Journal of Trauma and Acute Care Surgery最新文献

{"title":"Does frailty predict readmission and mortality in diverticulitis? A nationwide analysis.","authors":"Omar Hejazi, Christina Colosimo, Muhammad Haris Khurshid, Collin Stewart, Mohammad Al Ma'ani, Tanya Anand, Francisco Castillo Diaz, Lourdes Castanon, Louis J Magnotti, Bellal Joseph","doi":"10.1097/TA.0000000000004707","DOIUrl":"https://doi.org/10.1097/TA.0000000000004707","url":null,"abstract":"<p><strong>Introduction: </strong>Diverticulitis is a major health concern in the United States affecting up to 25% of elderly population. It is unknown if frailty increases the risk of recurrent diverticulitis. The aim of our study is to identify the association between frailty and recurrence of diverticulitis.</p><p><strong>Methods: </strong>We performed a retrospective analysis of the Nationwide Readmissions Database 2019 and included geriatric (65 years or older) patients admitted for acute complicated diverticulitis (ACD) who were managed nonoperatively between January and June and had a 6-month follow-up. Patients were stratified into nonfrail, prefrail, and frail groups using the five-factor modified frailty index. Primary outcome was readmission due to ACD or acute uncomplicated diverticulitis (AUD) at 1 and 6 months after the admission. Secondary outcome was mortality. Multivariable regression analysis was performed to identify the predictors of recurrent diverticulitis and outcomes.</p><p><strong>Results: </strong>We identified 10,807 patients (nonfrail, 1,953; prefrail, 4,616; frail, 4,238). No differences were found between the groups in readmissions for recurrent ACD and AUD at 1 month after discharge. However, nonfrail patients and prefrail had higher rates of ACD (p = 0.009) and AUD (p < 0.001) at 6 months after index admission. Frail patients had higher mortality on index admission (p < 0.001) and at 6 months (p < 0.001). On multivariable regression analyses, frailty was a predictor of mortality on index (adjusted odds ratio, 1.99; p < 0.001) and readmissions (adjusted odds ratio, 3.05; p < 0.001).</p><p><strong>Conclusion: </strong>Frailty was not identified as a predictor of developing recurrent diverticulitis; however, frail patients are at increased risk of mortality once they develop diverticulitis. Optimal management for frail patients with diverticulitis must be defined to improve outcomes.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326141","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 construct validity analysis of the military general surgeon Knowledge, Skills, and Abilities methodology with respect to procedural complexity.","authors":"Adam D Price, Ryan C Chae, Chad M Archdeacon, Ellen R Becker, Maia P Smith, Christopher B Horn, Lane L Frasier, Michael D Goodman, Ryan E Earnest, Valerie G Sams, Richard J Strilka","doi":"10.1097/TA.0000000000004678","DOIUrl":"https://doi.org/10.1097/TA.0000000000004678","url":null,"abstract":"<p><strong>Background: </strong>The Knowledge, Skills, and Ability-Clinical Activity (KSA-CA) methodology was developed to gauge surgeon readiness; it uses Current Procedural Terminology codes organized into high- and low-acuity procedural groups. This study will evaluate if the methodology has a measure of procedural complexity.</p><p><strong>Methods: </strong>Deidentified case logs from 41 general surgery residents (years 1-5) were analyzed. Individual Current Procedural Terminology codes were converted into KSA-CA scores and work relative value units (wRVUs). The wRVUs was used as surrogate measure of complexity. Correlations between the KSA-CA scores and median wRVU values, and the relationship between these metrics with the residents' clinical year were examined with Spearmen rank correlations (ρ).</p><p><strong>Results: </strong>The KSA-CA scores and wRVU values were strongly correlated with the training year (ρ > 0.85, p < 0.0001); the case logs were also correctly ranked by the KSA-CA score. The KSA-CA points and median wRVU values for the high-acuity procedures were also strongly correlated (ρ = 0.76, p = 0.0001). Finally, the wRVU value variability within most procedural groups was noted to be large; analysis of this variability identified areas where basic surgical skills were overrepresented in the KSA-CA score.</p><p><strong>Conclusion: </strong>The KSA-CA methodology is a valid measure of residents' case logs by clinical year. Also, the residents' KSA-CA scores and their median wRVU values were strongly correlated. These results support the validity of the KSA score as a proxy to procedural complexity. Several suggestions for the refinement of the KSA methodology were also presented to address overrepresentation of some basic clinical skills in the KSA-CA methodology.