JAMMI最新文献

{"title":"Establishing obstetrics-specific metrics and interventions for antimicrobial stewardship","authors":"Jeffrey Man Hay Wong, Denise J Wooding, Sarah E Leung, Vanessa Paquette, Ashley Roberts, Chelsea Elwood","doi":"10.3138/jammi-2022-0032","DOIUrl":"https://doi.org/10.3138/jammi-2022-0032","url":null,"abstract":"Background: To describe baseline antimicrobial stewardship (AMS) metrics and apply AMS interventions in an inpatient obstetrical population. Methods: From October 2018 to October 2019, our tertiary-care obstetrical center reviewed components of our AMS program, which included: (1) antimicrobial consumption data, (2) point prevalence surveys (PPS), and (3) prospective audit and feedback. We reviewed institutional data for antimicrobial consumption from the pharmacy database. Detailed point prevalence surveys were conducted for all antimicrobial prescriptions on two predefined dates each month. Daily audits and feedback assessed the appropriateness of all non-protocolized antimicrobials. Results: Our average antimicrobial length of therapy (LOT) was 12 days per 100 patient-days, where erythromycin (2.33), amoxicillin (2.28), and ampicillin (1.81) were the greatest contributors. Point prevalence surveys revealed that 28.8% of obstetrical inpatients were on antimicrobials, of which 11.2% were inappropriate. Protocolized antimicrobials were 62% less likely ( p = 0.027) to be inappropriate. From 565 audited prescriptions, 110 (19.5%) resulted in feedback, where 90% of recommendations were accepted and implemented. The most common reasons for interventions include incorrect dosage, recommending a diagnostic test before continuing antimicrobials, and changing antimicrobials based on specific culture and sensitivity. Conclusions: Antimicrobial use in obstetrics is unique compared to general inpatients. We provide a baseline set of metrics for AMS at our obstetrical center intending to lay the groundwork for AMS programming in our discipline. Antimicrobial protocolization, as well as audit and feedback, are feasible interventions to improve antimicrobial prescribing patterns.","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135203182","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 pitfalls of mass hospital health care worker testing for COVID-19.","authors":"Dominik Mertz, Gerald A Evans, Susy Hota","doi":"10.3138/jammi-2020-06-17","DOIUrl":"https://doi.org/10.3138/jammi-2020-06-17","url":null,"abstract":"On May 29, 2020, Ontario released an ambitious plan, “Protecting Ontarians through Enhanced Testing,” [1] for COVID-19. The approach included testing asymptomatic individuals who are at risk for infection due to suspected exposure or at-risk occupations and targeted testing campaigns for high-risk populations. Shortly thereafter, several Ontario hospitals were requested to conduct comprehensive health care worker (HCW) asymptomatic testing for COVID-19. While on the surface, broad testing of HCWs for COVID-19 seems to have merit, a deeper look raises questions regarding the rationale, effectiveness, and potential harms of this endeavour. To understand the rationale for targeting hospital HCWs for mass, asymptomatic testing, we must first ask what question we seek to answer by carrying out this testing. If the goal is to derive an estimate of community prevalence of COVID-19, hospital HCWs may or may not be representative of the general public. As a result, are we asserting that HCWs are at extremely high risk for acquiring COVID-19 despite personal protective equipment (PPE) use and are therefore driving community transmission? Studies to date have not suggested a significantly higher incidence of COVID-19 infection in acute hospital HCWs compared to the community, outside of outbreak settings [2–4]. Indiscriminate testing of asymptomatic HCWs is challenging to interpret. When asymptomatic persons test positive for COVID-19, we identify four groups with differing levels of infectious risk. In descending order, they are [1] those who are pre-symptomatic, [2] those who have a completely asymptomatic course of infection, [3] those who are recovering from infection, and [4] those with a false-positive test result. While pre-symptomatic individuals are likely as infectious as symptomatic individuals, this group will be a small minority of the true positive cases given that our current polymerase chain Dominik Mertz MD, MSc1, Gerald A Evans MD2, Susy Hota MD, MSc3 on behalf of the Ontario Infection Prevention and Control Community of Practice (see list) 1Hamilton Health Sciences Centre & McMaster University, Hamilton, Ontario; 2Kingston Health Sciences Centre & Queen’s University, Kingston, Ontario; 3University Health Network & University of Toronto, Toronto, Ontario","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":"121-123"},"PeriodicalIF":0.0,"publicationDate":"2020-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608737/pdf/jammi-2020-06-17.