Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine最新文献

{"title":"Efficacy and Safety of LY3127804, an Anti-Angiopoietin-2 Antibody, in a Randomized, Double-Blind, Placebo-Controlled Clinical Trial in Patients Hospitalized with Pneumonia and Presumed or Confirmed COVID-19.","authors":"Rosie S Jones,&nbsp;Patricia S Smith,&nbsp;Paul H Berg,&nbsp;Amparo de la Peña,&nbsp;Paul P Cook,&nbsp;Imad Shawa,&nbsp;Kathleen M Kioussopoulos,&nbsp;Yu Hu,&nbsp;Robert J Schott","doi":"10.1177/11795484221119316","DOIUrl":"https://doi.org/10.1177/11795484221119316","url":null,"abstract":"<p><strong>Background: </strong>Severe cases of coronavirus disease 2019 (COVID-19) are characterized by progressive respiratory failure and the development of acute respiratory distress syndrome (ARDS), with high mortality rates for patients requiring mechanical ventilation. Levels of the vascular growth factor Angiopoietin 2 (Ang2) in plasma have been strongly correlated with increased ARDS risk in patients with pneumonia or sepsis. The intent of this study was to determine whether LY3127804, an anti-Ang2 monoclonal antibody, could reduce the need for mechanical ventilation among patients admitted to the hospital with pneumonia and presumed or confirmed COVID-19.</p><p><strong>Methods: </strong>Patients admitted to hospital with confirmed pneumonia, presumed or confirmed COVID-19, and infiltrates on chest imaging and/or oxygen saturation of ≤ 95% on room air were stratified by age group (< 65 years and ≥ 65 years), sex, and site and randomly assigned 1:1 within each stratum to receive either LY3127804 (20 mg/kg) or placebo on Day 1 and possibly on Day 15. The primary end point for this study was number of days in which a patient did not require a ventilator over the 28-day study period.</p><p><strong>Results: </strong>Interim analysis assessed study futility after 95 randomized patients had 28-day data available and showed no benefit of LY3127804 in reducing the number of ventilator days over placebo. The study was subsequently terminated.</p><p><strong>Conclusion: </strong>LY3127804 treatment did not decrease the need for ventilator usage in patients hospitalized with pneumonia and presumed or confirmed COVID-19.</p><p><strong>Clinicaltrialsgov identifier: </strong>NCT04342897.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"16 ","pages":"11795484221119316"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ff/35/10.1177_11795484221119316.PMC9382233.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10377257","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":"Continuous Lower Abdominal Compression as a Therapeutic Intervention in COVID-19 ARDS.","authors":"Alexandru Cupaciu,&nbsp;Vladimir Cohen,&nbsp;Emmanuel Dudoignon,&nbsp;François Dépret","doi":"10.1177/11795484211053476","DOIUrl":"https://doi.org/10.1177/11795484211053476","url":null,"abstract":"<p><p>We report the case of a patient with severe COVID-19 ARDS, suggesting a possible therapeutic intervention by applying a continuous lower abdominal compression. In order to assess ventilation distribution, a lung CT scan was performed with and without lower abdominal compression.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":" ","pages":"11795484211053476"},"PeriodicalIF":2.0,"publicationDate":"2021-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/b3/10.1177_11795484211053476.PMC8655439.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39808206","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":"Self-Reported Smoking Status 10-Months After a Single Session Intervention Including an Education Conference About Smoking Harms and Announcement of Spirometric Lung-Age.","authors":"Khansa Derbel,&nbsp;Chiraz Maatoug,&nbsp;Amira Mchita,&nbsp;Khaoula Hadj Mabrouk,&nbsp;Helmi Ben Saad","doi":"10.1177/11795484211047041","DOIUrl":"https://doi.org/10.1177/11795484211047041","url":null,"abstract":"<p><strong>Background: </strong>Studies investigating the effects of announcing spirometric lung-age (SLA) on the smokers' self-reported smoking status reported conflicting results.</p><p><strong>Main objective: </strong>To evaluate the effects of a single session intervention including an education conference about smoking harms and announcement of SLA on the participants' self-reported smoking status.</p><p><strong>Methodology: </strong>An interventional study was conducted in a cable factory. The intervention included four steps: PowerPoint presentation about raising smoking hazards awareness; general questionnaire; measurement of the anthropometric and spirometric data, and announcement of SLA; and evaluation of the smokers' self-reported smoking status 10 months later (quitted smoking, decreased consumption; stable consumption, increased consumption).