Brain Hemorrhages最新文献

{"title":"Brain hemorrhages in traumatic brain injury and the excess burden conferred by anticoagulants and antiplatelets","authors":"Jai Gupta, L. Ganti","doi":"10.1016/j.hest.2024.05.003","DOIUrl":"https://doi.org/10.1016/j.hest.2024.05.003","url":null,"abstract":"","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141136479","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":"Fluid balance management with loop diuretics in patients with aneurysmal subarachnoid hemorrhage treated with clazosentan: A case series","authors":"Yosuke Akamatsu ,&nbsp;Kohei Chida ,&nbsp;Kenya Miyoshi ,&nbsp;Daigo Kojima ,&nbsp;Jun-Ichi Nomura ,&nbsp;Kengo Setta ,&nbsp;Takayuki Chiba ,&nbsp;Takahiro Koji ,&nbsp;Shunrou Fujiwara ,&nbsp;Hiroshi Kashimura ,&nbsp;Yoshitaka Kubo ,&nbsp;Kuniaki Ogasawara","doi":"10.1016/j.hest.2023.10.003","DOIUrl":"10.1016/j.hest.2023.10.003","url":null,"abstract":"<div><h3>Objective</h3><p>Pulmonary edema is a common complication in patients receiving clazonsentan. Here, we report our experience in managing fluid balance with loop diuretics in patients with aneurysmal subarachnoid hemorrhage (aSAH) treated with clazosentan.</p></div><div><h3>Methods</h3><p>Patients with aSAH who received prophylactic agents for vasospasm after aneurysm obliteration between June 2021 and April 2023 were enrolled. Fluid balance parameters and asymptomatic and symptomatic vasospasm and pulmonary edema incidence were compared in three periods: 1st period (fasudil therapy), 2nd period (clazosentan therapy alone), and 3rd period (clazosentan with loop diuretic therapy).</p></div><div><h3>Results</h3><p>Fluid intake and urine volume during the 2nd and 3rd periods were considerably lesser than those during the 1st period. Asymptomatic vasospasm incidence was considerably lesser in the 3rd period than that in the 1st and 2nd periods. However, the incidences of symptomatic vasospasm and rescue endovascular treatment were comparable among the three groups. Although the clinical outcomes at the last follow-up were comparable among the three groups, pulmonary edema incidence was markedly higher during the 2nd period than that in the 1st and 3rd periods.</p></div><div><h3>Conclusion</h3><p>Thus, proper management of fluid balance with clazosentan and diuretics would help in effective clazosentan therapy for vasospasm prophylaxis.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X23000414/pdfft?md5=d0c4658f8715f5141a48e41c4af0ee67&pid=1-s2.0-S2589238X23000414-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135762608","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":"Beneficial effects of clazosentan add-on treatment on delayed cerebral microcirculatory disturbances after aneurysmal subarachnoid hemorrhage","authors":"Hidenori Suzuki ,&nbsp;Hideki Nakajima ,&nbsp;Tomonori Ichikawa ,&nbsp;Ryuta Yasuda ,&nbsp;Takeshi Okada ,&nbsp;Fuki Goto ,&nbsp;Shota Ito ,&nbsp;Yasutaka Horiuchi ,&nbsp;Yotaro Kitano ,&nbsp;Hirofumi Nishikawa ,&nbsp;Masashi Fujimoto ,&nbsp;Naoki Toma","doi":"10.1016/j.hest.2023.10.006","DOIUrl":"10.1016/j.hest.2023.10.006","url":null,"abstract":"<div><h3>Objective</h3><p>This retrospective study aimed to analyze the prospectively collected data of computed tomography (CT) perfusion imaging and to examine if clazosentan add-on administration prevented post-subarachnoid hemorrhage (SAH) delayed cerebral microcirculatory dysfunctions.</p></div><div><h3>Methods</h3><p>A total of 36 consecutive patients with non-mild SAH due to ruptured anterior circulation aneurysms and no significant cardiopulmonary dysfunctions (mean age, 67.9 years; and admission World Federation of Neurological Surgeons grades IV–V, 66.7 %) underwent aneurysmal obliteration up to day 3 post-SAH, followed by our conventional treatment (fasudil hydrochloride, cilostazol and perampanel administrations; n = 20; January 2020 to May 2022) or add-on administration of clazosentan (10 mg/hr) to the conventional treatment (n = 16; June 2022 to May 2023).</p></div><div><h3>Results</h3><p>Clazosentan add-on treatment significantly affected perioperative fluid management, which appeared to have no effects on the finding of CT perfusion imaging performed a median of 6.5 to 7.0 days post-SAH. However, cerebral blood flow and mean transit time were better in patients receiving add-on administration of clazosentan, although angiographic vasospasm frequencies and cerebral blood volume values were similar between the two treatment groups.