Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Improving Adenoma Detection and Resection: The Role of Tools, Techniques and Simulation-Based Mastery Learning","authors":"Tonya Kaltenbach ,&nbsp;Lila Krop ,&nbsp;Tiffany Nguyen-Vu ,&nbsp;Roy Soetikno","doi":"10.1016/j.tige.2024.03.004","DOIUrl":"10.1016/j.tige.2024.03.004","url":null,"abstract":"<div><p>This comprehensive review addresses the critical role of colonoscopy in colorectal cancer (CRC) prevention. With CRC as one of the most common cancer types in men and women, high-quality colonoscopy is vital to reduce CRC incidence and mortality. Persistent gaps in quality, evidenced by interval CRCs and large variations in both provider adenoma detection rate (ADR) and resection methods, highlight the need to prioritize colonoscopy quality improvement through feedback and training.</p><p>This review delves into key factors influencing colonoscopy quality with lesion detection and removal. Excellent bowel preparation is necessary for effective colonoscopy, impacting lesion detection, ADR, procedure time, and complication risk. Optimal inspection techniques, encompassing provider maneuvers and utilization of technological devices such as distal attachment devices and artificial intelligence, hold promise in enhancing inspection quality. For optimal lesion resection, we explore cold snare polypectomy as a safe, cost-effective, and efficacious technique, particularly for diminutive and small polyps, and endoscopic mucosal resection for large (≥20 mm) polyps.</p><p>We outline the importance and critical need for quality assurance programs and to implement education science principles into endoscopy training. Innovative simulation-based mastery learning training, which includes various educational strategies to engage endoscopists in deliberate practice with assessment and feedback, holds great potential to efficiently scale the practice of high-quality colonoscopy to improve ADR and resection methods.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 167-176"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590030724000187/pdfft?md5=e0ec301472183f7511a6a9054ed4f413&pid=1-s2.0-S2590030724000187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273584","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":"Endoscopic Training in the African Context","authors":"","doi":"10.1016/j.tige.2024.05.001","DOIUrl":"10.1016/j.tige.2024.05.001","url":null,"abstract":"<div><p>The need for endoscopic service has been well established within gastroenterology globally, and it is equally critical in areas with limited resources. We highlight the educational situation in underserved areas, pertinent goals to aim for, current initiatives and programs, as well as limitations and potential for improvement. Gastroenterology training for medical and surgical endoscopists includes variable components of basic and advanced endoscopies. Various models for training have been used, including traditional 1- to 3-year fellowships, short courses for upskilling, exchange programs, bolus or apprenticeship training, and training camps. There is a steadily increasing demand for endoscopic procedures in the region. We highlight the successes and challenges of current models, which are at various levels, including trainee, institutional, and even geopolitical. In addition, we explore the role that national and international societies as well as industry partners and other stakeholders play in influencing and implementing training. Given the diversity in access to resources as well as endoscopic capacity, we also highlight some of the innovative ways that have been used to provide and continue endoscopy training. Successful training also involves curriculum development, adoption of guidelines, and discussions on assessment of competency as well as having a glimpse into the future of endoscopy training in resource-limited settings. Ultimately, the goal is to ensure harmonized and quality training efforts across the various settings.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 3","pages":"Pages 252-260"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590030724000321/pdfft?md5=c4837c18881f5fb0b81403fbfac72359&pid=1-s2.0-S2590030724000321-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141134839","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":"Endoscopic Tissues Sampling of Solid Pancreatic Lesions for Molecular Analysis","authors":"Divya M. Chalikonda,&nbsp;Uzma D. Siddiqui","doi":"10.1016/j.tige.2024.09.001","DOIUrl":"10.1016/j.tige.2024.09.001","url":null,"abstract":"<div><div>Endoscopic ultrasound (EUS)–guided tissue acquisition of solid pancreatic lesions is the diagnostic gold standard for most pancreas lesions. Since this technique was initially developed, there have been several iterations of the device technology and advancements in understanding technique to maximize diagnostic yield while minimizing adverse events. We describe the current literature on techniques for EUS-guided tissue acquisition, including fine-needle biopsy vs fine-needle aspiration, suction vs slow pull, fanning vs torque technique, and the use of rapid onsite cytopathology in obtaining a diagnosis. Additionally, modern medicine has allowed for use of these specimens to guide personalized cancer treatment for patients. Unique to this review, we have included a discussion on next-generation sequencing, organoids, and single-cell analysis and how EUS specimens perform in these novel downstream analyses.