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670522","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":"Asymmetric eye size in an infant.","authors":"Brett D Edwards,&nbsp;Joseph V Vayalumkal,&nbsp;Rupesh Chawla,&nbsp;Kevin Fonseca,&nbsp;Hong Yuan Zhou","doi":"10.3138/jammi-2020-0006","DOIUrl":"https://doi.org/10.3138/jammi-2020-0006","url":null,"abstract":"<p><p>Toxoplasmosis is an uncommon congenital infection in Canada, but one with potentially severe clinical manifestations, including fetal death. Neurologic and ocular manifestations are frequent in untreated disease; however, small eye size (microphthalmia) is a rare finding. This finding may be a marker of severe ocular disease. As universal screening does not occur in Canada, clinicians' early recognition is imperative, particularly given the lack of risk factors in many patients and the benefit that treatment may have even in initially asymptomatic disease. Here, we report a case of congenital toxoplasmosis and review the diagnostics and treatment of the infection.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":"187-192"},"PeriodicalIF":0.0,"publicationDate":"2020-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608731/pdf/jammi-2020-0006.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670581","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":"Rabies virus infection in a 21-year-old male presenting with ascending paralysis after a bat scratch.","authors":"Shay-Anne Daniels,&nbsp;Elizabeth M King,&nbsp;Christopher J Olivier,&nbsp;John Pd Harding,&nbsp;Christine Fehlner-Gardiner,&nbsp;Susan Nadin-Davis,&nbsp;Melanie Cm Murray","doi":"10.3138/jammi-2020-0007","DOIUrl":"https://doi.org/10.3138/jammi-2020-0007","url":null,"abstract":"<p><p>A 21-year-old, previously healthy male presented to hospital following 1 week of bilateral asymmetric ascending paralysis, odynophagia, and dysphagia. Initial magnetic resonance imaging (MRI) of the spine revealed an abnormal increased T2 signal with predominant dorsal column involvement and sparing of white matter throughout the cervical cord and extending to T5. The initial presumptive diagnosis was an acute infectious, versus inflammatory, myelitis. On reviewing the history, family members recalled a bat scratch on the left hand, sustained months prior, for which the patient did not seek or receive post-exposure prophylaxis (PEP). Rabies virus (RABV) RNA was detected by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in two saliva samples, while nuchal skin biopsy and cerebrospinal fluid (CSF) were negative. Serum was negative for RABV neutralizing antibody. Sequencing and phylogenetic analyses identified the infecting RABV as a variant associated with silver-haired bats. Following risk assessment of exposure, 67 health care workers and several family members were offered PEP.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":"201-208"},"PeriodicalIF":0.0,"publicationDate":"2020-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608735/pdf/jammi-2020-0007.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670583","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":"Using blood donors and solid organ transplant donors and recipients to estimate the seroprevalence of cytomegalovirus and Epstein-Barr virus in Canada: A cross-sectional study.","authors":"Curtis Mabilangan,&nbsp;Catherine Burton,&nbsp;Sheila O'Brien,&nbsp;Sabrina Plitt,&nbsp;Dean Eurich,&nbsp;Jutta Preiksaitis","doi":"10.3138/jammi-2020-0005","DOIUrl":"https://doi.org/10.3138/jammi-2020-0005","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are common, causing significant morbidity in pregnancy (congenital CMV) and transplant recipients (CMV, EBV). Canadian prevalence data are needed to model disease burden and develop strategies for future vaccines. We estimated prevalence using screening data from blood donors and solid organ transplant (SOT) donors and recipients.</p><p><strong>Methods: </strong>We retrospectively analyzed CMV and EBV serology from Alberta SOT donors (<i>n</i> = 3,016) and recipients (<i>n</i> = 4,614) (1984-2013) and Canadian Blood Services blood donors (<i>n</i> = 1,253,350) (2005-2014), studying associations with age, sex, organ, year, and geographic region.</p><p><strong>Results: </strong>CMV seroprevalence rises gradually with age. By age 70, CMV seropositivity ranged from 67% (blood donors) to 73% (SOT recipients). Significant proportions of women of child-bearing age were CMV-seronegative (organ donors, 44%; SOT recipients, 43%; blood donors, 61%). Blood donor CMV seroprevalence decreased from 48% in Western Canada to 30% in Eastern Canada. Women were more likely to be CMV-seropositive (ORs = 1.58, 1.45, and 1.11 for organ donors, SOT recipients, and blood donors, respectively) and EBV-seropositive (ORs = 1.87 and 1.46 for organ donors and SOT recipients, respectively). EBV prevalence rises rapidly, and by age 17-29 years, 81% of SOT recipients and 90% of organ donors were seropositive.