{"title":"State of the Art for Refractory Cough: Multidisciplinary Approach.","authors":"Anne E Vertigan","doi":"10.4046/trd.2023.0036","DOIUrl":"10.4046/trd.2023.0036","url":null,"abstract":"<p><p>Chronic cough is a common problem that can be refractory to medical treatment. Nonpharmaceutical management of chronic cough has an important role in well selected patients. This review article outlines the history of chronic cough management, current approaches to speech pathology management of the condition and new modalities of nonpharmaceutical treatment. There is a need for further research into nonpharmaceutical options with well described randomised control trials.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"264-271"},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/5b/trd-2023-0036.PMC10555522.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10359407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rigid Bronchoscopy for Post-tuberculosis Tracheobronchial Stenosis.","authors":"Hojoong Kim","doi":"10.4046/trd.2023.0017","DOIUrl":"10.4046/trd.2023.0017","url":null,"abstract":"<p><p>The healing process of tracheobronchial tuberculosis (TB) results in tracheobronchial fibrosis causing airway stenosis in 11% to 42% of patients. In Korea, where pulmonary TB is still prevalent, post-TB tracheobronchial stenosis (PTTS) is one of the main causes of benign airway stenosis causing progressive dyspnea, hypoxemia, and often life-threatening respiratory insufficiency. The development of rigid bronchoscopy replaced surgical management 30 years ago, and nowadays PTTS is mainly managed by bronchoscopic intervention in Korea. Similar to pulmonary TB, tracheobronchial TB is treated with combination of anti-TB medications. The indication of rigid bronchoscopy is more than American Thoracic Society (ATS) grade 3 dyspnea in PTTS patients. First, the narrowed airway is dilated by multiple techniques including ballooning, laser resection, and bougienation under general anesthesia. Then, most of the patients need silicone stenting to maintain the patency of dilated airway; 1.5 to 2 years after indwelling, the stent could be removed, this has shown a 70% success rate. Acute complications without mortality develop in less than 10% of patients. Subgroup analysis showed successful removal of the stent was significantly associated with male sex, young age, good baseline lung function and absence of complete one lobe collapse. In conclusion, rigid bronchoscopy could be applied to PTTS patients with acceptable efficacy and tolerable safety.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"245-250"},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/d9/trd-2023-0017.PMC10555523.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9357790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stridor in a Patient with Uncontrolled Diabetes: An Uncommon Adversary, Successfully Managed with Bronchoscopy.","authors":"Kuldeep Gulia, Suresh Singhal, Promil Jain, Dhruva Chaudhry, Aman Ahuja, Pawan Kumar Singh","doi":"10.4046/trd.2023.0074","DOIUrl":"10.4046/trd.2023.0074","url":null,"abstract":"Invasive mucormycosis is a fatal opportunistic infection caused by fungi from the Mucoraceae family. Uncontrolled diabetes mellitus and post-organ transplant status are two of the strongest risk factors for invasive mucormycosis. Rhino-cerebral, renal and pulmonary involvement are most commonly seen 1 . Isolated invasion of the trachea and larynx can lead to life-threatening airway obstruction; however, they are rare manifestations of invasive mucormycosis","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"319-321"},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/81/trd-2023-0074.PMC10555519.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9778342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Larry Ellee Nyanti, Chia Zhen Chua, Han Chuan Loo, Cheng Zhi Khor, Emilia Sheau Yuin Toh, Rasvinder Singh Gill, Eng Tat Chan, Ker Yin Tan, Taufiq Rosli, Muhammad Aklil Abd Rahim, Arfian Ibrahim, Nai Chien Huan, Hema Yamini Devi Ramarmuty, Kunji Kannan Sivaraman Kannan