</p></div><div><h3>Conclusion</h3><p>The findings suggest that clazosentan add-on treatment has beneficial effects against post-SAH angiographic vasospasm-unrelated delayed cerebral microcirculatory dysfunctions possibly by improving blood flow in smaller resistance arteries or arterioles.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X2300044X/pdfft?md5=dad888183e2d60ce0d53b778fa82a984&pid=1-s2.0-S2589238X2300044X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136128936","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":"Clazosentan, first approval in Japan: Has perioperative management of subarachnoid hemorrhage changed?","authors":"Hidenori Suzuki","doi":"10.1016/j.hest.2023.12.004","DOIUrl":"10.1016/j.hest.2023.12.004","url":null,"abstract":"","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X23000645/pdfft?md5=764f733c7c552eb6e685a70a2c6c68a0&pid=1-s2.0-S2589238X23000645-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138992296","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":"Impact of strict fluid management on the treatment outcome of clazosentan for cerebral vasospasm","authors":"Takaaki Itazu,&nbsp;Taichi Ikedo,&nbsp;Takeyoshi Tsutsui,&nbsp;Akihiro Niwa,&nbsp;Yuji Kushi,&nbsp;Saya Ozaki,&nbsp;Naoto Yamada,&nbsp;Koji Shimonaga,&nbsp;Eika Hamano,&nbsp;Kiyofumi Yamada,&nbsp;Hirotoshi Imamura,&nbsp;Hisae Mori,&nbsp;Koji Iihara,&nbsp;Hiroharu Kataoka","doi":"10.1016/j.hest.2023.12.001","DOIUrl":"10.1016/j.hest.2023.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>Clazosentan (CLA) reduces cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). However, adverse events including pulmonary edema were reported. We examined whether the strict management of fluid balance reduces the adverse events and improves patient outcomes.</p></div><div><h3>Methods</h3><p>Patients with aSAH between 2020 and 2023 were included. They were divided into pre-CLA (before CLA approval) and post-CLA (after approval) groups. The patients in the post-CLA group were further divided into the post-CLA1 (before the change in fluid management) and post-CLA2 (after the change) groups. To achieve fluid balance of 0–500 ml/day according to the modified protocol, the infusion volume was restricted.</p></div><div><h3>Results</h3><p>The daily fluid balance increased from the pre-CLA to the post-CLA1 periods (p = 0.01). The protocol changes decreased the pulmonary edema (post-CLA1 vs. post-CLA2, 44 vs. 22 %, p = 0.09) and discontinuation of CLA (44 vs. 9 %, p &lt; 0.01). The incidence of symptomatic spasm (SS) and delayed cerebral infarction (DCI) in the post-CLA2 were slightly reduced without significant differences (SS: 17 vs. 13 %, p = 0.69; DCI: 11 vs. 9 %, p = 1.00).</p></div><div><h3>Conclusion</h3><p>Strict management of fluid balance during CLA treatment reduced the adverse events and discontinuation of CLA administration. Fluid restriction may positively affect the management of cerebral vasospasms.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X2300061X/pdfft?md5=3109190f2bfaedbd0b9d40e1fcb24881&pid=1-s2.0-S2589238X2300061X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138615483","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":"A high cardiothoracic ratio increases the risk of severe pulmonary complications after early initiation of clazosentan in patients with aneurysmal subarachnoid hemorrhage","authors":"Rikuo Nishii,&nbsp;Tsuyoshi Ohta,&nbsp;Nobuyuki Fukui,&nbsp;Masaomi Koyanagi,&nbsp;Masanori Goto,&nbsp;Junichi Takeda,&nbsp;Ryu Fukumitsu,&nbsp;Tadashi Sunohara,&nbsp;Yuki Takano,&nbsp;Kunimasa Teranishi,&nbsp;Kota Nakajima,&nbsp;Yuji Naramoto,&nbsp;Yasuhiro Yamamoto,&nbsp;Satohiro Kawade,&nbsp;Ryo Sakisuka,&nbsp;Takateru Takamatsu,&nbsp;Masanori Tokuda,&nbsp;Hikari Tomita,&nbsp;Mai Yoshimoto,&nbsp;Nobuyuki Sakai","doi":"10.1016/j.hest.2023.11.007","DOIUrl":"10.1016/j.hest.2023.11.007","url":null,"abstract":"<div><h3>Objective</h3><p>Pulmonary complications, which are occasionally severe, are common adverse events following the administration of clazosentan. This study aimed to identify factors associated with severe pulmonary adverse events due to clazosentan after aneurysmal subarachnoid hemorrhage (aSAH).