Journal of Critical Care Medicine最新文献

{"title":"Machine learning to predict extubation success using the spontaneous breathing trial, objective cough measurement, and diaphragmatic contraction velocity: Secondary analysis of the COBRE-US trial.","authors":"Fabio Varón-Vega, Eduardo Tuta-Quintero, Adriana Maldonado-Franco, Henry Robayo-Amórtegui, Luis F Giraldo-Cadavid, Daniel Botero-Rosas","doi":"10.2478/jccm-2025-0009","DOIUrl":"10.2478/jccm-2025-0009","url":null,"abstract":"<p><strong>Introduction: </strong>Determining the optimal timing for extubation in critically ill patients is essential to prevent complications. Predictive models based on Machine Learning (ML) have proven effective in anticipating weaning success, thereby improving clinical outcomes.</p><p><strong>Aim of the study: </strong>The study aimed to evaluate the predictive capacity of five ML techniques, both supervised and unsupervised, applied to the spontaneous breathing trial (SBT), objective cough measurement (OCM), and diaphragmatic contraction velocity (DCV) to estimate a favorable outcome of SBT and extubation in critically ill patients.</p><p><strong>Material and methods: </strong>A post hoc analysis conducted on the COBRE-US study. The study included ICU patients who underwent evaluation of SBT, OCM, and DCV. Five ML techniques were applied: unsupervised and supervised to the data in both a training group and a test group. The diagnostic performance of each method was determined using accuracy.</p><p><strong>Results: </strong>In predicting SBT success, all supervised methods displayed the same accuracy in the training group (77.3%) and in the test group (69.6%). In predicting extubation success, decision trees demonstrated the highest diagnostic accuracy, 89.8% for the training group and 95.7% for the test group. The other supervised methods also showed a good diagnostic accuracy: 85.9% for the training group and 93.5% for the test group.</p><p><strong>Conclusions: </strong>In predictive models using OCM, DCV, and SBT as input variables through five ML techniques, decision trees and artificial neural networks demonstrated the best diagnostic performance. This suggests that these models can effectively classify patients who are likely to succeed in SBT and extubation during the weaning process from mechanical ventilation.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"70-77"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524925","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":"Association between hospital case volume and mortality in pediatric sepsis: A retrospective observational study using a Japanese nationwide inpatient database.","authors":"Shingo Ohki, Makoto Otani, Shinichi Tomioka, Kosaku Komiya, Hideki Kawamura, Taka-Aki Nakada, Satoshi Nakagawa, Shinya Matsuda, Nobuaki Shime","doi":"10.2478/jccm-2025-0006","DOIUrl":"10.2478/jccm-2025-0006","url":null,"abstract":"<p><strong>Introduction: </strong>The survival benefits of treatment at high-volume hospitals (HVHs) are well-documented for several critical pediatric conditions. However, their impact on pediatric sepsis, a leading cause of mortality among children, remains understudied.</p><p><strong>Aim of the study: </strong>To investigate the association between hospital case volume and mortality rates in pediatric sepsis.</p><p><strong>Material and methods: </strong>We conducted a retrospective cohort study using data from the Diagnosis Procedure Combination database. The study included patients who met the following criteria: 1) aged 28 days to 17 years; 2) discharged from the hospital between April 2014 and March 2018; 3) had a sepsis diagnosis coded under the International Classification of Diseases, 10th revision; 4) underwent blood cultures on hospital admission day (day 0) or day 1; 5) received antimicrobial agents on day 0 or 1; and 6) required at least one organ support measure (e.g., mechanical ventilation or vasopressors) on day 0 or 1. Hospitals were categorized by case volume during the study period, with HVHs defined as those in the highest quartile and low-volume hospitals (LVHs) as those in the remaining quartiles. In-hospital mortality rates between HVH and LVH groups were compared using mixed-effects logistic regression analysis with propensity score (PS) matching.</p><p><strong>Results: </strong>A total of 934 pediatric patients were included in the study, with an overall in-hospital mortality rate of 16.1%. Of them, 234 were treated at 5 HVHs (≥26 patients in 4 years), and 700 at 234 LVHs (<26 patients in 4 years). Upon PS matching, patients treated at HVHs demonstrated significantly lower odds of in-hospital mortality compared with those treated at LVHs (odds ratio, 0.42; 95% confidence interval, 0.22-0.80; P = 0.008).</p><p><strong>Conclusions: </strong>In pediatric patients with sepsis, treatment at HVHs was associated with lower odds of in-hospital mortality.