</p><p><strong>Results: </strong>Thirty-six smokers completed the four steps. Ten months after the intervention, 11.1% of smokers quitted smoking, 52.7% decreased their consumption by 7  ±  4 cigarettes/day, 30.5% kept a stable consumption, and 5.5% increased their consumption by 9  ±  6 cigarettes/day.</p><p><strong>Conclusion: </strong>Providing an education conference combined with announcing SLA motivated 64% of smokers to quit smoking or to reduce their cigarette consumption.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":" ","pages":"11795484211047041"},"PeriodicalIF":2.0,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/5c/10.1177_11795484211047041.PMC8532218.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39551362","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":"V.I.T.A.M. in COVID 19: A Systematic Approach to a Global Pandemic.","authors":"Siva Naga S Yarrarapu,&nbsp;Pankaj Bansal,&nbsp;David Abia-Trujillo,&nbsp;Austin Cusick,&nbsp;Megan Melody,&nbsp;Varun Moktan,&nbsp;Andrea Rivero,&nbsp;Tara J Brigham,&nbsp;Claudia Libertin,&nbsp;Lisa Brumble,&nbsp;J O'brein Jennifer,&nbsp;Augustine Lee,&nbsp;Torp Klaus,&nbsp;Christan Santos,&nbsp;Candido Rivera,&nbsp;Jason Siegel,&nbsp;Pramod Guru,&nbsp;Pablo Moreno Franco,&nbsp;Devang Sanghavi","doi":"10.1177/11795484211047432","DOIUrl":"https://doi.org/10.1177/11795484211047432","url":null,"abstract":"<p><strong>Introduction: </strong>In the unprecedented era of COVID-19, ongoing research and evolution of evidence has led to ever-changing guidelines for clinical monitoring and therapeutic options. Formulating treatment protocols requires the understanding and application of the evolving research.</p><p><strong>Objective: </strong>The primary objective of this study is to present a systematic evidence-based approach to synthesize the necessary data in order to optimize the management of COVID-19.</p><p><strong>Methods: </strong>At Mayo Clinic Florida, we developed a multidisciplinary centralized COVID Treatment Review Panel (TRP) of expert pulmonologists, intensivists, infectious disease specialists, anesthesiologists, hematologists, rheumatologists, and hospitalists that in real-time reviews the latest evidence in peer-reviewed journals, the available clinical trials, and help guide the rapid application of therapeutics or interventions to the patient and the bedside provider.</p><p><strong>Results/conclusions: </strong>The multi-disciplinary team approach of synthesizing clinical data and coordinating care is effective in responding to rapidly evolving and changing evidence. Systematic data collection and evidence-based treatment algorithms enable physicians to rapidly translate the current literature to clinical practice, and improve care and outcomes of patients.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":" ","pages":"11795484211047432"},"PeriodicalIF":2.0,"publicationDate":"2021-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0b/82/10.1177_11795484211047432.PMC8493324.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39502273","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":"Inflammatory Mechanism and Clinical Implication of Asthma in COVID-19.","authors":"Vasa Adi Wisnu Wardana,&nbsp;Alfian Nur Rosyid","doi":"10.1177/11795484211042711","DOIUrl":"https://doi.org/10.1177/11795484211042711","url":null,"abstract":"<p><p>Asthma is a chronic inflammatory disease of the respiratory tract that has become a public health problem in various countries. Referring to the Global Initiative for Asthma, the prevalence of asthma continues to increase especially in children. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that has declared a pandemic by the world health organization on March 2020. For many years, it has been known that people with asthma have a worse impact on respiratory viral infections. Asthma has been listed by the centers for disease control and prevention as one of the risk factors for COVID-19, although several studies have different results. SARS-CoV-2 utilizes angiotensin-converting enzyme 2 (ACE2) as its cellular receptor, and it has been known that the expression of the ACE2 receptor is reduced in asthma patients. This reduced expression could also be accounted from the therapy of asthma. This paper aims to discuss the pathophysiology of asthma and COVID-19 and the susceptibility of asthma patients in contracting COVID-19.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":" ","pages":"11795484211042711"},"PeriodicalIF":2.0,"publicationDate":"2021-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/e3/10.1177_11795484211042711.PMC8477697.