Pulse最新文献

{"title":"Options for Dealing with Pressure Dependence of Pulse Wave Velocity as a Measure of Arterial Stiffness: An Update of Cardio-Ankle Vascular Index (CAVI) and CAVI0.","authors":"Bart Spronck,&nbsp;Tammo Delhaas,&nbsp;Mark Butlin,&nbsp;Koen D Reesink,&nbsp;Alberto P Avolio","doi":"10.1159/000479322","DOIUrl":"https://doi.org/10.1159/000479322","url":null,"abstract":"<p><p>Pulse wave velocity (PWV), a marker of arterial stiffness, is known to change instantaneously with changes in blood pressure. In this mini-review, we discuss two main approaches for handling the blood pressure dependence of PWV: (1) converting PWV into a pressure-independent index, and (2) correcting PWV per se for the pressure dependence. Under option 1, we focus on cardio-ankle vascular index (CAVI). CAVI is essentially a form of stiffness index β - CAVI is estimated for a (heart-to-ankle) trajectory, whereas β is estimated for a single artery from pressure and diameter measurements. Stiffness index β, and therefore also CAVI, have been shown to theoretically exhibit a slight residual blood pressure dependence due to the use of diastolic blood pressure instead of a fixed reference blood pressure. Additionally, CAVI exhibits pressure dependence due to the use of an estimated derivative of the pressure-diameter relationship. In this mini-review, we will address CAVI's blood pressure dependence theoretically, but also statistically. Furthermore, we review corrected indices (CAVI₀ and β₀) that theoretically do not show a residual blood pressure dependence. Under option 2, three ways of correcting PWV are reviewed: (1) using an exponential relationship between pressure and cross-sectional area, (2) by statistical model adjustment, and (3) through reference values or rule of thumb. Method 2 requires a population to be studied to characterise the statistical model, and method 3 requires a representative reference study. Given these limitations, method 1 seems preferable for correcting PWV per se for its blood pressure dependence. In summary, several options are available to handle the blood pressure dependence of PWV. If a blood pressure-independent index is sought, CAVI₀ is theoretically preferable over CAVI. If correcting PWV per se is required, using an exponential pressure-area relationship provides the user with a method to correct PWV on an individual basis.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"5 1-4","pages":"106-114"},"PeriodicalIF":2.2,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000479322","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36099732","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":"Association of Haemodynamic Indices of Central and Peripheral Pressure with Subclinical Target Organ Damage.","authors":"Junli Zuo,&nbsp;Shaoli Chu,&nbsp;Isabella Tan,&nbsp;Mark Butlin,&nbsp;Jiehui Zhao,&nbsp;Alberto Avolio","doi":"10.1159/000484441","DOIUrl":"https://doi.org/10.1159/000484441","url":null,"abstract":"<p><strong>Background: </strong>Central aortic pressure has often been shown to be more closely associated with markers of vascular function and incidence of cardiovascular events compared to peripheral pressure. However, the potential clinical use of central aortic or peripheral haemodynamic indices as markers of target organ damage (TOD) has not been fully established.</p><p><strong>Methods: </strong>We evaluated associations of TOD with central aortic and peripheral haemodynamic indices (central aortic [cPP] and peripheral pulse pressure [pPP], central aortic augmentation index, and central and peripheral waveform factor) in 770 hospital inpatients (age 60 ± 10 years, 473 males) with primary hypertension. TOD was quantified in terms of arterial stiffness as measured by carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (IMT), and urine albumin-to-creatinine ratio (ACR). Subclinical TOD was defined as carotid IMT >0.9 mm, urine ACR >3.5 mg/mmol in females and >2.5 mg/mmol in males and/or cfPWV >12 m/s.</p><p><strong>Results: </strong>Both cPP and pPP showed significant correlation with cfPWV (<i>r =</i> 0.41 vs. 0.40; <i>p</i> < 0.01), ACR (<i>r =</i> 0.24 vs. 0.27; <i>p</i> < 0.01) and carotid IMT (<i>r</i> = 0.14 vs. 0.15; <i>p</i> < 0.01). Each SD increase in pPP and cPP was associated with increased risk of cfPWV >12 m/s (odds ratio [OR] = 2.7 and 2.9 for pPP and cPP, respectively), ACR >2.5 mg/mmol (OR = 1.2 and 1.4, respectively), and carotid IMT >0.9 mm (OR = 1.46 and 1.53, respectively). Compared to pPP, cPP had higher predictive power for TOD for age ≥60 years (OR = 3.07, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Although both pPP and cPP show an association with TOD in a hypertensive population, cPP provides additional information beyond pPP associated with TOD in a hypertensive cohort. Central aortic haemodynamic indices as potential biomarkers of subclinical TOD need to be validated by further prospective studies.