Apollo Medicine最新文献

{"title":"Epidemiology, Clinical Characteristics, and Outcomes of Culture-negative Sepsis","authors":"Varun Byrappa, Ramesh Venkataraman, Nagarajan Ramakrishnan, Ashwin Kumar Mani","doi":"10.4103/am.am_24_23","DOIUrl":"https://doi.org/10.4103/am.am_24_23","url":null,"abstract":"Abstract Aim: Culture-negative sepsis (CNS) is a common but understudied entity. The objective of this study was to compare the incidence, characteristics, and outcomes of CNS with culture-positive sepsis (CPS). Methods: This was a prospective observational study of patients admitted to the medical intensive care unit (ICU) of a tertiary hospital from January to December 2015 with clinical suspicion of severe sepsis as defined by Consensus Conference Criteria 2001. Results: Patients with severe sepsis ( n = 122) were studied of whom 66 (54%) were CPS and 56 (46%) were CNS. Patients with CNS had fewer comorbidities (0.7 ± 0.70 vs. 2 ± 0.8, P < 0.01). At presentation, CNS patients had less tachycardia (heart rate 92.5 ± 10.5 vs. 105.9 ± 13.2, P < 0.01), lower white blood cell counts (11859 ± 4791 vs. 14224 ± 3898, P = 0.003), lower need for vasopressors (38% vs. 68%, P < 0.01), and mechanical ventilation (23% vs. 53%, P < 0.01) compared to patients with CPS. The number of antibiotics on admission was similar between the groups (1.5 ± 0.6 vs. 1.6 ± 0.6, P = 0.36) but the duration of antibiotics was less in CNS (7.6 ± 1.7 days vs. 10.4 ± 2.6 days, P < 0.01). CNS had lower duration of ICU stay (6 ± 2.1 days vs. 7.8 ± 3.7 days, P < 0.01) and lower ICU mortality (7.1% vs. 22.7%, P = 0.02). Conclusion: CNS is very common in ICU. CNS patients compared to CPS tend to be less sick at presentation utilizing less resources but were initiated on a similar number of antibiotics on admission although for a shorter duration. Patients with CNS had a lower mortality in comparison to those with CPS.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"18 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":"135998808","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":"An Uncommon Case of Persistent Papilledema without Hydrocephalus in the Setting of Tuberculous Meningitis","authors":"D. Raval, V. Rathod, Princy D Lukhi, D. L. Solanki","doi":"10.4103/am.am_149_23","DOIUrl":"https://doi.org/10.4103/am.am_149_23","url":null,"abstract":"\u0000 \u0000 \u0000 Tuberculosis (TB) remains a health problem across the world, with an estimated 10.4 million cases and 1.8 million deaths resulting from the disease per year. The most fatal and disabling form of TB is tuberculous meningitis (TBM), of which approximately more than 100,000 new cases are occurring every year. TBM presents as extra-pulmonary TB, caused by the seeding of the meninges with Mycobacterium tuberculosis bacilli forming subependymal clusters known as rich’s foci. They can entrap within blood vessels as well as restrict Cerebrospinal fluid (CSF) flow, resulting in vasculitis, and hydrocephalus, respectively. These immune responses result in complications and sequelae in persons who recover from TBM. The outcome of TBM varies depending on factors such as the severity of the infection, the timing of diagnosis, and the promptness and effectiveness of treatment. Depending on these factors, the mortality rate can range from 20% to 60%. Delays in diagnosis and treatment can lead to complications such as neurological deficits, hydrocephalus, stroke, and vision problems.\u0000 \u0000 \u0000 \u0000 Here, we have discussed a case of a TBM patient who presented with constitutional symptoms such as headache, fever, cough, weight loss, and dizziness. During hospitalization, she developed a progressive diminished vision which led to difficulty in walking.\u0000 \u0000 \u0000 \u0000 Radio-imaging showed leptomeningitis without evidence of ventricular enlargement, CSF examination was consistent with TBM, and fundoscopy showed bilateral papilledema. Based on these findings, she was started on anti-TB therapy (ATT), however, her papilledema was persistent even after 15 days of therapy without any evidence of hydrocephalus, which is a very unusual finding in TBM.\u0000 \u0000 \u0000 \u0000 Our case outlines the rare presentation of papilledema without hydrocephalous in TBM.\u0000","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45075317","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":"Serous Papillary Adenofibroma of Fallopian Tube in a Case of Endometrial Adenocarcinoma","authors":"Maruti A. Dhakane, Ankita Majumder, Vandana Gite","doi":"10.4103/am.am_110_23","DOIUrl":"https://doi.org/10.4103/am.am_110_23","url":null,"abstract":"\u0000 \u0000 \u0000 Primary fallopian tube neoplasms are usually rare, and they are the rarest of all female genital tract neoplasms. According to the WHO classification, papillomas, adenofibroma, cystadenoma, cystadenofibroma, and metaplastic papillary tumors belong to the group of benign tumor masses that arise from the fallopian tubes.