of a group of 135 patients at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. The patients had three follow-up examinations, which were subject to analysis and static processing: before RFA (n=135), after 1 month (n=122) and after 1 year (n=81). All the patients were interviewed concerning their arrhythmia-related symptoms, which were assessed according to the U22 protocol. Results. Before the procedure, the patients noted a low level of well-being (4.3±1.0 points). During the follow-up visit 1 month after RFA, the patients rated their general condition during this period at 8.9±0.7 points. The registered changes were statistically significant compared to the initial state (p<0.0001). Thus, the radical elimination of AFL led to rapid improvement in the psycho-emotional and physical condition of the patients as early as within 1 month. Similar changes were observed during the assessment after 1 year, when the patients assessed their condition at 9.3±0.7 points (p<0.0001); there was statistically significant difference compared to the initial condition and the results at the first follow-up examination. These results confirm the stability of the positive trend during the medium-term follow-up. Conclusions. The U22 questionnaire found symptomatic improvement in patients undergoing RFA of cavotricuspid isthmus. The U22 questionnaire can be considered as another, additional control tool for patients who underwent RFA. The peculiarity of its application is the specificity of the assessment of paroxysmal symptoms and complaints, which are specifically related to rhythm disturbances, and the possibility of a simple analysis of the dynamics for a long time after the intervention.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"56 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Hip Chondrosarcoma Metastasis to the Right Ventricle","authors":"A. Cherukumudi, R. Bhagyashree, Ramesh C. Hebbale, R. Varadaraju","doi":"10.30702/ujcvs/23.31(04)/chb050-126129","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/chb050-126129","url":null,"abstract":"Background. While primary cardiac tumors occur rarely, it is observed that cardiac metastases are almost 20 times more common. These are, however, observed during autopsy and seldom missed in living patients. Patients with cardiac metastases present commonly with dyspnea on exertion or pleuritic chest pain. Most common site of intracardiac metastases is right atrium. Case presentation. Here we present a case of a 21-year-old male who presented for a routine check-up to the cardiac outpatient department for assessment of fitness for chemotherapy. He was a known case of right hip chondrosarcoma for 2 years, being treated with Ayurvedic medications. He had no symptoms related to the respiratory or cardiac system. He was afebrile during the examination, however, was restricted to a bed due to the pain in his right hip. On evaluation, the patient was diagnosed with a right ventricular thrombus extending to the pulmonary artery (PA) causing an impending pulmonary embolism. On opening the right atrium and PA, we found a loose, whitish-grey mass, adherent to the right ventricular papillary muscle, entangling the chordae. The tricuspid valve leaflets were also found to be tethered to this mass. The mass was found to extend to the PA beyond the leaflets, however, the leaflets were free of the tissue. The mass was extracted piece-meal through right atrium and PA approach. Histopathology revealed metastatic chondrosarcoma tissue. Conclusion. Cardiac metastases of chondrosarcoma are a rare condition, and can be often asymptomatic. Such patients often present with dyspnea, and imaging may not be able to rightly identify the cause. A high index of suspicion is necessary in patients with a known current or prior malignancy before committing to surgical intervention.","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"278 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139152646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of Hemodynamics in Elderly Patients Undergoing CABG Surgery at the Stage of Induction Anesthesia","authors":"A. R. Vitovskyi","doi":"10.30702/ujcvs/23.31(04)/v057-1419","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(04)/v057-1419","url":null,"abstract":"Due to the global trend of the population ageing, an important task of modern medicine is to improve the provision of medical care for elderly patients. These people have reduced compensatory reserves of the body and numerous chronic pathologies, necessitating a more meticulous approach to anesthesia induction and maintenance by anesthesiologists. According to the authors, the use of propofol and fentanyl leads to decreased myocardial contractility and reduction in overall peripheral vascular resistance. However, the resulting decrease in perfusion pressure in vital organs and tissues, as a consequence of the aforementioned effects, is unacceptable in elderly patients with coronary heart disease (CHD). The aim . To analyze changes in hemodynamics in elderly patients undergoing coronary artery bypass grafting (CABG) during the induction of anesthesia.   Materials and methods. A prospective study was conducted which included the results of examination of 20 patients with CHD over 60 years old who underwent CABG without the use of cardiopulmonary bypass at the National Amosov Institute of Cardiovascular Surgery (Kyiv, Ukraine). The mean age of the patients was 67.5±6.8 years. There were 16 (80%) men and 4 (20%) women. Typical manifestations of heart failure were noted (there were 1 [5%], 10 [50%] and 9 [45%] NYHA functional class I, II and III patients, respectively). Also, the patients were classified according to the Canadian classification of angina: 1 (5%), 9 (45%) and 10 (50%) patients fell within class I, II and III, respectively. Stage 2-3 hypertension was reported in 18 patients (90%). For induction of anesthesia, the following medications were used: propofol 1.5 mg/kg, fentanyl 2.0 μg/kg, and rocuronium bromide 0.1 mg/kg. Anesthesia maintenance included: propofol 4 mg/kg/hour, fentanyl 2.0 μg/kg/hour. Hemodynamic parameters saturation indices (SpO2), and transthoracic echocardiography parameters were recorded at the following stages: 1) upon the patient’s arrival in the operating room; 2) prior to tracheal intubation; 3) immediately after tracheal intubation; 4) 25 minutes after intubation. Results. Upon arrival in the operating room, the hemodynamic parameters reflected stable general condition of the examined patients. After administration of induction agents according to the study design, it was recorded that mean blood pressure (BP) was 72.7±4.76% (p<0.001), heart rate was 89.8±5.95% (p=0.0004), cardiac index was 81.47±6.6% (p<0.001), and systemic vascular resistance index (SVRI) was 89.9±7.02% of the baseline values (p=0.063). After intubation, an increase in most hemodynamic indicators was observed, although only mean BP, which constituted 86.7±8.8% of the baseline data (p<0.001), and SVRI (89.8±11.04% of the baseline data, p=0.0315), significantly differed from the baseline values. Within 25 minutes after the intubation, the parameters decreased again: with mean BP 74.9±7.9% (p<0.001), heart rate 91.3±9.5% (p=0.008), cardiac in","PeriodicalId":173557,"journal":{"name":"Ukrainian Journal of Cardiovascular Surgery","volume":"52 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}