Frontiers in Anesthesiology最新文献

{"title":"The pressure field model: a challenge to the conventional Starling and Guyton model of hemodynamic management","authors":"Stephen F. Woodford, Laurence Weinberg, L. Miles, Ruth C. Marshall, Bernhard Riedel, Philip J. Peyton","doi":"10.3389/fanes.2024.1400929","DOIUrl":"https://doi.org/10.3389/fanes.2024.1400929","url":null,"abstract":"Ensuring hemodynamic stability with adequate perfusion to vital organs is critical to the safe conduct of anesthesia. Recent advances in hemodynamic monitoring technologies allow pressure, flow, and resistance to be measured continuously; however, there is limited evidence to suggest that these technologies alter clinical management or improve patient outcomes significantly. This may be because the fundamental hemodynamic model, established by Starling and Guyton, fails to offer the granular level of insight needed to guide clinical management.We collected hemodynamic data from 950 patients who underwent major surgery with advanced hemodynamic monitoring (AHM) that provided continuously derived cardiac output and vascular resistance measurements. These measurements were based on the hemodynamic model of Starling and Guyton. Additionally, investigational monitoring software was developed to visualize a different hemodynamic model, termed the “pressure field” model. This model expresses the pulsatile, beat-to-beat relationship between ventricular performance (measured by stroke volume) and vascular tone (indicated by systemic elastance).Within this dataset were several patients who experienced major hemorrhage. Case studies of these patients demonstrate that abnormal pressure and flow regulation patterns are observed through the lens of the pressure field model, but these patterns are typically not visible through the lens of the traditional Starling and Guyton model (cardiac output and systemic vascular resistance, which involve averaging hemodynamic performance over successive cardiac cycles). Furthermore, “before and after” case studies using our investigational pressure field monitoring software suggest that the traditional Starling and Guyton hemodynamic model has limited utility in managing hemorrhage.We propose that the pressure field model may allow hemorrhage to be managed more effectively via improved monitoring granularity [the beat-by-beat visualization of the stroke volume-systemic elastance relationship, rather than the use of the composite metrics of cardiac output (heart rate × stroke volume) and systemic vascular resistance]. Further research into the utility of the pressure field model is warranted.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"3 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141640992","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":"Patient-centered perspectives on perioperative care","authors":"Wael Saasouh, Kristina Ghanem, Neil Al-Saidi, Lindsey LeQuia, George McKelvey, Muhammad Jaffar","doi":"10.3389/fanes.2024.1267127","DOIUrl":"https://doi.org/10.3389/fanes.2024.1267127","url":null,"abstract":"The collection and evaluation of patient-reported outcomes is essential to the development of patient and family centered care. Current patient surveying techniques are limited by delayed response times and restriction to specific health systems. The use of random-domain intercept technology (RDIT), by Real-Time Interactive World-Wide Intelligence (RIWI, Toronto, ON, Canada) mitigates current barriers by creating a dynamic real-time feedback environment and providing a mass sampling technique.RDIT was employed to survey a wide sample of respondents across the United States (US). Respondents who self-identified as having had a surgical procedure or cared for someone having a surgical procedure were included in the analysis.1,004 participants completed the survey and answered questions regarding demographics, perioperative details, sentiments on postoperative recovery, postoperative clinical endpoints, sentiments on healthcare professionals, and opinions on future surgical care.The results of this cross-sectional study identified areas with potential for improvement in the patient perioperative experience that could improve the patient experience. This novel use of RDIT provided a valuable tool for real-time feedback and mass sampling allowing the creation of a dynamic healthcare environment that fosters timely and targeted improvements to patient experiences and outcomes.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"51 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140755098","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":"Pre-operative immune cell numbers and ratios are associated with peri-operative adverse outcomes in transfused patients","authors":"Michelle Roets, David J. Sturgess, Ching-Yu Chen, J. Punnasseril, Lee Jones, Andre A. van Zundert, Melinda M. Dean","doi":"10.3389/fanes.2024.1319588","DOIUrl":"https://doi.org/10.3389/fanes.2024.1319588","url":null,"abstract":"Transfusion-related immune modulation (TRIM) and associated adverse outcomes during major surgery are increasingly important to patients and health services internationally. A panel of pre-operative blood tests is an essential part of the pre-operative anaesthetic assessment. This panel of blood tests commonly considers numbers of immune cells (i.e., lymphocytes, monocytes, and neutrophils and cell