Acute and Critical Care最新文献

{"title":"Venoarterial extracorporeal membrane oxygenation as a rescue strategy in high-risk pulmonary thromboembolism.","authors":"Woo Jin Jang, Ik Hyun Park, Gyu Tae Park, Tae Wan Kim, Won-Young Kim","doi":"10.4266/acc.002236","DOIUrl":"10.4266/acc.002236","url":null,"abstract":"<p><p>Acute high-risk pulmonary thromboembolism (PTE) is the most severe clinical manifestation of venous thromboembolism, carrying a substantial mortality rate, particularly when complicated by cardiogenic shock or cardiac arrest. Although current guidelines recommend systemic thrombolysis for high-risk PTE in the absence of contraindications, this approach is associated with a significant risk of major hemorrhage and may be precluded in patients with severe comorbidities, advanced frailty, or elevated perioperative risk. Consequently, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as an important mechanical circulatory support strategy for this vulnerable cohort. By bypassing the obstructed pulmonary vascular bed, VA-ECMO facilitates rapid hemodynamic stabilization, mechanically unloads the strained right ventricle, and reverses systemic hypoperfusion. This review elucidates the pathophysiological rationale for right ventricular unloading in high-risk PTE and examines the evolving approach toward catheter-directed interventions and patient-tailored treatment strategies. Furthermore, we evaluate the clinical outcomes of VA-ECMO when deployed either as a stand-alone therapy bridge to recovery alongside systemic anticoagulation or as a bridge to definitive active thrombus clearance.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"506-514"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799137","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":"Esmolol in the management of refractory ventricular fibrillation: a systematic review and meta-analysis.","authors":"Kathleen Lau, Yau-Lam Alex Chau, Ting-An Cheng, Michael Lai, David Seonguk Yeom, Ursula Ellis, Anthony Lau","doi":"10.4266/acc.001675","DOIUrl":"10.4266/acc.001675","url":null,"abstract":"<p><strong>Background: </strong>Refractory ventricular fibrillation (rVF) presents a significant challenge in advanced cardiovascular life support (ACLS), with traditional antiarrhythmics showing limited success in improving long-term survival and neurological function. Esmolol, a beta-1 selective adrenergic receptor antagonist, might offer benefits due to its rapid onset and catecholamine-suppressing effects during cardiac arrest.</p><p><strong>Methods: </strong>This systematic review and meta-analysis (SRMA) evaluates the effectiveness of esmolol in improving the temporary return of spontaneous circulation (ROSC), sustained ROSC, survival to discharge, and survival to discharge with favorable neurological outcomes in rVF patients. This SRMA reviewed Medline (Ovid), Embase (Ovid), and Cochrane Central (Ovid) from their inception until October 2, 2025, for full-text clinical or observational studies assessing esmolol use alongside standard ACLS in adult rVF in both prehospital and in-hospital settings.</p><p><strong>Results: </strong>The risk of bias was independently assessed using the Newcastle-Ottawa Scale. Pooled risk ratios (RRs; 95% CI) are reported. Analyses in which I² >50% used a random-effects model; otherwise, a common-effect model was used. Four studies (n=273) are included. Esmolol was associated with an increased temporary ROSC (RR, 1.80; 95% CI, 1.09-2.98), and although the links were not statistically significant, esmolol trended toward a benefit in sustained ROSC (RR, 1.25; 95% CI, 0.28-5.66), survival to discharge (RR, 1.08; 95% CI, 0.57-2.03), and survival to discharge with favorable neurological outcomes (RR, 2.08; 95% CI, 0.83-5.24).</p><p><strong>Conclusions: </strong>Esmolol was associated with improved temporary ROSC in rVF. The sensitivity analysis suggests potential benefits for sustained ROSC and neurological survival, but more data are needed. Further research is needed to clarify its role.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"598-607"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799186","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":"Minimum observation time to determine ventilator liberation success and its associated factors in tracheostomized patients in intensive and high-care units in Japan: a single-center retrospective study.","authors":"Toshiharu Nakama, Kenichi Satoh, Mitsunobu Toyosaki, Katsuya Takemura, Gen Ouchi, Takehiro Umemura","doi":"10.4266/acc.000338","DOIUrl":"10.4266/acc.000338","url":null,"abstract":"<p><strong>Background: </strong>Time-based criteria for mechanical ventilation (MV) liberation in tracheostomized patients undergoing T-tube trials with ventilator discontinuation are inconsistent. We aimed to define the minimum post-liberation observation time and identify factors associated with successful liberation.