{"title":"Determinants of Willingness to Undergo Lung Cancer Screening among High-Risk Current and Ex-smokers in Sabah, Malaysia: A Cross-Sectional Pilot Study.","authors":"Larry Ellee Nyanti, Chia Zhen Chua, Han Chuan Loo, Cheng Zhi Khor, Emilia Sheau Yuin Toh, Rasvinder Singh Gill, Eng Tat Chan, Ker Yin Tan, Taufiq Rosli, Muhammad Aklil Abd Rahim, Arfian Ibrahim, Nai Chien Huan, Hema Yamini Devi Ramarmuty, Kunji Kannan Sivaraman Kannan","doi":"10.4046/trd.2023.0051","DOIUrl":"10.4046/trd.2023.0051","url":null,"abstract":"<p><strong>Background: </strong>Attitudes towards smoking, lung cancer screening, and perceived risk of lung cancer have not been widely studied in Malaysia. The primary objective of this study was to describe the factors affecting the willingness of high-risk current smokers and ex-smokers to undergo low-dose computed tomography (LDCT) screening for lung cancer.</p><p><strong>Methods: </strong>A prospective, cross-sectional questionnaire study was conducted in current smokers or ex-smokers aged between 55 and 80 years at three hospitals in Kota Kinabalu, Sabah, Malaysia. The questionnaire recorded the following parameters: perceived lung cancer risk; Prostate Lung Colon Ovarian Cancer 2012 risk prediction model excluding race and ethnicity predictor (PLCOm2012norace); demographic characteristics; psychosocial characteristics; and attitudes towards lung cancer and lung cancer screening.</p><p><strong>Results: </strong>A vast majority of the 95 respondents (94.7%) indicated their willingness to undergo screening. Stigma of lung cancer, low levels of knowledge about lung cancer symptoms, concerns about financial constraints, and a preference for traditional medication were still prevalent among the respondents, and they may represent potential barriers to lung cancer screening uptake. A desire to have an early diagnosis (odds ratio [OR], 11.33; 95% confidence interval [CI], 1.53 to 84.05; p=0.02), perceived time constraints (OR, 3.94; 95% CI, 1.32 to 11.73; p=0.01), and proximity of LDCT screening facilities (OR, 14.33; 95% CI, 1.84 to 111.4; p=0.01) had significantly higher odds of willingness to undergo screening.</p><p><strong>Conclusion: </strong>Although high-risk current smokers and ex-smokers are likely to undergo screening for lung cancer, several psychosocial barriers persist. The results of this study may guide the policymakers and clinicians regarding the need to improve lung cancer awareness in our population.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":" ","pages":"284-293"},"PeriodicalIF":2.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/25/0a/trd-2023-0051.PMC10555520.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chronic Obstructive Pulmonary Disease and the Airway Microbiome: What Respirologists Need to Know.","authors":"Don D Sin","doi":"10.4046/trd.2023.0015","DOIUrl":"https://doi.org/10.4046/trd.2023.0015","url":null,"abstract":"Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The lower airways contain a rich and diverse microbiome, which may play a significant regulatory role in both health and disease. In COPD, the microbiome becomes perturbed, causing dysbiosis. Increased representation of members in the Proteobacteria phylum and certain members in the Firmicutes phylum has been associated with increased risk of exacerbations and mortality. Therapies such as inhaled corticosteroids and azithromycin may modulate the airway microbiome or its metabolites in patients with COPD. This paper provides an up-to-date overview of the airway microbiome and its importance in the pathophysiology of COPD and as potential therapeutic target in the future.","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":"86 3","pages":"166-175"},"PeriodicalIF":2.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/d2/trd-2023-0015.PMC10323206.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9787600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hongjo Choi, Dawoon Jeong, Young Ae Kang, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Jeongha Mok
{"title":"Impact of Anti-Tuberculosis Drug Use on Treatment Outcomes in Patients with Pulmonary Fluoroquinolone-Resistant Multidrug-Resistant Tuberculosis: A Nationwide Retrospective Cohort Study with Propensity Score Matching.","authors":"Hongjo Choi, Dawoon Jeong, Young Ae Kang, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Jeongha Mok","doi":"10.4046/trd.2023.0040","DOIUrl":"https://doi.org/10.4046/trd.2023.0040","url":null,"abstract":"<p><strong>Background: </strong>Effective treatment of fluoroquinolone-resistant multidrug-resistant tuberculosis (FQr-MDR-TB) is difficult because of the limited number of available core anti-TB drugs and high rates of resistance to anti-TB drugs other than FQs. However, few studies have examined anti-TB drugs that are effective in treating patients with FQr-MDR-TB in a real-world setting.</p><p><strong>Methods: </strong>The impact of anti-TB drug use on treatment outcomes in patients with pulmonary FQr-MDR-TB was retrospectively evaluated using a nationwide integrated TB database (Korean Tuberculosis and Post-Tuberculosis). Data from 2011 to 2017 were included.