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39474087","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":"Transient Impact of Dysglycemia on Sputum Conversion among Smear-Positive Tuberculosis Patients in a Tertiary Care Facility in Ghana.","authors":"Ernest Yorke,&nbsp;Vincent Boima,&nbsp;Ida Dzifa Dey,&nbsp;Maame-Boatemaa Amissah-Arthur,&nbsp;Vincent Ganu,&nbsp;Ernest Amaning-Kwarteng,&nbsp;John Tetteh,&nbsp;C Charles Mate-Kole","doi":"10.1177/11795484211039830","DOIUrl":"https://doi.org/10.1177/11795484211039830","url":null,"abstract":"<p><strong>Background: </strong>Apart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of sputum conversion among TB patients.</p><p><strong>Methods: </strong>We conducted a baseline cross-sectional study with a longitudinal follow-up of newly diagnosed smear-positive TB patients for 6 months. Sputum conversion rates between those with dysglycemia and those without were compared at 2 months (end of the intensive phase) and 6 months (end of the treatment). Descriptive statistics and logistic regression were computed to assess factors associated with dysglycemia as well as sputum conversion.</p><p><strong>Results: </strong>A significantly higher proportion of normoglycemic patients had negative sputum compared with those with dysglycemia (83% vs 67%, <i>P</i>-value < .05) at 2 months but not at 6 months (87% vs 77%, <i>P</i>-value > .05). After controlling for age group and adjusting for other covariates, patients with dysglycemia were 66% less likely to convert sputum than those with normoglycemia. Females were at least 7 times more likely than males and those with high waist-to-hip ratio (WHR) of 88% were less likely compared with those with low WHR for sputum conversion at 2 months, respectively. At 6 months, females (compared with males) and those with high WHR (compared with those with normal WHR) were at over 9 times increased odds and 89% less likely for sputum conversion, respectively.</p><p><strong>Conclusion: </strong>A significantly lower proportion of smear-positive TB patients with dysglycemia converted to smear negative after 2 months of treatment but not at the end of the treatment, thus suggesting a transient impact of dysglycemia on sputum conversion.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":" ","pages":"11795484211039830"},"PeriodicalIF":2.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/e3/10.1177_11795484211039830.PMC8458672.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39451340","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":"Lung Adenocarcinoma with Paraneoplastic Hyper-Eosinophilia Not Responding To Pembrolizumab.","authors":"Hisham Wehbe,&nbsp;Maria Kozah,&nbsp;Salwa A Koubaissi","doi":"10.1177/11795484211030164","DOIUrl":"https://doi.org/10.1177/11795484211030164","url":null,"abstract":"<p><strong>Background: </strong>Paraneoplastic hyper-eosinophilia associated with metastatic lung adenocarcinoma is a rare finding and has been associated with a poor prognosis when present. Early hyper-eosinophilia appearing following non-small cell lung cancer (NSCLC) treatment with immune checkpoint inhibitors (ICI) has been previously reported with contradictory outcomes.</p><p><strong>Case summary: </strong>We present the case of an elderly man with newly diagnosed metastatic lung adenocarcinoma and baseline hyper-eosinophilia, treated with pembrolizumab, and showing evidence of significant and rapid disease progression suggestive of hyper-progressive disease, worsening baseline hyper-eosinophilia, and a fatal outcome within 1 month of therapy initiation.</p><p><strong>Conclusion: </strong>Pre-treatment hyper-eosinophilia could represent a predictive factor of an unfavorable response to ICI treatment in cases of NSCLC. Additional similar cases are needed to draw a more conclusive relationship.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":" ","pages":"11795484211030164"},"PeriodicalIF":2.0,"publicationDate":"2021-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795484211030164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39299041","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":"Assessment of Ventilation and Perfusion in Patients with COVID-19 Discloses Unique Information of Pulmonary Function to a Clinician: Case Reports of V/P SPECT.","authors":"Marika Bajc,&nbsp;Fredrik Hedeer,&nbsp;Ari Lindqvist,&nbsp;Elin Trägårdh","doi":"10.1177/11795484211030159","DOIUrl":"https://doi.org/10.1177/11795484211030159","url":null,"abstract":"<p><p>V/P SPECT from 4 consecutive patients with COVID-19 suggests that ventilation and perfusion images may be applied to diagnose or exclude pulmonary embolism, verify nonsegmental diversion of perfusion from the ventilated areas (dead space ventilation) that may represent inflammation of the pulmonary vasculature, detect the reversed mismatch of poor ventilation and better preserved perfusion (shunt perfusion) in bilateral pulmonary inflammation and indicate redistribution of lung perfusion (antigravitational hyperperfusion) due to cardiac congestion. V/P mismatch and reversed mismatch may be extensive enough to diminish dramatically preserved matching ventilation/perfusion and to induce severe hypoxemia in COVID-19.