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"5 1-4","pages":"133-143"},"PeriodicalIF":2.2,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000484441","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36098878","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":"The Role of Vascular Calcification in Heart Failure and Cognitive Decline.","authors":"Hao-Min Cheng,&nbsp;Jiun-Jr Wang,&nbsp;Chen-Huan Chen","doi":"10.1159/000484941","DOIUrl":"https://doi.org/10.1159/000484941","url":null,"abstract":"<p><p>Vascular calcification is heterogeneous and triggered by multiple mechanisms. It has been implicated in the development of heart failure with preserved ejection fraction (HFpEF) and cognitive function impairment. Understanding the pathophysiology of vascular calcification may help us improve the management of HFpEF, atherosclerosis, accelerated arterial stiffness, hypertension, and cognitive dysfunction. Currently, there are no effective strategies for treating accelerated arterial stiffness. This may indicate that once arterial stiffness or vascular calcification has developed, it may be less likely to stop the ongoing pathophysiology. Therefore, earlier intervention targeting the probable pathways of vascular calcification may benefit the patients with vascular calcification and related pathological conditions. In this review, we briefly discuss the proposed pathophysiological roles of vascular calcification in the development of heart failure and cognitive decline, the animal models used to study the link between vascular calcification and cardiovascular diseases, and the possible corresponding management strategies.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"5 1-4","pages":"144-153"},"PeriodicalIF":2.2,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000484941","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36098879","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":"Vascular Aging and Cognitive Dysfunction: Silent Midlife Crisis in the Brain.","authors":"Chen-Hua Lin,&nbsp;Hao-Min Cheng,&nbsp;Shao-Yuan Chuang,&nbsp;Chen-Huan Chen","doi":"10.1159/000481734","DOIUrl":"https://doi.org/10.1159/000481734","url":null,"abstract":"<p><strong>Background: </strong>Vascular aging may cause cerebral microvascular damage and cognitive dysfunction. There is incremental evidence that consistently implicates arterial stiffness being involved in the manifestation of cognitive impairment in the elderly. However, few investigations have examined the relationship between arterial stiffness and cognitive impairment in midlife.</p><p><strong>Summary: </strong>Past studies inconsistently showed improved cognitive outcomes after antihypertensive therapy in elderly populations. Nevertheless, recent findings revealed that blood-pressure-lowering treatment in young adults might eliminate or halt the progression of the detrimental effects related to arterial stiffness, indicating that younger adults may have more favorable outcomes in cognition than their older counterparts if early intervention is conducted at the subclinical stage. Stiffening of the aorta may lead to an excessive flow pulsatility in the brain that may cause microvascular structural brain damage and worse cognitive performance. Recent investigations have suggested that arterial stiffness is likely to trigger initial silent brain damage, possibly preceding midlife, while the manifestation of cognitive decline and deterioration can be foreseen in the subsequent life span.</p><p><strong>Key message: </strong>Despite the recent novel findings, definite conclusions on causality between vascular aging and cognitive dysfunction cannot be drawn at present. Further well-powered longitudinal studies with superior neuroimaging indicator, vascular mechanical biomarkers, and sensitive cognitive assessment tools that examine a broad range of age populations may help extend our understanding of the association between vascular aging and cognitive dysfunction throughout the life span.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"5 1-4","pages":"127-132"},"PeriodicalIF":2.2,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000481734","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36098877","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":"Enhanced Aortic Pressure Wave Reflection in Patients with Aortic Coarctation after Aortic Arch Repair.","authors":"Tomoaki Murakami","doi":"10.1159/000478530","DOIUrl":"https://doi.org/10.1159/000478530","url":null,"abstract":"<p><strong>Background: </strong>In patients with aortic coarctation after successful aortic arch repair, it is well known that early-onset cardiovascular diseases can develop.</p><p><strong>Summary: </strong>We studied the pressure waveform in patients after aortic arch repair focusing on a pressure wave reflection. In patients after aortic arch repair, the repaired portion generates a new reflected pressure wave. As a result, the newly generated pressure wave causes aortic pressure augmentation, loss of pressure amplification, and left ventricular hypertrophy with fibrosis. Balloon dilatation of the aortic arch may also generate a new pressure wave reflection.</p><p><strong>Key messages: </strong>In patients with aortic coarctation after aortic arch repair, the reconstructed site generates a new pressure wave reflection. This could be one of the causes of their future cardiovascular diseases.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"5 1-4","pages":"82-87"},"PeriodicalIF":2.2,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000478530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36099728","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":"Validation of a Piezoelectric Sensor Array-Based Device for Measurement of Carotid-Femoral Pulse Wave Velocity: The Philips Prototype.","authors":"Shao-Kun Xu,&nbsp;Xiang-Fei Hong,&nbsp;Yi-Bang Cheng,&nbsp;Chang-Yuan Liu,&nbsp;Yan Li,&nbsp;Bin Yin,&nbsp;Ji-Guang Wang","doi":"10.1159/000486317","DOIUrl":"https://doi.org/10.1159/000486317","url":null,"abstract":"<p><strong>Background: </strong>Multiple piezoelectric pressure mechanotransducers topologized into an array might improve efficiency and accuracy in collecting arterial pressure waveforms for measurement of pulse wave velocity (PWV).