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included adults with tracheostomy who received MV in the intensive care unit and high-care unit of a Japanese hospital from November 14, 2019, to August 31, 2024. We measured maximum endurance time (MET) without MV, MV liberation success, and the shortest MET when success first exceeded 80% (mini-MET). Time to miniMET was assessed by Kaplan-Meier median survival time (MST), and competing risk analysis treating in-hospital death as a competing event was performed. Predictors were screened by univariate C-index, and survival tree cutoffs were examined using logistic regression sensitivity analyses.</p><p><strong>Results: </strong>Among 160 patients, MV liberation success increased with MET from 65% to 94% at 168 hours. The MST to achieve the mini-MET, which was identified as 4 hours, was 7 days (95% CI, 5-10 days). Mechanical power normalized by dynamic compliance (MPCdyn) ≤454.72 J/min and albumin >2.3 g/dl were associated with success. MST was 3 days when both were satisfied. In a covariate-adjusted model, low MPCdyn plus high albumin remained associated with success. Replacing MPCdyn with driving pressure yielded similar findings.</p><p><strong>Conclusions: </strong>Four hours may be a practical minimum post-liberation observation time, whereas 48 hours may be a conservative option. Stratification by MPCdyn or driving pressure plus albumin can support consistent MV liberation decisions after tracheostomy.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"550-563"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799189","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":"Peripheral administration of 11.7% hypertonic saline and phlebitis risk in acute ischemic stroke requiring hyperosmolar therapy in South Korea.","authors":"Beom-Seok Seo, Hyesuk Hong, Jong Hwa Hong, Jisu Jung, Hyunsoo Kim","doi":"10.4266/acc.003328","DOIUrl":"10.4266/acc.003328","url":null,"abstract":"<p><strong>Background: </strong>Hypertonic saline (HTS) is used for hyperosmolar therapy in acute ischemic stroke (AIS) but is traditionally administered via central venous catheter to minimize vascular complications. Procedural burden and urgency often necessitate peripheral administration in practice. We investigated phlebitis risk associated with peripheral 11.7% HTS in AIS patients requiring hyperosmolar therapy.</p><p><strong>Methods: </strong>This retrospective study included 200 AIS patients receiving hyperosmolar therapy with mannitol (January 2022-December 2024), classified into an HTS group (n=67) receiving additional peripheral 11.7% NaCl and a no-HTS group (n=133). Phlebitis was assessed using the Infusion Nurses Society Phlebitis Scale. The primary outcome was phlebitis within 72 hours of therapy initiation. Multivariable logistic regression assessed the independent association between HTS use and phlebitis, with a secondary analysis examining frequency-dependent risk.</p><p><strong>Results: </strong>Phlebitis occurred in 31.3% (21/67) of the HTS group versus 15.8% (21/133) of the noHTS group (P=0.016). Among those with phlebitis, most cases were mild (grade 1, 90.5%; grade 2, 9.5%), with no grade 3 or higher events. HTS was independently associated with phlebitis (adjusted OR, 2.19; 95% CI, 1.02-4.70; P=0.044) but not with mortality or hospital length of stay. Single administration was not associated with increased risk, whereas two administrations (adjusted OR, 5.43; P=0.005) and three or more (adjusted OR, 3.59; P=0.016) were associated with markedly elevated risk (P for trend=0.002).</p><p><strong>Conclusions: </strong>Peripheral 11.7% HTS was associated with increased phlebitis risk, though cases were predominantly mild. Risk increased with repeated rather than single-dose administration, suggesting caution is warranted when multiple peripheral doses are required.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"608-620"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931609","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":"Bedside peripherally inserted central catheter placement in trauma intensive care unit in South Korea: a comparative analysis of safety and tip positioning accuracy.","authors":"Jung Rae Cho, Hancheol Jo, Dae Sung Ma, Dong Hun Kim","doi":"10.4266/acc.002964","DOIUrl":"10.4266/acc.002964","url":null,"abstract":"<p><strong>Background: </strong>Transporting critically ill trauma patients for fluoroscopy-guided peripherally inserted central catheter (PICC) placement poses substantial risks. This study evaluated the clinical outcomes of bedside PICC insertion using a surface anatomical landmark-based measurement in a trauma intensive care unit (ICU).