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 4","pages":"Pages 347-358"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533696","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":"Utilization of Through-the-scope Sutures for Complex Tissue Apposition: A Series of Novel Cases","authors":"Calvin X. Geng ,&nbsp;Jagannath Kadiyala ,&nbsp;Ross C.D. Buerlein ,&nbsp;Vanessa M. Shami ,&nbsp;Andrew Y. Wang ,&nbsp;Alexander Podboy","doi":"10.1016/j.tige.2023.09.003","DOIUrl":"10.1016/j.tige.2023.09.003","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 1","pages":"Pages 42-45"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135408192","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":"Low Body Mass Index and Risk of Endoscopy-Related Adverse Events: A United States Cohort Propensity Score—Matched Study","authors":"Saurabh Chandan ,&nbsp;Rahul Karna ,&nbsp;Aakash Desai ,&nbsp;Babu P. Mohan ,&nbsp;Dushyant Singh Dahiya ,&nbsp;Daryl Ramai ,&nbsp;Antonio Facciorusso ,&nbsp;Mohammad Bilal ,&nbsp;Douglas G. Adler ,&nbsp;Gursimran S. Kochhar","doi":"10.1016/j.tige.2023.12.001","DOIUrl":"10.1016/j.tige.2023.12.001","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Patients with a low body mass index (LBMI) are often encountered in routine outpatient gastrointestinal (GI) endoscopy practice, and the assessment of procedure-related risks in this subset of individuals remains paramount. Although the risk of endoscopy-related adverse events (AEs) has been reported in patients with obesity, the association between LBMI and AEs has not been established.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study using TriNetX, a multi-institutional database, to assess the risk of endoscopy-related AEs in patients with LBMI (&lt;18.4 kg/m²) compared with patients with a nonobese body mass index (18.5-29.9 kg/m²) (control cohort) after low-risk outpatient diagnostic esophagogastroduodenoscopy (EGD), colonoscopy, or percutaneous endoscopic gastrostomy (PEG) tube placement. One-to-one (1:1) propensity score matching was performed. The primary endpoints were to assess the risk of GI bleeding, perforation, or aspiration pneumonia within 30 days. Risk was expressed as adjusted odds ratios (aORs) with 95% confidence intervals.</p></div><div><h3>Results</h3><p>A total of 28,677, 18,449, and 3076 patients with LBMI underwent EGD, colonoscopy, and PEG tube placement, respectively. After propensity score matching, compared with the control cohort, patients with LBMI undergoing EGD and colonoscopy with or without biopsies were at an increased risk for GI bleeding (aOR 1.36 and 2.21), perforation (aOR 1.96 and 2.65), and aspiration pneumonia (aOR 3.13 and 2.71), respectively. Additionally, patients in the LBMI PEG cohort were found to be at an increased risk for aspiration pneumonia (aOR 1.33).</p></div><div><h3>Conclusion</h3><p>Our study shows that, when compared with nonobese controls, patients with LBMI are at an increased risk of endoscopy-related AEs. Appropriate precautions must be considered while performing routine endoscopic procedures to offset these risks in such patients.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 99-108"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138617468","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":"Efficacy and Predictors of Success of Esophageal Hydraulic Balloon Dilation in Patients With and Without Previous Foregut Surgery","authors":"Anh D. Nguyen ,&nbsp;Austin Dickerson ,&nbsp;Jesse Zhang ,&nbsp;Ashton Ellison ,&nbsp;Chanakyaram A. Reddy ,&nbsp;Daisha J. Cipher ,&nbsp;Rhonda F. Souza ,&nbsp;Stuart J. Spechler ,&nbsp;Vani JA Konda","doi":"10.1016/j.tige.2023.12.002","DOIUrl":"10.1016/j.tige.2023.12.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p>The advantages of esophageal hydraulic balloon dilation<span><span> include the ability to dilate up to 30 mm without fluoroscopic guidance and real-time display of the esophagogastric junction diameter during dilation. We aimed to explore the safety and efficacy of esophageal hydraulic balloon dilation in patients with and without previous </span>foregut surgery, as well as to evaluate for predictors of clinical success.