</p></div><div><h3>Methods</h3><p>We conducted a retrospective study of 59 patients transported to our hospital and diagnosed with aSAH between April 2022 and May 2023.</p></div><div><h3>Results</h3><p>The analysis included 33 patients who were treated with clazosentan. Pulmonary complications occurred in 20 patients (61 %) and clazosentan administration was discontinued due to severe pulmonary complications in 7 patients (21 %). The cardiothoracic ratio on admission was significantly higher (57 % vs. 49 %, <em>p</em> = 0.0081) and clazosentan was initiated earlier after aSAH onset (42 vs. 66 h, <em>p</em> = 0.047) in patients who discontinued clazosentan compared with patients who completed administration of clazosentan. The median duration of clazosentan administration was 3.2 days in the discontinuation group. No significant associations were found between the time of clazosentan initiation and the incidence of angiographic vasospasm, delayed cerebral ischemia, or 90-day modified Rankin scale.</p></div><div><h3>Conclusions</h3><p>The risk of severe pulmonary complications is higher in patients with high cardiothoracic ratios on admission, and delaying clazosentan initiation may prevent pulmonary complications even in high-risk cases.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X23000517/pdfft?md5=e325369c7d66c8909b709c2192fa359b&pid=1-s2.0-S2589238X23000517-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135510272","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":"Could clazosentan, first approved in Japan, improve neurological prognosis after subarachnoid hemorrhage in combination with modified water-electrolyte management?","authors":"Eiji Shikata ,&nbsp;Izumi Yamaguchi ,&nbsp;Masaaki Korai ,&nbsp;Takeshi Miyamoto ,&nbsp;Tadashi Yamaguchi ,&nbsp;Hiroshi Kagusa ,&nbsp;Kenji Shimada ,&nbsp;Yoshiteru Tada ,&nbsp;Keiko T. Kitazato ,&nbsp;Yasuhisa Kanematsu ,&nbsp;Yasushi Takagi","doi":"10.1016/j.hest.2023.10.005","DOIUrl":"10.1016/j.hest.2023.10.005","url":null,"abstract":"<div><p>An aneurysmal subarachnoid hemorrhage (aSAH) is a devastating event associated with a high mortality and morbidity rate. Though numerous medications are used to prevent cerebral vasospasm and vasospasm-related cerebral infarction after aSAH, no effective pharmacological treatment has been established. Clazosentan, a highly selective endothelin receptor type A antagonist, was approved for use in Japan in April 2022 based on results of two pivotal randomized, placebo-controlled phase 3 studies (JapicCTI-163369, JapicCTI-163368). These studies indicated that clazosentan significantly reduced the incidence of vasospasm-related morbidity and all-cause mortality after aneurysm coiling and clipping. Clazosentan is thus expected to become a “game changer” for improving the neurological prognosis after aSAH. However, other reports indicate that even when clazosentan or nimodipine are administered for prophylaxis against delayed neurological decline, patients treated with increased colloid administration or hypertonic saline (3% sodium chloride) load exhibit poor functional outcome and higher mortality, suggesting that extra fluid and sodium derived from prophylactic colloid administration contribute to negative outcomes after aSAH. Pharmacological treatments such as clazosentan in addition to perioperative management involving delivery of less water and sodium might be crucial for achieving better outcomes than conventional therapy. Based on a literature review, we present here the future perspectives regarding clazosentan and the necessity for modifying management of the water-electrolyte balance by focusing on endothelin-1 and blood–brain barrier disruption.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X23000438/pdfft?md5=007dbb3fa62e5593cb4cd48a58198c33&pid=1-s2.0-S2589238X23000438-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136127697","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":"Evolving approaches in the management of patients with subarachnoid hemorrhage from 2002 to 2022: The impact of clazosentan and treatment modalities on outcomes","authors":"Hajime Maeda ,&nbsp;Tsuyoshi Izumo ,&nbsp;Kazuaki Okamura ,&nbsp;Susumu Yamaguchi ,&nbsp;Yoichi Morofuji ,&nbsp;Takayuki Matsuo","doi":"10.1016/j.hest.2023.11.006","DOIUrl":"10.1016/j.hest.2023.11.006","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to assess the changes in patient demographics, aneurysm characteristics, and treatment modalities for subarachnoid hemorrhage (SAH) over the past two decades.