ratios) that may be used as biomarkers to evaluate and potentially predict post-operative adverse outcomes.This retrospective data collection from eight hospital databases, within the Royal Brisbane and Women's Hospital, considered only patients who received blood transfusion during surgery (2016–2018) (n = 2,121). The association between pre-operative immune cell numbers and ratios and adverse outcomes were assessed. Adverse outcomes were coded using the International Classification of Diseases-10 (ICD-10) coding which specifically considered transfusion-related immune modulation. Results were adjusted for confounding factors.After adjustment, decreased pre-operative lymphocyte numbers and increased neutrophil/lymphocyte ratio (NLR) were associated with increased odds of developing infection; decreased NLR with decreased odds of developing adverse renal outcomes; and decreased lymphocyte numbers with decreased odds of developing adverse cardiovascular outcomes. Monocyte numbers, neutrophil numbers, and the lymphocyte/monocyte ratio (LMR) were not associated with increased adverse outcomes after adjustment.Pre-operative lymphocyte numbers and NLR are associated with adverse outcomes during peri-operative transfusion. Future assessment of peri-operative immune modulation should include the assessment of immune cell function and numbers.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139779834","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":"Pre-operative immune cell numbers and ratios are associated with peri-operative adverse outcomes in transfused patients","authors":"Michelle Roets, David J. Sturgess, Ching-Yu Chen, J. Punnasseril, Lee Jones, Andre A. van Zundert, Melinda M. Dean","doi":"10.3389/fanes.2024.1319588","DOIUrl":"https://doi.org/10.3389/fanes.2024.1319588","url":null,"abstract":"Transfusion-related immune modulation (TRIM) and associated adverse outcomes during major surgery are increasingly important to patients and health services internationally. A panel of pre-operative blood tests is an essential part of the pre-operative anaesthetic assessment. This panel of blood tests commonly considers numbers of immune cells (i.e., lymphocytes, monocytes, and neutrophils and cell ratios) that may be used as biomarkers to evaluate and potentially predict post-operative adverse outcomes.This retrospective data collection from eight hospital databases, within the Royal Brisbane and Women's Hospital, considered only patients who received blood transfusion during surgery (2016–2018) (n = 2,121). The association between pre-operative immune cell numbers and ratios and adverse outcomes were assessed. Adverse outcomes were coded using the International Classification of Diseases-10 (ICD-10) coding which specifically considered transfusion-related immune modulation. Results were adjusted for confounding factors.After adjustment, decreased pre-operative lymphocyte numbers and increased neutrophil/lymphocyte ratio (NLR) were associated with increased odds of developing infection; decreased NLR with decreased odds of developing adverse renal outcomes; and decreased lymphocyte numbers with decreased odds of developing adverse cardiovascular outcomes. Monocyte numbers, neutrophil numbers, and the lymphocyte/monocyte ratio (LMR) were not associated with increased adverse outcomes after adjustment.Pre-operative lymphocyte numbers and NLR are associated with adverse outcomes during peri-operative transfusion. Future assessment of peri-operative immune modulation should include the assessment of immune cell function and numbers.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"45 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139839579","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":"Postprocedural delirium following mechanical thrombectomy for acute ischemic stroke: a retrospective study","authors":"Alisha Sachdev, Daniel Torrez, Sarah Sun, George Michapoulos, Nicholas C. Rigler, Alexandra L. Feldner, Young Soo Hong, Robert J. McCarthy","doi":"10.3389/fanes.2024.1351698","DOIUrl":"https://doi.org/10.3389/fanes.2024.1351698","url":null,"abstract":"National representative estimates on in-hospital delirium after acute ischemic stroke are not well established and there is limited data on the impact of delirium on clinical outcomes following mechanical thrombectomy. We evaluated risk factors for delirium and the impact on outcomes following mechanical thrombectomy for acute ischemic stroke.This is a retrospective study of patients who underwent mechanical thrombectomy for acute ischemic stroke at a single tertiary comprehensive stroke center between April 2011 and December 2019. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Patient characteristics, comorbidities, laboratory data, elapsed times, tissue plasminogen activator use, duration of the procedure, type of anesthesia, National Institute of Health stroke scores (NIHSS), sedation scores, reperfusion grades, complications, length of hospital stay, discharge disposition, and 90-day mortality were evaluated.Five hundred and two patients were evaluated, and post-procedural delirium was identified in 24/467 (5.1%) patients. Thirty-five patients could not be assessed for delirium due to excessive sedation. The incidence of delirium in white vs. non-white patients <65 years was 5/137 (3.6%) compared to 0/91 (0%), and 7/176 (4.0%) compared to 12/63 (19%) in patients ≥65 years, P = 0.006. Bias reduction multi-variable analysis identified low postprocedural hemoglobin level odds ratio of 0.76 (95% CI 0.61–0.92, P = 0.006), greater age (odds ratio 1.04, 95% CI 1.01–1.009, P = 0.024), and non-white race odds ratio of 2.52 (95% CI 1.06–6.38, P = 0.030) as factors associated with delirium [Brier score = 0.045, C-index = 0.800, and Akaike Information Criterion (AIC) = 174]. General anesthesia was not associated with an increased delirium risk. NIHSS at 24 and 48 h and discharge, length of stay, and 90-day mortality were not different between delirium and no-delirium groups. Delirium patients had a reduced odds ratio of 0.13 (05% CI 0.01–1.00, P = 0.02) for home discharge.Delirium following mechanical thrombectomy for acute ischemic stroke primarily affected older patients and was associated with reduced odds of home discharge following hospitalization. Changes in NIHSS during hospitalization and 90-day mortality were not adversely affected by the presence of delirium. General anesthesia was not associated with an increased delirium risk following mechanical thrombectomy.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"51 46","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139845079","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":"Postprocedural delirium following mechanical thrombectomy for acute ischemic stroke: a retrospective study","authors":"Alisha Sachdev, Daniel Torrez, Sarah Sun, George Michapoulos, Nicholas C. Rigler, Alexandra L. Feldner, Young Soo Hong, Robert J. McCarthy","doi":"10.3389/fanes.2024.1351698","DOIUrl":"https://doi.org/10.3389/fanes.2024.1351698","url":null,"abstract":"National representative estimates on in-hospital delirium after acute ischemic stroke are not well established and there is limited data on the impact of delirium on clinical outcomes following mechanical thrombectomy. We evaluated risk factors for delirium and the impact on outcomes following mechanical thrombectomy for acute ischemic stroke.This is a retrospective study of patients who underwent mechanical thrombectomy for acute ischemic stroke at a single tertiary comprehensive stroke center between April 2011 and December 2019. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Patient characteristics, comorbidities, laboratory data, elapsed times, tissue plasminogen activator use, duration of the procedure, type of anesthesia, National Institute of Health stroke scores (NIHSS), sedation scores, reperfusion grades, complications, length of hospital stay, discharge disposition, and 90-day mortality were evaluated.Five hundred and two patients were evaluated, and post-procedural delirium was identified in 24/467 (5.1%) patients. Thirty-five patients could not be assessed for delirium due to excessive sedation. The incidence of delirium in white vs. non-white patients <65 years was 5/137 (3.6%) compared to 0/91 (0%), and 7/176 (4.0%) compared to 12/63 (19%) in patients ≥65 years, P = 0.006. Bias reduction multi-variable analysis identified low postprocedural hemoglobin level odds ratio of 0.76 (95% CI 0.61–0.92, P = 0.006), greater age (odds ratio 1.04, 95% CI 1.01–1.009, P = 0.024), and non-white race odds ratio of 2.52 (95% CI 1.06–6.38, P = 0.030) as factors associated with delirium [Brier score = 0.045, C-index = 0.800, and Akaike Information Criterion (AIC) = 174]. General anesthesia was not associated with an increased delirium risk. NIHSS at 24 and 48 h and discharge, length of stay, and 90-day mortality were not different between delirium and no-delirium groups. Delirium patients had a reduced odds ratio of 0.13 (05% CI 0.01–1.00, P = 0.02) for home discharge.Delirium following mechanical thrombectomy for acute ischemic stroke primarily affected older patients and was associated with reduced odds of home discharge following hospitalization. Changes in NIHSS during hospitalization and 90-day mortality were not adversely affected by the presence of delirium. General anesthesia was not associated with an increased delirium risk following mechanical thrombectomy.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"123 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139784943","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":"Technology in anesthesiology: friend or foe?","authors":"Wael Saasouh, Ewelina Suchocki, Matthew Weeks, George McKelvey, Muhammad Jaffar","doi":"10.3389/fanes.2023.1269410","DOIUrl":"https://doi.org/10.3389/fanes.2023.1269410","url":null,"abstract":"The field of medical technology has undergone significant advancements over the years, from the use of ancient scalpels, forceps, and sutures to complex devices like intraoperative MRI suites, artificial intelligence-enabled monitors, and robotic surgical systems. These advancements have had a profound impact on the way we diagnose, treat, and prevent diseases, and have significantly improved the quality of life for millions of people around the world. As we move forward, it is important to reflect on the direction of medical technology and consider the potential risks and benefits of new advancements. We must also ensure that these technologies are accessible to all and that they are used ethically and responsibly. There is still much to be discovered and developed in the field of medical technology, and it is up to us to ensure that we are moving in a positive direction that benefits everyone.