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":" ","pages":"11795484211030159"},"PeriodicalIF":2.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795484211030159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39275973","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":"Detection of Anti-SARS-CoV-2 Nucleocapsid and Spike Antibodies in Patients with Coronavirus Disease 2019 in Japan","authors":"H. Furukawa, S. Oka, T. Higuchi, Miho Yamaguchi, S. Uchiyama, T. Koiwa, Moriyuki Nakama, Masaaki Minegishi, H. Nagai, S. Tohma","doi":"10.1177/11795484221075492","DOIUrl":"https://doi.org/10.1177/11795484221075492","url":null,"abstract":"OBJECTIVES Coronavirus Disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Serological testing for anti-SARS-CoV-2 nucleocapsid (N) antibodies (Abs) and anti-SARS-CoV-2 spike (S) Abs is performed to detect prior COVID-19 infection. It is still controversial which antibodies are the most sensitive and specific, and which can be detected earliest after infection. Here, we evaluated the results of serological tests of anti-SARS-CoV-2 N and S Abs in Japan. METHODS Symptomatic COVID-19 patients (n = 84) and control patients with rheumatoid arthritis (n = 93) were recruited at Tokyo National Hospital. Anti-SARS-CoV-2 N and S Abs were measured by commercial electrochemiluminescence immunoassays. RESULTS The fraction of patients positive for anti-SARS-CoV-2 N and S Abs was highest >14 days after symptom onset. The frequency of anti-SARS-CoV-2 S Ab positivity at this time (80.4%) tended to be slightly but not significantly lower than anti-SARS-CoV-2 N Ab positivity (84.8%). Optimized cut-off levels for anti-SARS-CoV-2 N and S Ab positivity were lower than the manufacturer's recommended cut-off levels. Using multiple linear regression analyzes with anti-SARS-CoV-2 N and S Abs, we created an Ab-index with high sensitivity. CONCLUSION To increase the sensitivity of serological diagnostic tests for COVID-19, it is suggested that both anti-SARS-CoV-2 N and S Abs should be measured and cut-off levels decreased.","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"179 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2021-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80085997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Quick Review on the Multisystem Effects of Prone Position in Acute Respiratory Distress Syndrome (ARDS) Including COVID-19.","authors":"Janet O Adeola,&nbsp;Shivani Patel,&nbsp;Evelyne N Goné,&nbsp;George Tewfik","doi":"10.1177/11795484211028526","DOIUrl":"https://doi.org/10.1177/11795484211028526","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this review is to highlight the multisystem effects of prone position in ARDS patients with a focus on current findings regarding its use in COVID-19 patients.</p><p><strong>Methods: </strong>Two reviewers comprehensively searched PubMed database for literature regarding pathophysiology and efficacy of prone position in ARDS patients as well as specific data regarding this approach in COVID-19 patients.</p><p><strong>Conclusion: </strong>Prone positioning is well-documented to improve oxygenation and cardiac function in ARDS patients and might confer increased survival, with benefits that outweigh risks such as facial edema, endotracheal tube displacement, and intraabdominal organ dysfunction in obese patients. Severe COVID-19 pneumonia, while meeting ARDS criteria, differs from typical ARDS in several ways. Data would suggest that advantages of prone position would become limited after significant disease progression and fibrosis. The use of this technique in COVID-19 requires prolonged sessions that are unprecedented in the treatment of ARDS patients. New data regarding COVID-19 pathophysiology and patients continues to evolve daily. More frequently, patients are proned while maintaining spontaneous breathing-the results of this intervention are an area for future studies. There is more to learn about the appropriate use of prone position in COVID-19 patients. The multisystem risks and benefits require clinicians to adopt a patient centered decision-making algorithm when employing this technique in COVID-19 patients.</p><p><strong>Level of evidence: </strong>NA.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":" ","pages":"11795484211028526"},"PeriodicalIF":2.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795484211028526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39195561","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}