</p><p><strong>Conclusions: </strong>Canada has relatively low and perhaps decreasing age-specific EBV and CMV prevalence, making Canadians vulnerable to primary infection-associated morbidity and suggesting benefit from future vaccines. Collection and analysis of routine serology screening data are useful for observing trends.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":"158-176"},"PeriodicalIF":0.0,"publicationDate":"2020-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608736/pdf/jammi-2020-0005.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670520","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":"Drug use evaluation (DUE) of ceftriaxone: A quality metric in a pediatric hospital.","authors":"Clara Delorme,&nbsp;Isabelle Viel-Thériault,&nbsp;Tassnim Moradipour,&nbsp;Nicole Le Saux","doi":"10.3138/jammi-2019-0026","DOIUrl":"https://doi.org/10.3138/jammi-2019-0026","url":null,"abstract":"<p><strong>Background: </strong>Ceftriaxone is frequently used as empiric therapy because of its broad spectrum and dosing characteristics. The purpose of this study was to evaluate the appropriateness of ceftriaxone therapy among hospitalized children using drug use evaluation (DUE) methodology.</p><p><strong>Methods: </strong>Hospitalized patients who received one or fewer dose of intravenous ceftriaxone at Children's Hospital of Eastern Ontario between January 1, 2018, and June 30, 2018, were identified. Duration was defined as empiric if 72 or less and definitive if more than 72 hours. Two infectious disease physicians reviewed the charts and rated appropriateness using a previously developed scale.</p><p><strong>Results: </strong>A total of 276 ceftriaxone courses in 248 patients (mean age 6.0 y) were reviewed. Of these, 153 (55.4%) were assessed as definitively or possibly indicated. The most common reason for inappropriate empiric use was an overly broad spectrum. Of the 120 courses given empirically for which there was no indication, the three most common reasons were lower respiratory infections (51; 42.5%), head and neck infections (18; 15.0%), and intra-abdominal infections (15; 12.5%). Of the 39 (14.1%) courses of ceftriaxone that were given for more than 72 hours, 14 (35.9%) met criteria for a definitive or possible indication.</p><p><strong>Conclusion: </strong>Ceftriaxone is still overused as empiric therapy. Although 85% of courses were discontinued after three doses, 14% were continued for longer than 72 hours, with approximately one-third ultimately meeting an indication. DUE using Canadian pediatric and local guidelines criteria is useful to identify clinical presentations for which narrower spectrum antimicrobials should be used.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":"139-144"},"PeriodicalIF":0.0,"publicationDate":"2020-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3138/jammi-2019-0026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670580","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":"<i>Pandoraea</i> sp infection in a lung transplant patient and the critical role of MALDI-TOF in accurate bacterial identification.","authors":"Catherine-Audrey Boutin,&nbsp;Gilbert Cornut,&nbsp;Véronica Bilik Pinto,&nbsp;Simon Grandjean Lapierre","doi":"10.3138/jammi-2020-0001","DOIUrl":"https://doi.org/10.3138/jammi-2020-0001","url":null,"abstract":"<p><p>Diagnosis and clinical management of pulmonary infections in lung transplant patients are challenging. The increased diversity of bacterial species identified from clinical samples with novel proteomics-based systems can further complicate clinical decision making in this highly vulnerable population. Whether newly recognized organisms are colonizers or true pathogens often remains controversial since symptoms causality and impact on lung function is often unknown. We present the case of a 48-year-old female lung transplant patient with <i>Pandoraea</i> sp infection. We review and discuss the role of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for accurate bacterial identification. We report on therapeutic management and clinical outcome.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":"177-181"},"PeriodicalIF":0.0,"publicationDate":"2020-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608733/pdf/jammi-2020-0001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670582","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":"Comparison of Accelerate PhenoTest BC Kit and MALDI-TOF MS/VITEK 2 System for the rapid identification and antimicrobial susceptibility testing of gram-negative bacilli causing bloodstream infections.","authors":"William Stokes,&nbsp;Lorraine Campbell,&nbsp;Johann Pitout,&nbsp;John Conly,&nbsp;Deirdre Church,&nbsp;Dan Gregson","doi":"10.3138/jammi-2020-0004","DOIUrl":"https://doi.org/10.3138/jammi-2020-0004","url":null,"abstract":"<p><strong>Background: </strong>Our laboratory uses matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI) and the VITEK 2 system (DV2) directly from positive blood cultures (BC) for organism identification (ID) and antimicrobial susceptibility testing (AST). Our objective was to compare direct MALDI-DV2 with a commercial BC ID-AST platform, the Accelerate Pheno system (AXDX), in the ID-AST of clinical and seeded BC positive for gram-negative bacilli (GNB).