</p><p><strong>Methods: </strong>This retrospective cohort study included trauma ICU patients who underwent PICC insertion between September 2023 and August 2024 at a regional trauma center. Insertion location was categorized as bedside or fluoroscopy-guided. Outcomes included optimal tip positioning, aberrant-course malposition, complication rates, and catheter dwell time. Multivariable linear regression identified factors associated with PICC duration.</p><p><strong>Results: </strong>Among 282 PICC procedures (171 bedside, 111 fluoroscopy), the bedside group had significantly higher injury severity scores and more frequent mechanical ventilation. Using the cmbased carina-distance criterion, optimal tip positioning was achieved in 73.1% of bedside and 65.5% of evaluable fluoroscopy-guided insertions (P=0.184). However, using the vertebral body unit-based radiologic criterion, target-zone achievement was lower in the bedside group than in the fluoroscopy group (48.5% vs. 64.9%). Initial aberrant-course malposition occurred in nine bedside insertions (5.3%) and in no fluoroscopy-guided insertions, and all were corrected before clinical use. Overall complication rates were comparable (17.5% vs. 18.0%, P=0.919).</p><p><strong>Conclusions: </strong>Bedside PICC insertion using a surface anatomical measurement method may be a feasible transport-free option for selected critically ill trauma ICU patients.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"631-640"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931620","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":"Optimal oxygenation in the intensive care unit: what recent trials do-and do not-tell us.","authors":"Masaji Nishimura","doi":"10.4266/acc.000312","DOIUrl":"10.4266/acc.000312","url":null,"abstract":"<p><p>Oxygen therapy is one of the most widely used interventions in critical care. Numerous observational studies and randomized controlled trials (RCTs) have evaluated conservative versus liberal oxygenation strategies, yet their results remain inconsistent, a pattern commonly observed in large clinical trials across multiple fields. Recent advances in intensive care unit practices further complicate the interpretation of prior findings, highlighting the need for a clearer framework to interpret oxygenation targets. This narrative review summarizes major observational studies, RCTs, and meta-analyses evaluating oxygenation strategies in critically ill patients. We examine variation in study designs, target and achieved oxygenation levels, and evolving critical care practices. Physiological principles, including oxygen delivery, oxygen utilization, and the oxyhemoglobin dissociation curve, are applied to interpret current evidence and define clinically meaningful safety margins, while acknowledging the limitations of interpreting heterogeneous trial and meta-analytic results. Recent RCTs have found relatively small differences in oxygenation between study groups; both conservative and liberal oxygenation targets are generally within a safe physiological range. However, evidence from the LOCO2 trial indicates excessively low targets may be harmful, suggesting a safer lower limit of approximately peripheral oxygen saturation (SpO2) 92%-93%. Retrospective studies indicate acceptable outcomes with arterial oxygen partial pressure (PaO2) values up to approximately 120 mm Hg. Because the upper portion of the oxyhemoglobin dissociation curve is flat, SpO2 cannot reliably detect hyperoxemia. Rather than determining the superiority of conservative or liberal oxygenation strategies, current evidence supports defining a practical therapeutic window. For most critically ill patients, an SpO2 range of 92-97% likely represents a safe and clinically meaningful target.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"480-492"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934448","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":"Bedside muscle ultrasonography to detect fasciculations and support diagnosis of amyotrophic lateral sclerosis in a mechanically ventilated intensive care unit patient.","authors":"Hiroyuki Kida, Taro Kanai, Masayo Morita, Takashi Hasegawa","doi":"10.4266/acc.002080","DOIUrl":"10.4266/acc.002080","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"711-713"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399598","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 the NUTRIC-PNI score and NUTRIC score to assess nutritional risk and predict 28-day mortality in critically ill patients: a prospective cohort study in Vietnam.","authors":"Pham Dang Hai, Nguyen Hong Tot, Nguyen Duc Loc, Nguyen Huu Thanh, Nguyen Thi Tuong Vi, Dang Huu Thien","doi":"10.4266/acc.002950","DOIUrl":"10.4266/acc.002950","url":null,"abstract":"<p><strong>Background: </strong>Adequate nutritional support is crucial in enhancing clinical outcomes for critically ill patients. The nutrition risk in the critically ill (NUTRIC) score serves as a risk assessment tool to identify critically ill patients at high risk of malnutrition. This score incorporates interleukin-6 (IL-6) as a key component, which may be costly and less accessible in low- and middle-income countries.