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139386648","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":"Effects of aprepitant on post-operative nausea and vomiting in patients with congenital heart disease undergoing cardiac surgery or catheterization procedures: a retrospective study with subjects as their own historical control","authors":"John W. Belk, Mark D Twite, Katherine S. Klockau, Lori J. Silveira, Rachel G. Clopton","doi":"10.3389/fanes.2023.1190383","DOIUrl":"https://doi.org/10.3389/fanes.2023.1190383","url":null,"abstract":"For patients undergoing cardiac surgery and catheterization procedures, severe post-operative nausea and vomiting (PONV) can occur despite standard anti-emetic interventions. Aprepitant, a neurokinin-1 (NK-1) receptor blocker, is safe and effective at preventing PONV resistant to standard therapies.Patients with a history of severe PONV presenting for cardiac surgery or catheterization procedures from January 1, 2018 to January 6, 2021 were identified. After pharmacist approval, patients received aprepitant pre-operatively (Dose: 80 mg for weight >50 kg, 40 mg for weight 30–50 kg). A retrospective chart review was performed. Primary outcomes of the incidence of PONV and PONV-related complications were evaluated.Seventeen patients were included with a mean age of 16.0 years at the time of their initial procedure, which acted as the “control” procedure, and 17.5 years when they received aprepitant. After the control procedure 64.7% of patients required rescue anti-emetics. When this group of patients received aprepitant pre-operatively at their subsequent procedure, only 17.6% required rescue medication (p = 0.005). Similarly, 64.7% of patients suffered at least one PONV-related complication after the control procedure. With aprepitant use pre-operatively, 5.9% of the same patients experienced a PONV-complication (p = 0.0003). Specifically, unplanned ICU admission due to severe PONV after catheterization procedures decreased from 55.6% (5/9) in the control group to 0 after these patients were treated pre-emptively with aprepitant (p = 0.01). For surgical patients, there were significant decreases in PONV-related complications including delayed oral intake and delayed ambulation (p = 0.04) in the aprepitant group compared to the control group.This small, retrospective study supports the conclusion that preoperative aprepitant administration in patients undergoing cardiac catheterization or cardiac surgery with a history of congenital heart disease and severe PONV significantly reduces the incidence of PONV and PONV-related complications. Decreasing these complications will likely improve the surgical experience for patients and families while also decreasing hospital costs and improving efficiency.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"2014 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132221849","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":"Cerebral autoregulation and cerebral blood flow response to mean arterial pressure challenge following induction of general anaesthesia for neuroradiology procedure","authors":"Elsa Manquat, Hugues Ravaux, J. Souilamas, Thibaut Chamoux, Jona Joaquim, E. Gayat, F. Vallée, J. Cartailler","doi":"10.3389/fanes.2023.1169961","DOIUrl":"https://doi.org/10.3389/fanes.2023.1169961","url":null,"abstract":"Intraoperative hypotension is common following general anaesthesia induction with propofol, but its impact on cerebral autoregulation (CA) remains unclear. We investigate the incidence and risk factors of impaired CApost-propofol induction and its recovery after a mean arterial pressure (mAP) challenge.We included 40 non-emergency neuroradiology surgery patients [58 (47, 58)years old., 57% women]. We recorded mAP, mean blood flow velocity in the mean cerebral artery (MCAvmean), and regional cerebral oxygen saturation (rSO2). We computed the mean flow index (Mxa) pre and post mAP challenge. Mxa > 0.3 defined poor CA.After anaesthesia induction, 21 (53%) had impaired CBF autoregulation (CA−, Mxa > 0.3). The average mAP was 66 ± 9 mmHg, average MCAv was 39 ± 12 cm.s−1, and rSO2 was 63 ± 7%. We found no significant difference in age, norepinephrine infusion rate, and cardiovascular risks factors were similar between CA− and CA+ (Mxa ≤ 0.3) patients. Among the 22 patients (CA−: n = 14; CA+: n = 8) undergoing mAP challenge, there was a significant Mxa improvement and MCAv increase among CA− patients, (CA−: 0.63 ± 0.18 vs. 0.28 ± 0.20, p < 0.001), and [absolute variation: 1 (0.7–1.5) vs. 7 (3–9) cm.sec−1], respectively.After induction of general anaesthesia for neuroradiology procedure, 53% of the patients had an impaired CA, regardless of age or medical history. Importantly, a mAP challenge effectively restored CA and improved CBF.identifier, NCT04288869","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"178 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133035926","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":"Safety in obstetric anesthesia requires more research and support","authors":"A. Van Zundert","doi":"10.3389/fanes.2023.1249720","DOIUrl":"https://doi.org/10.3389/fanes.2023.1249720","url":null,"abstract":"","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"130 19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115328535","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}