Turkish Journal of Emergency Medicine最新文献

{"title":"A patient with acute quadriparesis in the emergency department: Unmasking the diagnosis through electrocardiography.","authors":"Anukarthika Somasundaram, M Mari Selva Ganesh, V T Amrithanand","doi":"10.4103/tjem.tjem_427_25","DOIUrl":"10.4103/tjem.tjem_427_25","url":null,"abstract":"<p><p>Electrolyte abnormalities may masquerade as acute neurological or cardiac emergencies in the emergency department (ED). In such atypical presentations, a timely bedside electrocardiography (ECG) often provides the earliest and most critical clue, facilitating an accurate diagnosis, guiding appropriate management, and improving patient outcomes. A 32-year-old male presented with rapidly evolving flaccid quadriparesis without sensory or autonomic involvement. A bedside ECG provided a critical clue, revealing a Mobitz type I block with ischemia-mimicking ST-T changes and prominent U waves. This prompted urgent testing, which confirmed profound hypokalemia and hypomagnesemia. Swift intravenous repletion reversed both paralysis and conduction abnormalities within 72 h. Although electrolyte abnormalities are known to produce typical ECG changes, their presentation with conduction disturbances such as Wenckebach block is rare and easily misinterpreted as ischemia or structural heart disease. Prompt recognition of these atypical ECG findings at the bedside is critical to avoid unnecessary invasive workups and to initiate lifesaving electrolyte correction.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"252-255"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714123","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":"A literature review and case report: Traumatic appendicitis in an elderly patient with spinal cord injury and medical comorbidities.","authors":"Sarah Khosropanah, Mohsen Rahmanian, Mohammad Ashrafazimi, Amir Rahmanian Sharif Abad","doi":"10.4103/tjem.tjem_327_25","DOIUrl":"10.4103/tjem.tjem_327_25","url":null,"abstract":"<p><p>Acute appendicitis is a leading cause of acute abdomen, yet its onset after blunt trauma remains exceedingly rare and diagnostically challenging - particularly in the elderly and in patients with concurrent neurological injuries. We present the case of a 65-year-old woman who developed acute appendicitis following a motor vehicle collision that also caused thoracic spinal fractures with canal involvement. Initially hemodynamically stable with a normal abdominal examination and a negative focused assessment with sonography for trauma, she developed right lower quadrant pain 22 h posttrauma, which localized and intensified by 56 h. Contrast-enhanced computed tomography (CT) at 59 h revealed an 8-mm inflamed appendix with periappendiceal fat stranding, and open appendectomy at 61 h confirmed acute appendicitis with fibrous obliteration. The patient's recovery was uneventful. This case underscores how concurrent spinal injury and immobilization can obscure evolving abdominal pathology, emphasizing the importance of repeated clinical assessment and timely CT imaging in elderly polytrauma patients. In addition to the case presentation, we conducted a comprehensive literature review of all reported cases of posttraumatic appendicitis, summarizing demographic, clinical, and diagnostic patterns to contextualize this rare phenomenon. Together, these findings reinforce the need for heightened diagnostic vigilance and multidisciplinary coordination when evaluating delayed abdominal pain in trauma patients with neurological compromise.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"256-261"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714118","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":"Lessons learned from life-threatening respiratory and cardiac complications in diphtheria: A case report and literature review.","authors":"Tan Nicko Octora, Seruni Estari, Bambang Pujo Semedi, Dominicus Husada","doi":"10.4103/tjem.tjem_334_25","DOIUrl":"10.4103/tjem.tjem_334_25","url":null,"abstract":"<p><p>Diphtheria remains a serious threat and can cause life-threatening complications. We report the case of a 6-year-old girl with severe respiratory and cardiac involvement due to diphtheria. She presented with classic signs, including pseudomembrane, bull neck, lymphadenopathy, and respiratory distress. <i>Corynebacterium diphtheriae</i> var. mitis with a positive toxigenic strain was confirmed. Her condition worsened, requiring intensive care admission and high-flow nasal cannula support. She later developed ventricular tachycardia with hemodynamic instability, which was successfully treated with intravenous magnesium sulfate (MgSO₄). The patient recovered with antibiotics, antitoxin, and supportive care. This case highlights the potential for severe diphtheria complications, even with timely treatment. It also suggests a possible role for MgSO₄ in managing diphtheria-induced arrhythmias, though further research is needed. Early diagnosis, aggressive management, and continued vaccination efforts are critical to reducing diphtheria-related morbidity and mortality.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"146-149"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943206","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":"Electronic cigarette use as a rare cause of diffuse alveolar hemorrhage.","authors":"Fatma Hançer Çelik, Ayşe Şule Akan, Fatma Ünlü, Necmi Baykan, Ömer Salt","doi":"10.4103/tjem.tjem_123_25","DOIUrl":"10.4103/tjem.tjem_123_25","url":null,"abstract":"<p><p>The increasing use of electronic cigarettes (e-cigarettes) among young adults has led to the emergence of electronic cigarette or vaping-associated lung injury (EVALI), which includes a wide spectrum of pulmonary complications. Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening manifestation of EVALI. We aim to present a fatal case of DAH in a previously healthy young adult following recent e-cigarette use. A 23-year-old Turkish male with no prior medical history presented with dyspnea, cough, and hemoptysis 2 days after initiating frequent e-cigarette use. He had no history of chronic illness, substance use, or allergies. On admission, he was hypoxic with bilateral rales and diffuse ground-glass opacities on chest computed tomography (CT). Laboratory tests revealed severe anemia, leukocytosis, and elevated inflammatory markers. Despite treatment with high-dose corticosteroids, tranexamic acid, antibiotics, and supportive therapy, the patient's condition deteriorated, and he died on the 7^th day of hospitalization. E-cigarette use has been increasingly associated with severe lung injuries, including DAH. The exact pathophysiology remains unclear but may involve direct alveolar epithelial damage and inflammatory responses. Our case is consistent with previously reported cases of vaping-induced DAH and highlights the potential severity of this condition. E-cigarettes are not a safe alternative to traditional tobacco. Clinicians should maintain a high index of suspicion for DAH in patients presenting with hemoptysis and respiratory failure following vaping. Early recognition and aggressive management are critical to improve outcomes.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"142-145"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943232","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":"Effectiveness of a video-based refresher on cardiopulmonary resuscitation skill retention in college students: A single-blind randomized controlled trial.","authors":"Kyeongmin Jang, Sung Hwan Kim","doi":"10.4103/tjem.tjem_283_25","DOIUrl":"10.4103/tjem.tjem_283_25","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiopulmonary resuscitation (CPR) skills decline within months after training, particularly among lay college students. We evaluated whether a brief video-based refresher improves 6-month CPR skill retention.</p><p><strong>Methods: </strong>We conducted a single-blind randomized controlled trial among 2^nd-year college students in Seoul, South Korea, who had completed Basic Life Support (BLS). Participants were randomized to an experimental group (<i>n</i> = 33) that received a 2-min video refresher at 3 months or to a control group (<i>n</i> = 30) with no refresher. CPR competencies - cardiac arrest recognition, emergency medical system (EMS) activation, chest compressions, and automated external defibrillator (AED) use - were assessed immediately after training and at 6 months using a standardized checklist.</p><p><strong>Results: </strong>At 6 months, the experimental group showed significantly better retention for cardiac arrest recognition (<i>P</i> = 0.003), EMS activation (<i>P</i> = 0.003), and chest compression performance (<i>P</i> = 0.020) than the control group. AED use did not differ significantly between groups (<i>P</i> = 0.235).</p><p><strong>Conclusion: </strong>A brief video refresher delivered 3 months after BLS significantly enhances 6-month retention of key CPR skills in college students. This low-cost, scalable strategy may help maintain CPR competence where repeated hands-on training is hard to provide.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"116-123"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943152","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 of total body surface area on effective surgical treatment and mortality in adult burn patients: A 5-year retrospective analysis in an Indonesian National Referral Hospital.","authors":"Aditya Wardhana, Tiara Putri Leksono, Indira Saraswati Sanjaya, Billy Sandy Handiansyah, Nadya Farhana","doi":"10.4103/tjem.tjem_246_25","DOIUrl":"10.4103/tjem.tjem_246_25","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluates the association of total body surface area (TBSA) on surgical treatment outcomes and mortality rates in burn patients.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on adult burn patients admitted to an Indonesian National Referral Hospital from January 2020 to November 2024. Factors associated with mortality, including age, TBSA, and surgery count, were analyzed using the SPSS software version 26.</p><p><strong>Results: </strong>This study included 595 patients, with a mean age of 41.74 ± 14.95 years and a male predominance (<i>n</i> = 406, 68.2%). Flame or explosion-related burns were the most common cause of hospitalization (<i>n</i> = 473, 79.4%). Overall mortality was 42.2%. Surgical activity and length of stay (LOS) increased with TBSA, peaking in the 21%-40% groups (median operations 3 [interquartile range 2-4]), but declined in >40% TBSA due to early deaths. Kaplan-Meier curves confirmed steep survival loss within 2 weeks among >40% TBSA patients (log-rank <i>P</i> < 0.001). In multivariable regression, independent predictors of mortality were age (adjusted odds ratio [aOR] 1.021, <i>P</i> = 0.004), male sex (aOR 1.60, <i>P</i> = 0.040), TBSA 31%-40% (aOR 8.27, <i>P</i> = 0.002), and > 40% (aOR 22.3, <i>P</i> < 0.001). Longer LOS (aOR 0.967, <i>P</i> = 0.019) and more operations (aOR 0.737, <i>P</i> < 0.001) were protective. Receiver operating characteristic analysis of numeric TBSA showed good discrimination (AUC = 0.813), with an optimal cutoff at ~ 33.8% (sensitivity 83.7%, specificity 66.3%).</p><p><strong>Conclusion: </strong>TBSA remains the principal driver of burn outcomes, with mortality risk rising sharply beyond ~34%. Early deaths in the largest burn group explain the paradox of fewer operations despite extensive injury.