</p><p><strong>Results: </strong>The study population consisted of 1,082 patients with FQr-MDR-TB. The overall treatment outcomes were as follows: treatment success (69.7%), death (13.7%), lost to follow-up or not evaluated (12.8%), and treatment failure (3.9%). On a propensity-score-matched multivariate logistic regression analysis, the use of bedaquiline (BDQ), linezolid (LZD), levofloxacin (LFX), cycloserine (CS), ethambutol (EMB), pyrazinamide, kanamycin (KM), prothionamide (PTO), and para-aminosalicylic acid against susceptible strains increased the treatment success rate (vs. unfavorable outcomes). The use of LFX, CS, EMB, and PTO against susceptible strains decreased the mortality (vs. treatment success).</p><p><strong>Conclusion: </strong>A therapeutic regimen guided by drug-susceptibility testing can improve the treatment of patients with pulmonary FQr-MDR-TB. In addition to core anti-TB drugs, such as BDQ and LZD, treatment of susceptible strains with later-generation FQs and KM may be beneficial for FQr-MDR-TB patients with limited treatment options.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":"86 3","pages":"234-244"},"PeriodicalIF":2.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/80/trd-2023-0040.PMC10323203.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9792263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Inhaled Corticosteroids Is Not Associated with the Risk of Pneumonia in Asthma.","authors":"Ye Jin Lee, Yong-Bum Park","doi":"10.4046/trd.2022.0147","DOIUrl":"https://doi.org/10.4046/trd.2022.0147","url":null,"abstract":"<p><p>The introduction of inhaled corticosteroids (ICS) for the management of asthma has led to a decrease in acute exacerbation of asthma. However, there are concerns regarding the safety of long-term ICS use, particularly pneumonia. Growing evidence indicates that ICS use is associated with an increased risk of pneumonia in patients with chronic obstructive pulmonary disease, whereas the risk in patients with asthma remains unclear. This review discusses the effect of ICS on pneumonia among patients with asthma to update the existing literature. Asthma is associated with an increased risk of pneumonia. Several hypotheses have been proposed to explain this association, including that asthma impairs the clearance of bacteria owing to chronic inflammation. Therefore, controlling airway inflammation with ICS may prevent the occurrence of pneumonia in asthma. In addition, two meta-analyses investigating randomized control trials showed that ICS use was associated with a protective effect against pneumonia in asthma.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":"86 3","pages":"151-157"},"PeriodicalIF":2.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/d7/trd-2022-0147.PMC10323202.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9779904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Alfaiate, Rita Rodrigues, Ana Aguiar, Raquel Duarte
{"title":"Tuberculosis and COVID-19 Related Stigma: Portuguese Patients Experiences.","authors":"Ana Alfaiate, Rita Rodrigues, Ana Aguiar, Raquel Duarte","doi":"10.4046/trd.2022.0062","DOIUrl":"https://doi.org/10.4046/trd.2022.0062","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB)-related stigma has been well-documented. Since the emergence of the coronavirus disease 2019 (COVID-19), different organizations have been alerted to the fact that stigma could arise again. Due to stigma's negative effects, this qualitative study aimed to explore the stigma felt by patients by evaluating the following: COVID-19 stigma and its temporal progression through the pandemic; stigma perceived by different patients with TB before and during COVID-19 pandemic; and difference perceived by individuals who contracted both diseases.</p><p><strong>Methods: </strong>A semi-structured interview was developed according to the available literature on the theme. It was performed individually in 2022 upon receiving signed informed consent. Participants were recruited with a purposive sampling approach by searching medical records. Those who currently or previously had pulmonary TB and/ or COVID-19 were included. Data were subjected to thematic analysis.</p><p><strong>Results: </strong>Nine patients were interviewed, including six (66.7%) females. The median age of patients was 51±14.7 years. Four participants (44.4%) had completed high school and four (44.4%) were never smokers. Three had both TB and COVID-19. Four only had TB and two only had COVID-19. Interviews identified eight main themes: knowledge and beliefs, with several misconceptions identified; attitudes towards the disease, varying from social support to exclusion; knowledge and education, assumed as of extreme importance; internalized stigma, with self-rejection; experienced stigma, with discrimination episodes; anticipated stigma, modifying actions for avoiding stigma; perceived stigma, with judgment by others prevailed; and temporal evolution of stigma.</p><p><strong>Conclusion: </strong>Individuals expressed strong stigma for both diseases. De-stigmatization of respiratory infectious diseases is crucial for limiting stigma's negative impact.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":"86 3","pages":"216-225"},"PeriodicalIF":2.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/a8/trd-2022-0062.PMC10323204.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9780447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oh Beom Kwon, Solji Han, Hwa Young Lee, Hye Seon Kang, Sung Kyoung Kim, Ju Sang Kim, Chan Kwon Park, Sang Haak Lee, Seung Joon Kim, Jin Woo Kim, Chang Dong Yeo