</span></p></div><div><h3>Methods</h3><p>We reviewed our database for patients who had esophageal hydraulic balloon dilation, and patients were divided into those with and without previous foregut surgery. Clinical success was determined by improvement in Eckardt/Brief Esophageal Dysphagia<span> Questionnaire scores or, if not available, by physician assessment documented in the medical records<span><span>. Technical success was defined as the ability to successfully perform esophageal hydraulic balloon dilation with visualization of the waist and stabilization of the balloon. Univariate analysis and </span>logistic regression were used to evaluate predictors of clinical success after dilation.</span></span></p></div><div><h3>Results</h3><p>Among 80 patients who had esophageal hydraulic balloon dilation (36 without and 44 with previous foregut surgery), clinical success was achieved in 48% of patients without previous foregut surgery (43% in achalasia<span> and 73% in esophagogastric junction outflow obstruction) and 83% of patients with previous foregut surgery (87% in surgically treated achalasia and 80% in patients without achalasia with previous fundoplication). Technical success was achieved in 86% of patients without previous foregut surgery and 98% in patients with previous foregut surgery. There was 1 esophageal perforation (1.3%). Opiate use was a negative predictor of clinical success.</span></p></div><div><h3>Conclusion</h3><p>Clinical success rates after esophageal hydraulic balloon dilation differ depending on the patient's foregut surgery history. Opiate users appear to have a lower clinical success rate compared with nonusers.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 109-120"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139013664","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":"The Impact of Frailty on ERCP-Related Adverse Events: Findings From a National Cohort","authors":"Umer Farooq ,&nbsp;Zahid Ijaz Tarar ,&nbsp;Abdallah El Alayli ,&nbsp;Faisal Kamal ,&nbsp;Alexander Schlachterman ,&nbsp;Anand Kumar ,&nbsp;David E. Loren ,&nbsp;Thomas E. Kowalski","doi":"10.1016/j.tige.2023.12.010","DOIUrl":"10.1016/j.tige.2023.12.010","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure that has evolved from being primarily diagnostic to predominantly therapeutic, leading to an increased potential for ERCP-related adverse events. </span>Frailty<span> is an independent predictor of adverse outcomes, and its impact on ERCP-related outcomes requires investigation. This study evaluated the impact of frailty on ERCP-related adverse events.</span></p></div><div><h3>Methods</h3><p><span>The National Inpatient Sample from 2016 to 2019 was used to identify adult patients who underwent ERCP. Frailty was defined using the Frailty Risk Score. Outcomes were categorized into procedure-related adverse events, sedation-related adverse events, and hospitalization outcomes. Multivariate linear or logistic regression was used as appropriate. Stata, version 14.2, was used to perform analyses considering a 2-sided </span><em>P</em> &lt; 0.05 to be statistically significant.</p></div><div><h3>Results</h3><p><span>Among a total of 693,730 ERCPs performed, 870,30 (12.54%) were frail. Frail patients had higher odds of procedure-related adverse events, including hemorrhage (9.1/1000 vs 4.9/1000) and duodenal perforation, but not post-ERCP pancreatitis, </span>bile duct<span><span><span><span> perforation, cholecystitis, and </span>cholangitis. Frailty imparted a higher risk of sedation-related respiratory failure, </span>aspiration pneumonia, and the requirement of </span>intubation<span> and mechanical ventilation. Inpatient mortality was higher among frail patients (4.54% vs 1.03%), and they had prolonged hospital stays and higher hospitalization costs.</span></span></p></div><div><h3>Conclusion</h3><p>Frailty is associated with worse outcomes in patients<span> undergoing ERCP, with higher risks of hemorrhage and sedation-related adverse events, in addition to increased resource utilization. Therefore, the findings of this study suggest strict adherence to guidelines governing anticoagulant management during the peri-endoscopic period, and sedative administration should be carefully monitored. Preprocedural optimization measures and diligent monitoring can minimize resource utilization and decrease periprocedural morbidity.