</p><p><strong>Level of evidence: </strong>Analysis of Surgeon Operative Volume; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326118","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":"Interrater reliability between surgeons and pediatric emergency providers in the cervical spine assessment of injured children.","authors":"Fahd A Ahmad, Lorin R Browne, Nicolaus W Glomb, Monica Harding, Lawrence J Cook, Rebecca K Burger, Pradip P Chaudhari, Alexander J Rogers, Caleb E Ward, Daniel Rubalcava, Kenneth Yen, Nathan Kuppermann, Julie C Leonard","doi":"10.1097/TA.0000000000004695","DOIUrl":"https://doi.org/10.1097/TA.0000000000004695","url":null,"abstract":"<p><strong>Background: </strong>Cervical spine injury (CSI) is uncommon in children but an important consideration during trauma evaluation. The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated a CSI prediction rule to guide cervical spine imaging decisions in children after blunt trauma. Our objective was to determine the interrater reliability between EM providers and surgeons for history and physical examination findings used to evaluate children for CSI after blunt trauma.</p><p><strong>Methods: </strong>This was a planned secondary analysis of a prospective, observational multicenter study that enrolled children aged 0 year to 17 years evaluated for blunt trauma in 18 PECARN emergency departments (EDs). We collected data on injury mechanisms, history and physical examination findings, imaging ordered, and suspicion of CSI from EM and surgery providers. Kappa, prevalence, and bias-adjusted kappa (PABAK) were used to compare interrater reliability of variables associated with CSI.</p><p><strong>Results: </strong>Surgeons cared for 8,041 of the 22,430 children enrolled in the parent study. About 18.6% (1494/8041) had data collection forms completed by both EM providers and surgeons and were included in the analysis. Agreement between EM and surgery providers per kappa was moderate (kappa 0.41-0.6) to substantial (kappa 0.61-0.8), while PABAK analyses showed substantial to almost perfect agreement for variables in the PECARN CSI prediction rule. There was agreement between EM and surgery providers in overall clinical suspicion for CSI in 64.2% (959/1494) of patients. Retrospective application of the PECARN Rule indicated that ED and surgical provider assessments would have led to the same imaging decision in 73.7% (1101/1494) of patients.</p><p><strong>Conclusion: </strong>We identified moderate to substantial agreement between EM providers and surgeons for clinical findings that comprise the PECARN Cervical Spine Injury Prediction Rule. Agreement between providers during shared decision-making will strengthen the use of the prediction rule and may lead to decreased cervical spine imaging in EDs.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiologic; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326142","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":"Negative pressure wound therapy in resource-limited environments: Review and field guide.","authors":"Lauren Luther, Ridge Maxson, Daniel J Stinner","doi":"10.1097/TA.0000000000004708","DOIUrl":"https://doi.org/10.1097/TA.0000000000004708","url":null,"abstract":"<p><strong>Abstract: </strong>Negative pressure wound therapy (NPWT) has emerged as a valuable tool in the management of traumatic soft tissue injuries. Negative pressure wound therapy alters the local wound environment through a variety of mechanisms at both the macroscopic and microscopic level to reduce edema, stimulate angiogenesis, decrease bacterial burden, and promote healing. In battlefield or disaster response settings, NPWT offers additional advantages including reductions in dressing changes and the skilled personnel required to complete them, as well as less exposure to the surrounding environment and associated infection risk. Despite these potential benefits, NPWT use in the austere environment can be limited by logistical and financial constraints associated with commercially available NPWT products. A variety of effective, low-cost NPWT systems have been devised to overcome these barriers. This review summarizes the existing literature on improvised NPWT systems. It also presents a detailed list of potential substitutions for the fundamental NPWT components, as well as techniques for troubleshooting and augments to consider in special scenarios. We aim to provide a concise and practical field guide for construction of an improvised NPWT system to facilitate delivery of evidenced-based wound care in austere environments with infrastructure constraints.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333412","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":"Sex-related differences in cognition after severe murine traumatic brain injury: A Morris water maze study evaluating learning and memory.","authors":"Patricia Santos Carlin, Michael Coons, Priyanka Bele, Lewis J Kaplan, Matthew Culkin, Anastasia Georges, Christina L Jacovides, Patricia Martinez-Quinones, David Meaney, Alexandra Kauffman, Douglas Smith, Gary A Bass, Jose L Pascual","doi":"10.1097/TA.0000000000004668","DOIUrl":"https://doi.org/10.1097/TA.0000000000004668","url":null,"abstract":"<p><strong>Background: </strong>A number of sex-related outcomes following severe traumatic brain injury (TBI) appear to principally favor females. However, sex-related differences in post-TBI learning and memory remain underexplored. We hypothesized that females realize greater cognitive recovery than males following severe TBI.