\u0000 \u0000 \u0000 \u0000 In our case, during an abdominal hysterectomy in a 45-yearold woman suspicious of endometrial adenocarcinoma, a right tubal mass was incidentally found.\u0000 \u0000 \u0000 \u0000 Microscopic findings revealed features of serous papillary adenofibroma. Serous papillary adenofibroma is a very rare tumor. Till date, only a few cases have been reported worldwide, more so in the presence of endometrial malignancy.\u0000 \u0000 \u0000 \u0000 Serous papillary adenofibroma is often an incidental finding; thus, it is important to gross the specimen minutely to look for any such finding in the adnexa to avoid missing out on such rare neoplasm.\u0000","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41695393","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":"Study on Intratumoral Heterogeneity of Expression of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 in Carcinoma Breast","authors":"R. Uthayasuriyan, Sheba S. K. Jacob, S. Shah","doi":"10.4103/am.am_123_23","DOIUrl":"https://doi.org/10.4103/am.am_123_23","url":null,"abstract":"\u0000 \u0000 \u0000 The aim of this study was to study intratumoral heterogeneity in the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) between two different cores/blocks of core needle biopsy (CNB), two different blocks of the same lesion in resection specimen (RS), and in between the CNB and RS.\u0000 \u0000 \u0000 \u0000 This is a prospective observational study of all the cases of breast carcinoma received in the department of histopathology for 2 years. All the patients with breast carcinoma diagnosed by CNB and RS were analyzed by three pathologists independently by immunohistochemistry.\u0000 \u0000 \u0000 \u0000 Of the 75 cases, 74 were females and 1 male with a peak incidence of 60–70 years. Invasive breast carcinoma of no special type (97%) was the most common, followed by invasive lobular carcinoma (3%). Grade III tumors (44%) were more common, followed by Grade II (39%) and Grade I (17%). ER and PR showed a concordance rate of 96% (P < 0.05), whereas the HER2 showed a concordance rate of 93% (P < 0.05%). The concordance of ER decreased with increasing tumor size and grade, while PR and HER2 showed variable concordance with tumor size and grade.\u0000 \u0000 \u0000 \u0000 The concordance rate of ER and PR (96%) was higher than (93%) HER2. In most cases, biomarker expression in core biopsy and single tumor block was reflective of breast carcinoma as a whole. However, because of the heterogeneous expression of biomarkers, we recommend testing tumors with negative biomarker expression on CNB, again on the RS.\u0000","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41639134","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":"Decompressive Craniectomy in Postpartum Cortical venous Thrombosis Masquerading as Postspinal Headache","authors":"Neelam Suri, Vinit Suri, K. Suri","doi":"10.4103/am.am_111_22","DOIUrl":"https://doi.org/10.4103/am.am_111_22","url":null,"abstract":"\u0000 \u0000 \u0000 Cerebral venous sinus thrombosis is commonly seen during pregnancy or in the postpartum period due to multiple physiological changes resulting in an altered state of homeostasis and a hypercoagulable state. Cortical vein thrombosis is a subgroup of cerebral venous thrombosis where there is an involvement of the superficial cerebral veins and may occur with or without coexisting sinus venous thrombosis. Early identification of the diagnosis is of utmost importance to reduce morbidity and mortality. Differentiation from postspinal headache may be difficult until the occurrence of neurological features and a high level of suspicion for this condition is required. Contrast magnetic resonance imaging venography or computed tomography venography can confirm the diagnosis.\u0000 \u0000 \u0000 \u0000 We report a case of postpartum cortical venous thrombosis with malignant cerebral sinus venous thrombosis (CSVT).\u0000 \u0000 \u0000 \u0000 The patient was managed with a lifesaving decompressive craniectomy (DC) procedure and anticoagulants with a favorable response.\u0000 \u0000 \u0000 \u0000 Obstetricians should be aware of this medical complication of pregnancy and of its management. Medical treatment with anticoagulants is the mainstay of therapy. Patients with malignant CSVT presenting with rapid and severe neurological decline carry a high mortality, and early DC in this subgroup can be lifesaving. Contraceptive agents containing estrogens should not be administered in patients with a previous history of CSVT, and prophylactic low-molecular-weight heparin should be administered throughout a subsequent pregnancy and continued into the puerperium.