{"title":"Prediction of Postoperative Lung Function in Lung Cancer Patients Using Machine Learning Models.","authors":"Oh Beom Kwon, Solji Han, Hwa Young Lee, Hye Seon Kang, Sung Kyoung Kim, Ju Sang Kim, Chan Kwon Park, Sang Haak Lee, Seung Joon Kim, Jin Woo Kim, Chang Dong Yeo","doi":"10.4046/trd.2022.0048","DOIUrl":"https://doi.org/10.4046/trd.2022.0048","url":null,"abstract":"<p><strong>Background: </strong>Surgical resection is the standard treatment for early-stage lung cancer. Since postoperative lung function is related to mortality, predicted postoperative lung function is used to determine the treatment modality. The aim of this study was to evaluate the predictive performance of linear regression and machine learning models.</p><p><strong>Methods: </strong>We extracted data from the Clinical Data Warehouse and developed three sets: set I, the linear regression model; set II, machine learning models omitting the missing data: and set III, machine learning models imputing the missing data. Six machine learning models, the least absolute shrinkage and selection operator (LASSO), Ridge regression, ElasticNet, Random Forest, eXtreme gradient boosting (XGBoost), and the light gradient boosting machine (LightGBM) were implemented. The forced expiratory volume in 1 second measured 6 months after surgery was defined as the outcome. Five-fold cross-validation was performed for hyperparameter tuning of the machine learning models. The dataset was split into training and test datasets at a 70:30 ratio. Implementation was done after dataset splitting in set III. Predictive performance was evaluated by R2 and mean squared error (MSE) in the three sets.</p><p><strong>Results: </strong>A total of 1,487 patients were included in sets I and III and 896 patients were included in set II. In set I, the R2 value was 0.27 and in set II, LightGBM was the best model with the highest R2 value of 0.5 and the lowest MSE of 154.95. In set III, LightGBM was the best model with the highest R2 value of 0.56 and the lowest MSE of 174.07.</p><p><strong>Conclusion: </strong>The LightGBM model showed the best performance in predicting postoperative lung function.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":"86 3","pages":"203-215"},"PeriodicalIF":2.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/a1/trd-2022-0048.PMC10323210.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9787602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chin Kook Rhee, Ji-Yong Moon, Hyonsoo Joo, Ji Ye Jung, Jung-Kyu Lee, Kyung Hoon Min, Hyeon-Kyoung Koo, Seong Yong Lim, Hyoung Kyu Yoon, Sang Yeub Lee
{"title":"Summary of Korean Asthma Guideline.","authors":"Chin Kook Rhee, Ji-Yong Moon, Hyonsoo Joo, Ji Ye Jung, Jung-Kyu Lee, Kyung Hoon Min, Hyeon-Kyoung Koo, Seong Yong Lim, Hyoung Kyu Yoon, Sang Yeub Lee","doi":"10.4046/trd.2023.0052","DOIUrl":"https://doi.org/10.4046/trd.2023.0052","url":null,"abstract":"<p><p>Asthma is a chronic inflammatory airway disease that is characterized by variable airflow obstruction. The Korean Asthma Study Group of the Korean Academy of Tuberculosis and Respiratory Diseases has recently updated the Korean Asthma Guideline. This review summarizes the updated Korean Asthma Guideline. Asthma prevalence is increasing worldwide, and in Korea. Variable airflow obstruction can be confirmed by bronchodilator response or other tests, and should be established prior to the controller medication. A low-dose inhaled corticosteroid-formoterol is used to alleviate symptoms in all treatment step, and it can be used as a controller as well as reliever in steps 3-5. This approach is preferred, because it reduces the risk of severe exacerbations, compared to the use of short-acting β2-agonist as reliever. In severe asthma, phenotype/endotype based on the underlying inflammation should be evaluated. For type 2 severe asthma, the biologics should be considered.</p>","PeriodicalId":23368,"journal":{"name":"Tuberculosis and Respiratory Diseases","volume":"86 3","pages":"158-165"},"PeriodicalIF":2.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/7c/trd-2023-0052.PMC10323208.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9798233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}