</p></div><div><h3>Methods</h3><p>We analyzed SAH 6,446 patients between 2002 and 2022, which was divided into three periods: 2002–2011 (FP), 2012–2021 (SP), and post-clazosentan 2022 (PC). The final cohort included 2878, 2016, and 152 patients in FP, SP, and PC groups, respectively. We examined patient demographics, surgical procedures, spasm prevention therapy, and delayed ischemic neurological deficits (DIND).</p></div><div><h3>Results</h3><p>The mean age of the patients increased over the study period (64, 66, and 68 years in FP, SP, and PC groups, respectively). Clipping was the predominant method during FP (79 %); however, coiling surpassed clipping in 2022 (coiling vs. clipping, 47 % vs. 46.3 %). Before clazosentan introduction, fasudil was the primary spasm prevention treatment (&gt;80 %); however, its use decreased (63.9 %) after clazosentan introduction. DIND varied across FP, SP, and PC groups (37.4 %, 24.2 %, and 16.7 % respectively). Age and generation were significantly associated with DIND and irreversibility.</p></div><div><h3>Conclusion</h3><p>Regarding the management of patients with SAH, shift from clipping to coiling, and the introduction of new spasm prevention treatments such as clazosentan were observed, led to a decrease in DIND.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X23000505/pdfft?md5=832725d93f0fd4ffbe7b31cbe971bf53&pid=1-s2.0-S2589238X23000505-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135510273","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":"Initial results of clazosentan with multiple-drug management for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage","authors":"Tatsuki Kimura,&nbsp;Kaima Suzuki,&nbsp;Hiroki Sato,&nbsp;Aoto Shibata,&nbsp;Yushiro Take,&nbsp;Hidetoshi Ooigawa,&nbsp;Masataka Yoshimura,&nbsp;Shinya Kohyama,&nbsp;Hiroki Kurita","doi":"10.1016/j.hest.2024.01.004","DOIUrl":"10.1016/j.hest.2024.01.004","url":null,"abstract":"<div><h3>Objective</h3><p>Cerebral vasospasm is an unelucidated complication of subarachnoid hemorrhage. Various treatments exist against cerebral vasospasms however, consensus on the optimal treatment is lacking. We use clazosentan, which is used to prevent cerebral vasospasm, with multidrug combinations. In this study, we aimed to clarify the initial results of using clazosentan in multidrug combinations in the real world.</p></div><div><h3>Methods</h3><p>We retrospectively investigated 54 patients who were treated for subarachnoid hemorrhage and received clazosentan. We compared the results of these patients on the basis of two groups: those with good outcomes (modified Rankin scale score: 0–3) and poor outcomes (4–6) at discharge.</p></div><div><h3>Results</h3><p>Among the patients, poor outcome was observed in 19 patients (35.2 %). Angiographic vasospasms occurred in 10 patients (good outcome [n = 6] vs. poor outcome [n = 4]; p = 0.73), and symptomatic vasospasms occurred in 4 patients (n = 2 vs. n = 2, p = 0.61). The incidence of pleural effusion (28.6 % vs. 73.7 %, p &lt; 0.01) and the mean daily fluid balance (303.5 mL/day vs. 785.4 mL/day, p &lt; 0.01) were higher in the poor outcome group.</p></div><div><h3>Conclusion</h3><p>Pleural effusion and high positive balance may be associated with poor outcome. However, the number of cases examined was small; therefore, further large-scale studies with a bigger sample size are needed.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X24000135/pdfft?md5=4299f1a83ece989eff9004b4f29c1b6e&pid=1-s2.0-S2589238X24000135-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639241","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":"Recent trends of treatment strategies and outcomes of basal ganglia hemorrhages at a single institution","authors":"Benjamin M. Abraham, Kelli Manikowski, Nathan Risk, Aaron Schmid, Arielle Coy, Bradley N. Bohnstedt","doi":"10.1016/j.hest.2024.03.001","DOIUrl":"https://doi.org/10.1016/j.hest.2024.03.001","url":null,"abstract":"","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140276018","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}