\u0000","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43147070","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":"Challenges in the Prevention of Surgical Site Infections in India","authors":"Isabella Princess","doi":"10.4103/am.am_100_23","DOIUrl":"https://doi.org/10.4103/am.am_100_23","url":null,"abstract":"\u0000 \u0000 Surgical site infections (SSIs) are health-care-associated infections that burden not only patients undergoing various surgical procedures but the health-care facilities providing care as well. Although preventable, SSIs contribute to complicated and lengthy hospital stays for patients undergoing surgeries, especially in developing countries more than in developed nations. Anticipating and implementing measures to curtail such preventable events in a health-care facility are of utmost importance in providing quality health care. Enhancing and strengthening infection control practices lie in the hands of all health-care workers coming in contact with a patient from the time of admission to discharge. The standard guidelines and protocols are in place by various organizations worldwide on SSI prevention. These guideline-based recommendations are discussed in this review to guide clinicians, microbiologists, infection control specialists, and nurses to excel in safe surgery practices, thereby achieving effective and sustainable patient care. Apart from this, hurdles in our country and ways of handling the same are also discussed.\u0000","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43605146","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":"Effect of Oral Clonidine and Gabapentin as Premedication on Intraoperative Hemodynamic Responses and Postoperative Analgesia Requirement in Laparoscopic Cholecystectomy","authors":"Megha Tyagi, Arvinpreet Kour, Ajaydeep Singh, Ritu Gupta, Ramnandan Prasad","doi":"10.4103/am.am_94_23","DOIUrl":"https://doi.org/10.4103/am.am_94_23","url":null,"abstract":"\u0000 \u0000 \u0000 Laparoscopic cholecystectomy pain is a sensory and emotional experience connected with actual or potential tissue damage. Effective pain control is quite important, with around 70% of patients still complaining of moderate-to-severe pain postoperatively. Uncontrolled perioperative pain may raise patient morbidity and mortality rates. Both gabapentin and clonidine as premeditated can be easily administered have minimal side effects, are easily available at a low price, both them have a sedative effect that can decrease anxiety and they can blunt the stress response. Moreover, both drugs have anti-nociceptive effects that may be beneficial for controlling postoperating pain which is the basis of our current study.\u0000 \u0000 \u0000 \u0000 This study aims to compare the efficacy of oral clonidine with gabapentin before induction of anesthesia in attenuating hemodynamic stress response to laryngoscopy, intubation, and carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy and to compare the efficacy of oral clonidine with oral gabapentin for postoperative pain control.\u0000 \u0000 \u0000 \u0000 Hundred patients undergoing laparoscopic surgery and qualifying inclusion criteria were randomly allocated into two groups each containing 50 patients. Group I patients were given Tab. Clonidine (300 μg) and Group II patients were given tablet Gabapentin (600 mg) orally 60 min before induction of general anesthesia. Hemodynamic changes and the incidence of postoperative pain in both groups were measured and compared.\u0000 \u0000 \u0000 \u0000 Hemodynamic blunting to pressor stress of laryngoscopy and intubation was seen in both groups with better results obtained in the group receiving clonidine in the form of lesser variations in heart rate, systolic blood pressure, and diastolic blood pressure. Postoperative analgesia was achieved in both groups but gabapentin showed a better analgesic profile in the form of lesser Visual Analog Scale scoring and decreased utilization of rescue analgesia.\u0000 \u0000 \u0000 \u0000 Clonidine (300 μg) cause a greater attenuation of intraoperative hemodynamic stress responses, whereas gabapentin (600 mg) provides superior postoperative analgesia.\u0000","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45948387","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":"A Case Report on Left Ruptured Tubal Ectopic Pregnancy Post - Tubal Recanalization","authors":"Neharika Lamsal, Y. Sandhya, Rinju Sara Rajan, Sona P. Sam","doi":"10.4103/am.am_107_23","DOIUrl":"https://doi.org/10.4103/am.am_107_23","url":null,"abstract":"\u0000 \u0000 \u0000 An ectopic pregnancy occurs when the fertilized egg is implanted and develops outside the endometrium, i.e. in the fallopian tubes, cervix, ovary, or abdomen. It commonly presents as vaginal bleeding, lower abdominal pain, and amenorrhea.\u0000 \u0000 \u0000 \u0000 In this case study, we report on a 40-year-old woman G3P2 L2 complaining of excessive bleeding per vagina and abdominal pain for 5 days along with generalized weakness for 15 days, presented to the emergency department of SSIMS and RC, Davangere.