</p><p><strong>Methods: </strong>CD1 male (n = 12) and female (n = 12) mice were randomized to controlled cortical impact (severe TBI: impactor tip diameter, 3 mm; impact velocity, 6 m/s; depth, 1 mm; dwell time, 100 milliseconds) or sham craniotomy and followed for 14 days. Body weight loss recovery was measured daily as a surrogate of neuroclinical recovery. Mice underwent Morris water maze testing to evaluate learning (locating submerged escape platform) with cued and spatial trials and to recall (remembering platform location after it was removed) with probe trials.</p><p><strong>Results: </strong>Compared with uninjured male mice, male mice with TBI failed to recover lost weight for the first 7 postinjury days (i.e., day 5: MTBI: -3.7% ± 1.5% vs. MSh: +4.1% ± 1.4% body weight; p < 0.01), while female mice with TBI recovered the same lost weight and at the same rate as sham female mice (FTBI: -1.6% ± 1.0% vs. FSh: -1.8% ± 0.9%, -0.02% ± 0.01%; p > 0.9). Learning (cued and spatial) after TBI was significantly worse in males but not in females. In probe trials, impaired memory after injury was only observed in females.</p><p><strong>Conclusion: </strong>Severe TBI worsens cued and spatial learning and impairs weight loss recovery in male but not female mice. Female, but not male, mice sustain memory impairment after identical severe TBI. While the mechanism(s) that underpin these observations remain unclear, sex-related neurocognitive outcome differences question the universal applicability of trial-based evidence for clinical care.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326144","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":"Too early to put ketamine aside.","authors":"Nicolas Cazes, Évelyne Peroux, Hélène Marsaa","doi":"10.1097/TA.0000000000004558","DOIUrl":"https://doi.org/10.1097/TA.0000000000004558","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326145","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":"The incidence, outcome, and treatment of advanced organ failure and support after trauma: A review with implications for future large-scale combat operations.","authors":"Elizabeth K Powell, Richard Betzold, Ronald David Hardin, Jeffrey Biberston, Emily Hathaway, Michael S Tripp, Valerie G Sams, John B Holcomb, Jennifer M Gurney, Matthew D Tadlock","doi":"10.1097/TA.0000000000004685","DOIUrl":"https://doi.org/10.1097/TA.0000000000004685","url":null,"abstract":"<p><strong>Abstract: </strong>Future large-scale combat operations could involve delayed patient evacuation because of contested theaters of operations where United States and allied forces are unlikely to have air superiority. Prolonged casualty care could be more prevalent with delays in evacuation, requiring personnel prepared to provide critical care for injured warfighters and innovation aimed at supporting patients for longer periods of time. We conduct a review on the incidence and mortality rates of organ failure, describe the potential benefits of organ support, and offer recommendations to improve the care of patients in future conflicts. We performed a review examining the incidence and mortality of organ failure and the documented use of advanced modalities in the care of patients with organ failure. The search was conducted from the database's inception to June 21, 2024. Primary literature from previous review articles was also incorporated into this review. Authors reviewed relevant abstracts and full manuscripts. Acute respiratory failure and the need for respiratory support are common in severely injured trauma patients. Acute renal failure and the need for advanced renal support were also found to be common after injury. Although less common, advanced extracorporeal support, when required, can improve patient outcomes. In order to prepare for future conflicts, investment in personnel training, sustainment, and innovative technology will be essential to saving lives.</p><p><strong>Level of evidence: </strong>Systemic Review; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333413","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":"Do as I say and not as I do: Surgical critical care program directors and diplomates shape the future.","authors":"Tyler J Jones, Carol L Barry, Kimberly A Davis, Niels D Martin, Caroline O Prendergast, Thomas K Duncan, Amy N Hildreth, Kenji Inaba, Aaron R Jensen, Andrew T Jones, Steven L Moran, Tina L Palmieri, Nicole A Stassen, Krista L Kaups, Deborah M Stein","doi":"10.1097/TA.0000000000004615","DOIUrl":"https://doi.org/10.1097/TA.0000000000004615","url":null,"abstract":"<p><strong>Background: </strong>In 1987, the Trauma, Burn, Surgical Critical Care Specialty Board of the American Board of Surgery began offering certification in surgical critical care (SCC). The blueprint for the certifying examination (CE) has changed little since then. The Trauma, Burn, Surgical Critical Care Specialty Board sought to modernize the content of the CE. A draft blueprint was vetted with SCC program directors (PDs) and diplomates to determine how frequently the proposed topics should be tested and how frequently these topics were encountered in clinical practice. The purpose of the study was to evaluate the importance placed on blueprint topics by SCC educators and practitioners, and their relevance to clinical practice.