</p><p><strong>Objective: </strong>In the present study, we validated a piezoelectric sensor array-based prototype (Philips) against the validated and clinically widely used Complior device (Alam Medical).</p><p><strong>Methods: </strong>We recruited 33 subjects with a wide distribution of PWV. For the validation, PWV was measured sequentially with the Complior device (four times) and the Philips prototype (three times). With the 99 paired PWV values, we investigated the agreement between the Philips prototype and the Complior device using Pearson correlation analysis and Bland-Altman plot. We also performed analysis on the determinants and reproducibility of PWV measured with both devices.</p><p><strong>Results: </strong>The correlation coefficient for PWV measured with the two devices was 0.92 (<i>p</i> < 0.0001). Compared with the Complior device, the Philips prototype slightly overestimated PWV by 0.24 (± 2 standard deviations, ± 1.91) m/s, especially when PWV was high. The correlation coefficient between the difference and the average of the Philips and Complior measurements was 0.21 (<i>p</i> = 0.035). Nonetheless, they had similar determinants. Age, mean arterial pressure, and sex altogether explained 81.6 and 83.9% of the variance of PWV values measured with the Philips prototype and Complior device, respectively. When the two extremes of the three PWV values measured with the Philips prototype and the Complior device were investigated, the coefficients of variation were 8.26 and 3.26%, respectively.</p><p><strong>Conclusions: </strong>Compared with the Complior device, the Philips prototype had similar accuracy, determinants, and reproducibility in measuring PWV.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"5 1-4","pages":"161-168"},"PeriodicalIF":2.2,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000486317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36098881","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":"Aortic-Brachial Pulse Wave Velocity Ratio: A Measure of Arterial Stiffness Gradient Not Affected by Mean Arterial Pressure.","authors":"Catherine Fortier,&nbsp;Marie-Pier Desjardins,&nbsp;Mohsen Agharazii","doi":"10.1159/000480092","DOIUrl":"https://doi.org/10.1159/000480092","url":null,"abstract":"Background: Aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV), is used for the prediction of cardiovascular risk. This mini-review describes the nonlinear relationship between cf-PWV and operational blood pressure, presents the proposed methods to adjust for this relationship, and discusses a potential place for aortic-brachial PWV ratio (a measure of arterial stiffness gradient) as a blood pressure-independent measure of vascular aging. Summary: PWV is inherently dependent on the operational blood pressure. In cross-sectional studies, PWV adjustment for mean arterial pressure (MAP) is preferred, but still remains a nonoptimal approach, as the relationship between PWV and blood pressure is nonlinear and varies considerably among individuals due to heterogeneity in genetic background, vascular tone, and vascular remodeling. Extrapolations from the blood pressure-independent stiffness parameter β (β0) have led to the creation of stiffness index β, which can be used for local stiffness. A similar approach has been used for cardio-ankle PWV to generate a blood pressure-independent cardio-ankle vascular index (CAVI). It was recently demonstrated that stiffness index β and CAVI remain slightly blood pressure-dependent, and a more appropriate formula has been proposed to make the proper adjustments. On the other hand, the negative impact of aortic stiffness on clinical outcomes is thought to be mediated through attenuation or reversal of the arterial stiffness gradient, which can also be influenced by a reduction in peripheral medium-sized muscular arteries in conditions that predispose to accelerate vascular aging. Arterial stiffness gradient, assessed by aortic-brachial PWV ratio, is emerging to be at least as good as cf-PWV for risk prediction, but has the advantage of not being affected by operating MAP. Key Messages: The negative impacts of aortic stiffness on clinical outcomes are proposed to be mediated through attenuation or reversal of arterial stiffness gradient. Aortic-brachial PWV ratio, a measure of arterial stiffness gradient, is independent of MAP.","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"5 1-4","pages":"117-124"},"PeriodicalIF":2.2,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000480092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36098875","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":"Increase in the Arterial Velocity Pulse Index of Patients with Peripheral Artery Disease.","authors":"Naotaka Murata,&nbsp;Kazuki Shiina,&nbsp;Jun Yamashita,&nbsp;Nobuhiro Tanaka,&nbsp;Taishiro Chikamori,&nbsp;Akira Yamashina,&nbsp;Hirofumi Tomiyama","doi":"10.1159/000486162","DOIUrl":"https://doi.org/10.1159/000486162","url":null,"abstract":"<p><strong>Background: </strong>Recently, a simple parameter calculated from the brachial pressure waveform recorded using an oscillometric device (arterial velocity pulse index [AVI]: ratio of the forward/reflected pressure wave amplitudes) has become available to assess the pathophysiological abnormalities associated with vascular damage. Peripheral artery disease (PAD) represents one of the disease entities associated with the advanced stages of atherosclerotic vascular damage. The present study was conducted to examine whether an increase in the AVI might be influenced by the presence of PAD.