\u0000 \u0000 \u0000 \u0000 On examination and ultrasound reports, the patient was diagnosed with posttubal recanalization with 3 weeks left ruptured tubal ectopic pregnancy. The patient consented to undergo an emergency laparotomy with bilateral salpingectomy under spinal anesthesia; thus her condition was successfully managed.\u0000 \u0000 \u0000 \u0000 Maternal age of 35 years or older, and a history of tubal sterilization and recanalization has been known to increase the risk of ectopic pregnancies.\u0000","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46565510","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":"Persistent Postural-perceptual Dizziness","authors":"Santosh Kumar Swain","doi":"10.4103/am.am_144_23","DOIUrl":"https://doi.org/10.4103/am.am_144_23","url":null,"abstract":"\u0000 \u0000 \u0000 Persistent postural-perceptual dizziness (PPPD) is characterized by chronic subjective dizziness, phobic postural vertigo, and related disorders. For at least 3 months, it exhibits varying symptoms of vertigo, unsteadiness, or dizziness.\u0000 \u0000 \u0000 \u0000 Research articles regarding PPPD were searched by viewing the Scopus, PubMed, Medline, and Google Scholar databases online. A search strategy using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used.\u0000 \u0000 \u0000 \u0000 It presents a typical chronic vestibular system and brain malfunction that result in persistent dizziness, nonspinning vertigo, and/or unsteadiness. Persistent nonvertiginous dizziness and hypersensitivity to motion and visual stimuli are the main signs and symptoms of PPPD. These symptoms appeared either when there were no active neuro-otologic illnesses or when an episodic vestibular condition was present but could not completely account for the symptoms. Psychological mechanisms that resemble cognitive models of health anxiety and panic disorder are involved in the PPPDs development and maintenance.\u0000 \u0000 \u0000 \u0000 Since PPPDs diagnostic criteria only involve symptoms, the patient’s clinical history is crucial in making the diagnosis. Once diagnosed, effective communication and personalized treatment plans, such as serotonergic medicines, cognitive behavioral therapy, and specialized physical therapy (vestibular rehabilitation), help manage PPPD. Since PPPD is a relatively recent clinical diagnosis, many medical practitioners who treat patients who feel dizzy are unfamiliar with it.\u0000","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46651447","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":"Sexual Dysfunction in Diabetes Mellitus – An Observational Cohort Study","authors":"G. Mohan, G. S. Mann, T. Sikri","doi":"10.4103/am.am_36_23","DOIUrl":"https://doi.org/10.4103/am.am_36_23","url":null,"abstract":"\u0000 \u0000 \u0000 The objectives of the study are to assess the prevalence and type of sexual dysfunction (SD) in males and females living with diabetes mellitus and to further assess erectile dysfunction in males who score more than 10 points in the Arizona Sexual Experience (ASEX) scale with help of the International Index of Erectile Function-5 (IIEF-5) scale.\u0000 \u0000 \u0000 \u0000 An observational cohort study was conducted on 153 diabetic patients visiting SGRDIMSR hospital, Vallah, Sri Amritsar in the Punjab region of North India. Patients aged between 18 and 50 years who were sexually active and in a healthy sexual relationship with their partner were included in the study after an informed consent. ASEX score was used for the assessment of SD and males who score more than 10 points were further assessed for erectile dysfunction with the help of IIEF-5 scale. SPSS Statistics for Windows, Version 23.0. Armonk, NY, USA: IBM Corp., Chicago, was used for data analysis.\u0000 \u0000 \u0000 \u0000 SD was prevalent in 64.05% (n = 98) of study participants overall, 65.9% (n = 5) in female and 61.5% (n = 40) in male groups, respectively. Mean scores of each sexual domain were drive (3.85 ± 1.10) > overall satisfaction (3.34 ± 1.06) > orgasm (3.14 ± 0.96) > arousal (3.11 ± 0.84) > erection/lubrication (2.65 ± 0.82) in that order. 69.84% of male diabetic had some degree of erectile dysfunction as assessed further by IIEF-5 score. The prevalence of SD was found to be higher in patients belonging to elderly age group (P = 0.001), longer duration of diabetes (P = 0.001), and deteriorating glycemic control (P = 0.001).\u0000 \u0000 \u0000 \u0000 Diabetes-related SD is quite prevalent in diabetic patients with 6 out of every 10 patients experiencing this problem. Thus, sexuality needs to be discussed frequently and openly with diabetic patients. In our study, factors such as elderly age of the patient, longer duration of diabetes, and worsening glycemic control of the patient are found to increase the prevalence of SD. Furthermore, the prevalence is higher in patients who already have existing complications of diabetes such as neuropathy, retinopathy, or albuminuria.\u0000","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48021782","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}