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"87-94"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524899","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":"The implementation gap in critical care: From nutrition to ventilation.","authors":"Razvan Azamfirei","doi":"10.2478/jccm-2025-0011","DOIUrl":"10.2478/jccm-2025-0011","url":null,"abstract":"","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"3-4"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524947","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":"The effect of pre-existing sarcopenia on outcomes of critically ill patients treated for COVID-19.","authors":"Thomas Bradier, Sébastien Grigioni, Céline Savoye-Collet, Gaétan Béduneau, Dorothée Carpentier, Christophe Girault, Maximillien Grall, Grégoire Jolly, Najate Achamrah, Fabienne Tamion, Zoé Demailly","doi":"10.2478/jccm-2024-0045","DOIUrl":"10.2478/jccm-2024-0045","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia, defined by a loss of skeletal muscle mass and function, has been identified as a prevalent condition associated with poor clinical outcome among critically ill patients. This study aims to evaluate the impact of pre-existing sarcopenia on outcomes in critically ill patients with acute respiratory failure (ARF) due to COVID-19.</p><p><strong>Material and methods: </strong>A retrospective study was carried out on COVID-19 patients admitted to intensive care. Pre-existing sarcopenia was assessed using early CT scans. Clinical outcomes, including duration of high-flow oxygenation (HFO), mechanical ventilation (MV), length of hospital stay (LOS) and ICU mortality, were evaluated according to sarcopenia status.</p><p><strong>Results: </strong>Among the studied population, we found a high prevalence (75 patients, 50%) of pre-existing sarcopenia, predominantly in older male patients. Pre-existing sarcopenia significantly impacted HFO duration (6.8 (+/-4.4) vs. 5 (+/-2.9) days; p=0.005) but did not significantly affect MV requirement (21 (28%) vs. 23 (37.3%); p=185), MV duration (7 vs. 10 days; p=0.233), ICU mortality (12 (16%) vs. 10 (13.3 %); p=0.644) or hospital LOS (27 vs. 25 days; p=0.509). No differences in outcomes were observed between sarcopenic and non-sarcopenic obese patients.</p><p><strong>Conclusions: </strong>Pre-existing sarcopenia in critically ill COVID-19 patients is associated with longer HFO duration but not with other adverse outcomes. Further research is needed to elucidate the mechanisms and broader impact of sarcopenia on septic critically ill patient outcomes.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"33-43"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524871","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":"Midodrine initiation criteria, dose titration, and adverse effects when administered to treat shock: A systematic review and semi-quantitative analysis.","authors":"Madeleine M Puissant, Kaitlin J Armstrong, Richard R Riker, Samir Haydar, Tania D Strout, Kathryn E Smith, David B Seder, David J Gagnon","doi":"10.2478/jccm-2025-0007","DOIUrl":"10.2478/jccm-2025-0007","url":null,"abstract":"<p><strong>Objective: </strong>Systematically examine the literature describing midodrine to treat shock and to summarize current administration and dosing strategies.</p><p><strong>Data sources: </strong>Structured literature search conducted in MEDLINE (PubMed) from inception through May 10, 2023.</p><p><strong>Study selection and data extraction: </strong>Abstracts and full texts were assessed for inclusion by two blinded, independent reviewers. English-language publications describing use of midodrine in adult patients with shock were included. Data were extracted by two blinded, independent abstractors using a standardized extraction tool. Quality assessments were completed by paired reviewers using JBI methodology.</p><p><strong>Data synthesis: </strong>Fifteen of 698 (2%) screened manuscripts were included with 1,714 patients with a variety of shock types. Seven studies (47%) were retrospective, two (13%) prospective observational, and six (40%) randomized controlled studies. Midodrine was initiated to facilitate intravenous vasopressor (IVP) weaning in most (11, 73%) studies; only two (13%) reported IVP weaning protocol use. Starting doses were 10 mg every 8 hours (4, 27%) or three times a day (3, 20%), 20 mg every 8 hours (2, 13%); six studies (40%) did not report initial midodrine dosing. A midodrine titration protocol was reported in 6 (40%) studies. Thirteen (87%) studies evaluated for bradycardia, identified in 6 (46%) studies among 204 patients; only one (0.5%) patient required midodrine discontinuation. Three (20%) studies reported on hypertension with an incidence of 7-11%. Four (27%) studies assessed for ischemia; 5/1128 (0.4%) patients experienced mesenteric ischemia requiring midodrine discontinuation.</p><p><strong>Relevance to patient care and clinical practice: </strong>This review explores the pragmatic details involved in initiating, titrating, and weaning midodrine for the bedside clinician and identifies rates of adverse events and complications.