</p><p><strong>Methods: </strong>Surgical critical care PDs and diplomates separately reviewed the blueprint and assessed the frequency topics should appear on the CE (4, annually; 3, biennially; 2, every few years; 1, never). Diplomates were also asked how frequently they encountered each topic in practice (4, daily; 3, weekly to monthly; 2, a few times/year; 1, never). Results were compared with t tests, and Cohen's d was calculated. A p value of <0.001 and a moderate effect size (d > 0.50) were used for significance.</p><p><strong>Results: </strong>Response rates were 42% (n = 70) for PDs and 30% (n = 1307) for diplomates. A total of 188 topics were evaluated. Program directors requested more frequent assessment than diplomates in 28 categories (d's ranged from -0.51 to -0.87) with obstetrical emergencies and intensive care unit billing and coding being the most discordant. For 17 topics, diplomates expressed high discordance between the importance for testing and their current practice.</p><p><strong>Conclusion: </strong>Surgical critical care practice has evolved significantly over the past 35 years. Modernization of the assessments used to measure knowledge should be aligned with practice but requires a balance of topics that are infrequently encountered but are exquisitely time-sensitive and life-threatening.</p><p><strong>Level of evidence: </strong>Survey Study; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326140","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":"Pediatric blunt thoracic aortic injuries: Understanding the role of patient size and utilization of thoracic endovascular aortic repair.","authors":"Heather Grubbs, Katherine B Snyder, Kenneth Stewart, Alisa Cross, Alessandra Landmann, Jeremy Johnson, Benjamin Greif, Paul McGaha","doi":"10.1097/TA.0000000000004709","DOIUrl":"https://doi.org/10.1097/TA.0000000000004709","url":null,"abstract":"<p><strong>Background: </strong>Thoracic aortic trauma management includes nonoperative observation, open repair, or thoracic endovascular aortic repair (TEVAR). While TEVAR is frequently used in adults, there is no standardized treatment for pediatric thoracic aortic trauma despite many pediatric patients with adult-equivalent height and weight. We aim to better understand the management of blunt pediatric thoracic aortic trauma by evaluating patient size and interventions as well as the utilization of TEVAR in this population.</p><p><strong>Methods: </strong>This is a retrospective review of the American College of Surgeons Trauma Quality Improvement Participant User Files with thoracic aortic trauma identified by International Classification of Diseases, Tenth Revision, codes. Patients younger than 18 years with blunt thoracic aortic trauma from 2017 to 2022 were included. Injury mechanism, patient height/weight, blood product requirements, diagnosis/injury scoring, concomitant injuries, operative interventions, length of stay, and mortality were reviewed.</p><p><strong>Results: </strong>We identified 346 patients with blunt thoracic aortic trauma younger than 18 years who met the inclusion criteria, 135 underwent TEVAR, 24 underwent open repair, and 187 were nonoperative. The mean ages for the open and TEVAR cohorts were 15.5 and 15.6 years, respectively. The mean height and weight were 165.1 cm and 71 kg for open repair patients, 171.7 cm and 80.5 kg for TEVAR patients, and 163.5 cm and 67.9 kg for the nonoperative patients (p < 0.01). Mortality rates for patients surviving the emergency department were 27.8% for nonoperative, 16.7% for open, and 3.7% for TEVAR (p < 0.01).</p><p><strong>Conclusion: </strong>Despite increased critical care and prolonged hospital stays, patients undergoing TEVAR demonstrated better outcomes with lower mortality rates and higher likelihood of discharge home rather than to rehab or nursing facilities. This highlights the need for consideration of height, weight, and anatomy in addition to age for thoracic aortic trauma management and could lead to increased utilization of TEVAR in this population with improved patient outcomes.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326143","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":"Critical insights into longer time to surgery for pelvic ring injuries is associated with increased systemic complications.","authors":"Minahil Laraib Asif, Safa Nasir, Mohsin Ali, Khair Ul Inam","doi":"10.1097/TA.0000000000004633","DOIUrl":"https://doi.org/10.1097/TA.0000000000004633","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285110","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}