</p><p><strong>Methods: </strong>A prospective cohort study was conducted among patients admitted to a tertiary hospital. IL-6 in the NUTRIC score was replaced by the Prognostic Nutritional Index (PNI) to establish the NUTRIC score incorporating the PNI (NUTRIC-PNI) score. The outcomes are determining the concordance in identifying nutritional risk and comparing the prognostic value between NUTRIC-PNI and NUTRIC scores in predicting 28-day mortality in critically ill patients.</p><p><strong>Results: </strong>A total of 123 patients were analyzed with a mean age of 69±16 years and 72.4% were male. The Cohen's Kappa coefficient of 0.869 indicates strong agreement between the two scoring systems. The NUTRIC-PNI and NUTRIC scores demonstrated comparable predictive accuracy for 28-day mortality, each achieving an area under the curve of 0.68 (95% CI, 0.59-0.78 for NUTRIC-PNI and 0.59-0.77 for NUTRIC; P<0.001). The logistic regression analysis demonstrated that the NUTRIC-PNI and its high-risk classification were independent predictors of 28-day mortality (OR, 1.38; 95% CI, 1.05-1.81; P=0.021 and OR, 4.21; 95% CI, 1.55-11.43; P=0.005, respectively).</p><p><strong>Conclusions: </strong>The concordance and performance of the NUTRIC-PNI score are comparable to the NUTRIC score. Furthermore, the NUTRIC-PNI score and its high-risk classification were independent predictors of 28-day mortality in critically ill patients. In addition to the modified NUTRIC score, the NUTRIC-PNI score is feasible and beneficial for routine clinical practice, particularly in resource-limited settings.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"681-691"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799206","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":"Subclavian central venous catheterization in critically ill children in Türkiye: a safe and feasible approach in a single-center experience.","authors":"Abdulrahman Özel, Esma Nur Özen, Servet Yüce, Sude Menekşe, Hazal Erdem, Merve Boyraz","doi":"10.4266/acc.003975","DOIUrl":"10.4266/acc.003975","url":null,"abstract":"<p><strong>Background: </strong>Central venous catheter (CVC) insertion is essential procedure in the management of critically ill pediatric patients. However, the optimal catheter insertion site remains controversial due to varying complication rates. This study aimed to evaluate the feasibility and safety of subclavian vein (SCV) catheterization compared to femoral vein (FV) and internal jugular vein (IJV) access in a pediatric intensive care setting.</p><p><strong>Methods: </strong>This retrospective study included all patients admitted to the pediatric intensive care unit (PICU) of a tertiary hospital over a 1-year period (March 2022-March 2023) who underwent nontunneled CVC placement.</p><p><strong>Results: </strong>Among 174 patients included (median age 29 months, 60.3% male), 52.9% had SCV, 23.6% FV, and 23.6% IJV catheterization. The overall CVC success rate was 99.4%. There was no statistically significant difference in mechanical complications, catheter-related bloodstream infections, or thrombosis between groups; however, thrombosis occurred most frequently in the FV group (12.2%). The median age in the SCV group was significantly lower than in the other groups (20 months; interquartile range, 10-63; P<0.001), while the presence of chronic diseases was significantly higher in this group (P=0.002). In multivariate logistic regression, catheter site was identified as the only independent predictor of thrombosis, with FV catheterization associated with increased risk (odds ratio, 2.75; P=0.016).</p><p><strong>Conclusions: </strong>SCV catheterization appears to be a feasible and safe option for critically ill children, even in younger patients and in the presence of chronic comorbidities. Despite potential technical challenges, SCV access represents a viable alternative to IJV and may offer potential advantages over FV, particularly with regard to thrombosis risk.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"661-669"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931769","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":"Correction: Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience.","authors":"Edin Botan, Emrah Gün, Emine Kübra Şen, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli","doi":"10.4266/acc.2022.00395.e1","DOIUrl":"10.4266/acc.2022.00395.e1","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"718"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931637","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}