</p><p><strong>Conclusions: </strong>Published literature describing midodrine use for shock is heterogeneous and comprised primarily of low or very low quality data. Future controlled trials addressing the shortcomings identified in this systematic review are warranted.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"5-22"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524931","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":"Choking and laryngospasm: Exploring commonalities and treatment strategies.","authors":"Gad Estis, Asia Estis-Deaton, Tiberiu Ezri","doi":"10.2478/jccm-2025-0010","DOIUrl":"10.2478/jccm-2025-0010","url":null,"abstract":"","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"101-102"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524900","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":"Effect of sleep quality on weaning from mechanical ventilation: A scoping review.","authors":"Hana Locihová, Darja Jarošová, Karolína Šrámková, Jana Slonková, Renáta Zoubková, Klára Maternová, Karel Šonka","doi":"10.2478/jccm-2024-0043","DOIUrl":"10.2478/jccm-2024-0043","url":null,"abstract":"<p><strong>Introduction: </strong>Mechanically ventilated patients have disturbed sleep.</p><p><strong>Aim of the study: </strong>To explore whether there is a relationship between successful or unsuccessful weaning of patients and their sleep quality and circadian rhythm.</p><p><strong>Materials and methods: </strong>A scoping review. The search process involved four online databases: CINAHL, MEDLINE, ProQuest, and ScienceDirect. Original studies published between January 2020 and October 2022 were included in the review.</p><p><strong>Results: </strong>Six studies met the inclusion criteria. These studies showed that patients with difficult weaning were more likely to have atypical sleep, shorter REM sleep, and reduced melatonin metabolite excretion. Muscle weakness was an independent factor associated with prolonged weaning from mechanical ventilation and was significantly more frequent in patients with atypical sleep. Heterogeneous patient samples and the methodology of the studies hamper a clear interpretation of the results.</p><p><strong>Conclusions: </strong>A relationship was found between abnormal sleep patterns, reduced melatonin metabolite (6-sulfa-toxymelatonin) excretion, and unsuccessful weaning. However, the causality is not clear from the existing research.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"23-32"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524901","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":"Intraabdominal hypertension is less common than it used to be: A pilot step wedge trial.","authors":"Shane Smith, Fran Priestap, Neil Parry, Robert Arntfield, Patrick Murphy, Kelly Vogt, Ian Ball","doi":"10.2478/jccm-2025-0002","DOIUrl":"10.2478/jccm-2025-0002","url":null,"abstract":"<p><strong>Objective: </strong>This is a pilot study to determine the feasibility of a multicentre stepped wedge cluster randomized trial of implementing the 2013 World Society of the Intraabdominal Compartment Syndrome (WSACS) guidelines as an intervention to treat intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in critically ill patients.</p><p><strong>Design: </strong>Single-centre before-and-after trial, with an observation / baseline period of 3 months followed by a 9-month intervention period.</p><p><strong>Setting: </strong>A 35 bed medical-surgical-trauma intensive care unit in a tertiary level, Canadian hospital.</p><p><strong>Patients: </strong>Recruitment from consecutively admitted adult intensive care unit patients.</p><p><strong>Intervention: </strong>In the intervention period, treatment teams were prompted to implement WSACS interventions in all patients diagnosed with IAH.</p><p><strong>Measurements and main results: </strong>129 patients were recruited, 59 during the observation period and 70 during the intervention period. Only 17.0% and 12.9%, respectively, met diagnostic criteria for IAH. Many recruited patients did not have intraabdominal pressures measured regularly per study protocol. There was no difference in ICU mortality for patients in either cohort or between those with and without IAH.</p><p><strong>Conclusions: </strong>The incidence of IAH in our patient population has decreased significantly since 2015. This is likely due to a significant change in routine care of critically ill patients, especially with respect to judicious goal-directed fluid resuscitation. Patient recruitment and protocol adherence in this study were low, exacerbated by other staffing and logistical pressures during the study period. We conclude that a larger multicentre trial is unlikely to yield evidence of a detectable treatment effect.