</p><p><strong>Methods and results: </strong>The AVI was measured from oscillometric recordings of the brachial pressure waveform, and the ankle-brachial pressure index (ABPI) was determined by an oscillometric method. Study 1: In 341 consecutive patients admitted for the management of cardiovascular disease and/or cardiovascular risk factors, the ABPI and the AVI were measured simultaneously. An ABPI ≤0.90 was observed in 19 subjects, and logistic regression analysis revealed a significant association between AVI and ABPI ≤0.90 (odds ratio = 1.81; 95% confidence interval = 1.15-2.84; <i>p</i> = 0.01). Study 2: In another 19 patients with PAD, percutaneous transluminal angioplasty resulted in a decrease in the AVI from 31 ± 8 to 27 ± 8 (<i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>Possible presence of PAD must be taken into account while applying the AVI for the assessment of vascular damage.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"5 1-4","pages":"154-160"},"PeriodicalIF":2.2,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000486162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36098880","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":"Large Artery Stiffness Assessment Using SphygmoCor Technology.","authors":"Mark Butlin,&nbsp;Ahmad Qasem","doi":"10.1159/000452448","DOIUrl":"https://doi.org/10.1159/000452448","url":null,"abstract":"<p><p>Large artery stiffness assessment has been an integral part of the SphygmoCor technology since 1998. Aortic stiffness is approximated with non-invasive measurement of carotid-femoral pulse wave velocity, with improvements made with time to make the assessment procedure quicker and more user independent. Also standard in the devices is the ability to reliably calculate the central aortic waveform shape from a peripheral pressure waveform from either the brachial or radial artery. This waveform contains much information beyond peak and trough (systolic and diastolic pressure). Relative waveform features such as the augmentation index, wave reflection magnitude, reflection time index, and subendocardial viability ratio are parameters that are influenced by the stiffness of systemic arteries. This article briefly describes these parameters related to large artery stiffness and provides reference to validation and repeatability studies relative to the clinical use of the SphygmoCor devices. It is beyond the scope to review here the 424 original research articles that have employed SphygmoCor devices in measuring arterial stiffness. Instead, the method of measurement across the devices is described, including tonometry, volumetric displacement through cuff placement around limbs, and ambulatory monitoring. Key population and subpopulation studies are cited where the average stiffness parameter progression with age and gender, as measured by SphygmoCor devices, is quantified in the healthy and general population. Finally, with reference to guidelines from working groups on arterial stiffness and hypertension, the clinical utility of large artery stiffness measurement is discussed in the context of the arterial stiffness parameters provided by the SphygmoCor systems.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"4 4","pages":"180-192"},"PeriodicalIF":2.2,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000452448","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756920","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":"Arterial Stiffness: Recommendations and Standardization.","authors":"Raymond R Townsend","doi":"10.1159/000448454","DOIUrl":"https://doi.org/10.1159/000448454","url":null,"abstract":"<p><p>The use of arterial stiffness measurements in longitudinal cohorts of normal populations, hypertensive patients, diabetic patients, healthy elderly, and patients on hemodialysis have confirmed the value of this important measure of arterial health, and established its complementary role to measures of blood pressure. Its contribution to understanding cardiovascular and mortality risk beyond blood pressure measurements has moved measures of arterial stiffness into the ranks of factors such as elevated cholesterol, diabetes, and left ventricular hypertrophy in considering cardiovascular risk. The recent international collaboration's publication of reference ranges for normal people and those with hypertension, along with the American Heart Association's recent scientific statement on standardizing arterial stiffness measurements are important aspects to consider in future studies employing these valuable methods, particularly as interventions that not only lower blood pressure but improve arterial function are tested in the clinical arena.</p>","PeriodicalId":29774,"journal":{"name":"Pulse","volume":"4 Suppl 1","pages":"3-7"},"PeriodicalIF":2.2,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000448454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34796179","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}