</p><p><strong>Methods: </strong>BC positive for GNB were collected over a 3-mo period and tested using AXDX and direct MALDI-DV2 and compared with conventional methods. A subset of sterile BC were seeded with multi-drug-resistant GNB.</p><p><strong>Results: </strong>Twenty-nine clinical samples and 35 seeded samples were analyzed. Direct MALDI had a higher ID failure rate (31.0%) than AXDX (3.4%; <i>p</i> < 0.001). Time to ID-AST was 1.5-6.9 h, 5.8-16.5 h, and 21.6-33.0 h for AXDX, direct MALDI-DV2, and conventional methods, respectively (<i>p</i> < 0.001). For clinical samples, AXDX and DV2 had essential agreement (EA) or categorical agreement (CA) of more than 96%. For seeded samples, AXDX had EA, CA, VME, ME, and minor error (mE) of 93.2%, 89.0%, 2.2%, 0%, and 9.2%, respectively. AXDX had a large number of non-reports (6.1%) stemming from meropenem testing. DV2 had EA, CA, VME, ME, and mE of 97.5%, 94.7%, 1.3%, 0%, and 4.1%, respectively.</p><p><strong>Conclusions: </strong>Direct MALDI-DV2 and AXDX both had high agreement for clinical samples, but direct MALDI-DV2 had higher agreement when challenged with MDR GNB.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":"145-157"},"PeriodicalIF":0.0,"publicationDate":"2020-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608732/pdf/jammi-2020-0004.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670579","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":"Canadian physicians' knowledge, attitudes, and beliefs about the risk of HTLV infection in solid organ transplantation.","authors":"Glenn Patriquin,&nbsp;Jill E Hatchette,&nbsp;Todd F Hatchette","doi":"10.3138/jammi-2019-0017","DOIUrl":"https://doi.org/10.3138/jammi-2019-0017","url":null,"abstract":"","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":"124-126"},"PeriodicalIF":0.0,"publicationDate":"2020-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608730/pdf/jammi-2019-0017.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670584","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":"<i>Pseudomonas aeruginosa</i> infection in intensive care: Epidemiology, outcomes, and antimicrobial susceptibilities.","authors":"Brittany E Kula,&nbsp;Darren Hudson,&nbsp;Wendy I Sligl","doi":"10.3138/jammi-2020-0003","DOIUrl":"https://doi.org/10.3138/jammi-2020-0003","url":null,"abstract":"<p><strong>Background: </strong><i>Pseudomonas aeruginosa</i> (PA) infection in the intensive care unit (ICU) contributes to substantial mortality. In this study, we describe the epidemiology, antimicrobial susceptibilities, and outcomes of ICU patients with pseudomonal infection.</p><p><strong>Methods: </strong>ICU patients with PA were identified and classified as colonized or infected. Infected patients were reviewed for source, patient characteristics, antimicrobial susceptibilities, appropriateness of empiric antimicrobial therapy, and 30-day mortality. Independent predictors of mortality were identified using multivariable logistic regression.</p><p><strong>Results: </strong>One hundred forty (71%) patients with PA were infected. Mean patient age was 55 (SD 18) years; 62% were male. Admission categories included medical (71%), surgical (20%), and trauma or neurological (9%). Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 19 (SD 10). One hundred twenty-six (90%) patients were mechanically ventilated, 102 (73%) required vasopressors, and 27 (19%) received renal replacement; 32 (23%) died within 30 days. Infection was nosocomial in 101 (72%) cases. Sources were respiratory (66%), skin-soft tissue (11%), urinary (10%), blood (5%), surgical (5%), gastrointestinal (2%), or unknown (1%). Twenty (14%) isolates were multi-drug resistant; 6 (4%) were extensively drug resistant. Empiric antimicrobial therapy was effective in 97 (69%) cases. Liver disease (adjusted OR [aOR] 6.2, 95% CI 1.5 to 25.7; <i>p</i> = 0.01), malignancy (aOR 5.0, 95% CI 1.5 to 17.3; <i>p</i> = 0.01), and higher APACHE II score (aOR 1.1, 95% CI 1.0 to 1.1; <i>p</i> = 0.02) were independently associated with 30-day mortality.</p><p><strong>Conclusions: </strong>PA infection in ICU is most commonly respiratory and associated with substantial mortality. Existing malignancy, liver disease, and higher APACHE II score were independently associated with mortality.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":"130-138"},"PeriodicalIF":0.0,"publicationDate":"2020-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608728/pdf/jammi-2020-0003.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40670585","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}