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"95-100"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524907","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":"Risk factors and outcomes of critically ill pregnant COVID-19 patients: Experience from the first and second waves of the pandemic.","authors":"Dita Aditianingsih, Noor Hafidz, Aino Nindya Auerkari, Zarah Tin Cahyaningrum, El Nissi Leonard, Chrisella Annabelle","doi":"10.2478/jccm-2025-0008","DOIUrl":"10.2478/jccm-2025-0008","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding the association between risk factors and clinical outcomes of COVID-19 can lead to identifying suitable management strategies for reducing the mortality rate among maternal COVID-19 patients in the ICU.</p><p><strong>Aim of the study: </strong>This study aims to investigate the clinical outcomes and risk factors associated with pregnant and postpartum women diagnosed with COVID-19 and admitted to the intensive care unit (ICU) between May 2020 and September 2021.</p><p><strong>Materials and methods: </strong>This retrospective cohort study was conducted at the Universitas Indonesia Hospital. Secondary data was collected from the medical records to include all pregnant and postpartum women diagnosed with confirmed COVID-19 admitted to the hospital during the research period.</p><p><strong>Results: </strong>The study included 113 patients and found that admission to the ICU, age, and gestational age significantly influenced clinical outcomes, with a mortality rate of 42.11% among ICU-admitted patients. Pre-existing comorbidities such as type-2 diabetes mellitus, congestive heart failure, and coronary artery disease were associated with ICU admission. Having at least one comorbidity was found to increase the mortality rate by six-fold.</p><p><strong>Conclusions: </strong>The study emphasizes the importance of monitoring and evaluating maternal and fetal complications during COVID-19 infection, highlighting the need for multidisciplinary management involving intensivists, obstetricians, anesthesiologists, and infectious disease specialists. The findings underscore the significance of baseline health status in treatment planning and the potential for evidence-based interventions to improve maternal outcomes and pregnancy preservation. Further research is warranted to validate these results and enhance understanding of the underlying pathophysiology.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"54-63"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524934","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":"Hypercapnia outcome in COVID-19 acute respiratory distress syndrome patients on mechanical ventilator: A retrospective observational cohort.","authors":"Sarwat Rasheed, Sidra Javed, Thanyat Rasheed, Shaiza Farman, Elisha Shalim","doi":"10.2478/jccm-2025-0004","DOIUrl":"10.2478/jccm-2025-0004","url":null,"abstract":"<p><strong>Introduction: </strong>Acute respiratory distress syndrome (ARDS) is characterized by progressive lung inflammation which leads to increased dead space that can cause hypercapnia and can increase the risk of patient morbidity and mortality. In an attempt to improve ARDS patient outcomes provision of protective lung ventilation has been shown to improve patient mortality but increases the incidence of hypercapnia. Therefore, the role of carbon dioxide in ARDS remains contradicted by conflicted evidence. This study aims to examine this conflicting relationship between hyper-capnia and mortality in mechanically ventilated COVID-19 ARDS patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study. The data was collected from the medical records of the patients admitted with COVID-19 ARDS in Sindh Infectious Disease Hospital & Research Centre (SIDH & RC) from August 2020 to August 2022 and who received mechanical ventilation for more than 48 hours. The patients were grouped into severe and no severe hypercapnia groups based on their arterial blood carbon dioxide levels (PaCO2). To understand the effect of hypercapnia on mortality we performed multivariable logistic regression, and inverse probability-weighted regression to adjust for time-varying confounders.</p><p><strong>Results: </strong>We included 288 patients to detect at least 3% of the effect on mortality. Our analysis revealed an association of severe hypercapnia with severe lung injury, low PaO2/FiO2, high dead space, and poor compliance. In univariate analysis severe hypercapnia showed higher mortality: OR=3.50, 95% CI (1.46-8.43). However, after, adjusting for disease severity hypercapnia is not found to be associated with mortality: OR=1.08, 95% CI (0.32-3.64). The sensitive analysis with weighted regression also shows no significant effect on mortality: OR=1.04, 95% CI (0.95-1.14).</p><p><strong>Conclusion: </strong>This study showed that hypercapnia is not associated with mortality in COVID-19 ARDS patients.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"11 1","pages":"44-53"},"PeriodicalIF":0.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524903","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}