</span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 138-144"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139392813","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":"Preface: Endoscopy in Resource-Limited Settings","authors":"Mark Topazian ,&nbsp;Lars Aabakken","doi":"10.1016/j.tige.2024.06.003","DOIUrl":"10.1016/j.tige.2024.06.003","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 3","pages":"Page 205"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961111","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":"Endoscopic Ultrasound Can Measure Esophageal Remodeling in Eosinophilic Esophagitis","authors":"Simon S. Rabinowitz ,&nbsp;Jeremy Weedon ,&nbsp;Evan Grossman ,&nbsp;Steven M. Schwarz ,&nbsp;Sairaman Nagarajan ,&nbsp;Frank Gress","doi":"10.1016/j.tige.2023.12.005","DOIUrl":"10.1016/j.tige.2023.12.005","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Although esophageal widening is a normal consequence of growth in pediatric individuals, esophageal remodeling plays a major role in the morbidity of pediatric and adult </span>eosinophilic esophagitis<span> (EoE). However, the disease is defined by esophageal dysfunction and mucosal eosinophilia. One potential explanation is the difficulty in quantitating remodeling.</span></p></div><div><h3>Methods</h3><p><span><span>This prospective, IRB-approved longitudinal study evaluated endoscopic ultrasound (EUS) in 78 children, adolescents, and young adults referred to a single academic medical center for esophageal indications. Patients with proven EoE had serial EUS exams that measured total wall thickness (TWT) and esophageal wall sublayers during routine </span>endoscopies to manage their disease. Student </span><em>t</em> tests and mixed linear models were employed to compare groups.</p></div><div><h3>Results</h3><p>TWTs from the distal (2.3 ± 0.5 vs 1.7 ± 0.3, <em>P</em> &lt; 0.01) and mid esophagus (2.1 ± 0.5 vs 1.6 ± 0.3, <em>P</em> &lt; 0.05) were increased in active EoE patients &gt; 10 years of age compared with similarly aged controls. After achieving clinical and histologic remission, their TWTs were significantly decreased (distal: 1.9 ± 0.4 vs 2.3 ± 0.5, <em>P</em> &lt; 0.05; mid: 1.7 ± 0.4 vs 2.1 ± 0.5, <em>P</em><span> &lt; 0.05). Mixed linear models further demonstrated that during active EoE, TWTs, esophageal muscle<span><span> layers, and the mucosa and </span>submucosa were thickened in older adolescents at both sites (</span></span><em>P</em> &lt; 0.05 for each). In remission, TWTs returned to control values.</p></div><div><h3>Conclusion</h3><p>This pilot study demonstrates that EUS, a unique application of point-of-care ultrasound, can identify the esophageal remodeling that occurs in older adolescents with active EoE. Furthermore, EUS has defined this remodeling as a transmural phenomenon that occurs in the mid and distal esophagus and can completely reverse with adequate treatment.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 121-129"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138993266","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 Electronic Medical Record Prediction Model to Identify Inadequate Bowel Preparation in Patients at Outpatient Colonoscopy","authors":"Jared A. Sninsky ,&nbsp;J. Vincent Toups ,&nbsp;Cary C. Cotton ,&nbsp;Anne F. Peery ,&nbsp;Shifali Arora","doi":"10.1016/j.tige.2023.12.008","DOIUrl":"10.1016/j.tige.2023.12.008","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span><span><span>Inadequate bowel preparation during </span>colonoscopy is associated with decreased </span>adenoma detection, increased costs, and patient procedural risks. The aim of this study was to develop a prediction model for identifying patients at high risk of inadequate bowel preparation for potential clinical integration into the </span>electronic medical record (EMR).</p></div><div><h3>Methods</h3><p>A retrospective study was conducted using outpatient screening/surveillance colonoscopies at the University of North Carolina from 2017 to 2022. Data were extracted from the EMRs of <em>Epic</em> and <em>ProVation</em><span>, including demographic, socioeconomic, and clinical variables. Logistic regression, LASSO regression, and gradient boosting machine models were evaluated and validated in a held-out testing set.</span></p></div><div><h3>Results</h3><p>The dataset included 23,456 colonoscopies, of which 6.25% had inadequate bowel preparation. The reduced LASSO regression model demonstrated an area under the curve of 0.65 (95% CI 0.63-0.67) in the held-out testing set. The relative risk of inadequate bowel prep in the high-risk group determined by the model was 2.42 (95% CI 2.07-2.82) compared with patients identified as low risk. The model calibration in the testing set revealed that among patients categorized as having 0%-11%, 11%-22%, and 22%-33% predicted risk of inadequate prep, the respective proportions of patients with inadequate prep were 5.5%, 19.3%, and 33.3%. Using the reduced LASSO model, a rudimentary code for a potential Epic FHIR application called <em>PrepPredict</em> was developed.</p></div><div><h3>Conclusion</h3><p>This study developed a prediction model for inadequate bowel preparation with the potential to integrate into the EMR for clinical use and optimize bowel preparation to improve patient care.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 130-137"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189412","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}