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"94-101"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942926","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":"Evaluation of patients who presented to the emergency department of a state hospital following the earthquakes centered in Kahramanmaraş/Pazarcık and Elbistan, Türkiye.","authors":"Mustafa Alpaslan, Necmi Baykan, Fatma Ünlü, Ömer Salt, Serhat Koyuncu","doi":"10.4103/tjem.tjem_231_25","DOIUrl":"10.4103/tjem.tjem_231_25","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to analyze patients who presented to the emergency department of a state hospital following the devastating earthquakes of February 6, 2023, centered in Kahramanmaraş and to contribute updated evidence to the literature.</p><p><strong>Methods: </strong>In this retrospective study, data were collected on patients presenting to the emergency department between February 6 and 13, 2023. Variables included demographic characteristics, patterns of presentation, province of origin, time elapsed since the event, chief complaints, clinical findings, treatments administered in the emergency department and during hospitalization, and patient outcomes. Comparisons were made between traumatic and nontraumatic cases, as well as between patients who arrived walk-in and those transported by ambulance.</p><p><strong>Results: </strong>A total of 652 patients were evaluated. Of these, 58.6% were female, with a mean age of 30.87 ± 22.80 years. Most patients (84.2%) were discharged. The most frequent injury types were soft tissue injuries (31.7%), crush injuries (17.3%), and rhabdomyolysis (10.5%). Among patients admitted to the intensive care unit, 86.4% had traumatic injuries. Two-thirds (66.7%) of deceased patients were also traumatic cases. Ambulance transport was recorded in 24.8% of traumatic patients compared with 4.9% of nontraumatic patients. Notably, none of the traumatic patients transported by ambulance were discharged; 72.4% were hospitalized, 25% required intensive care, and 2.6% died.</p><p><strong>Conclusion: </strong>Unlike previous studies that focused mainly on epicentral hospitals, this study provides novel insights by evaluating both traumatic and nontraumatic patient presentations in a nonepicentral, secondary-care hospital located far from the disaster zone. This perspective highlights the delayed but significant healthcare burden in peripheral hospitals, which has been largely overlooked in the literature.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"132-141"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943180","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":"Evaluation of ChatGPT's performance on emergency medicine board examination questions.","authors":"Mustafa Can Guzelce, Sefer Ozgur, Ilker Salli","doi":"10.4103/tjem.tjem_262_25","DOIUrl":"10.4103/tjem.tjem_262_25","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the performance of a large language model (ChatGPT) in answering official sample questions from the Turkish Board of Emergency Medicine (TBEM). Two versions of the model, GPT-4 and GPT-4o, were assessed to explore consistency and accuracy across iterations.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted using 25 standardized multiple-choice questions publicly released by TBEM. Each question was manually entered into GPT-4 and GPT-4o through the OpenAI interface. Both models were prompted to select the best single answer from the provided options without additional clarification or training context. Model responses were evaluated for accuracy, consistency upon repetition, and domain-specific error types. This study is compliant with the STROBE statement and the MedinAI reporting guidelines.</p><p><strong>Results: </strong>GPT-4 correctly answered 20 out of 25 questions (80%) on the first attempt. On repetition, its score improved to 84%. GPT-4o also achieved a score of 88% (22/25) on its first attempt and showed consistent results upon a second evaluation, providing identical answers in both trials. Errors occurred in the domains of trauma during pregnancy, pediatric resuscitation, and adult resuscitation protocols. Both models demonstrated strong performance in fact-based domains and in questions involving image descriptions.</p><p><strong>Conclusion: </strong>GPT-4 and GPT-4o performed above the TBEM passing threshold, showing solid accuracy across a range of emergency medicine topics. Both excelled in fact-based and image-related questions. However, they showed limitations in clinical reasoning, particularly in scenarios requiring nuanced judgment. These tools may support examination preparation but should not replace the expertise of trained emergency physicians.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"110-115"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943144","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":"Pneumomediastinum due to excessive cheering during a football match.","authors":"Abdullah Önür, Emre Sanci","doi":"10.4103/tjem.tjem_250_25","DOIUrl":"10.4103/tjem.tjem_250_25","url":null,"abstract":"<p><p>A 19-year-old female presented to the emergency department with the sudden onset of chest pain. The patient had a complaint after cheering for her team during a football match. Initial blood workup and imaging were normal. However, before discharge, a widespread crepitation in the neck was detected during re-examination. Further imaging revealed a pneumomediastinum, and the patient was admitted to the hospital. This case emphasizes the importance of follow-up and re-examination before discharging the patients.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"153-155"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943185","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 effectiveness of uric acid in determining prognosis in nonvariceal upper gastrointestinal bleeding and its comparison with risk scores.","authors":"Mustafa Yilmaz Gok, Akkan Avci, Yeliz Simsek, Aysun Sahin, Senem Derya Tatar, Erdem Aksay, Ahmet Burak Urfalioglu, Sadiye Yolcu","doi":"10.4103/tjem.tjem_190_25","DOIUrl":"10.4103/tjem.tjem_190_25","url":null,"abstract":"<p><strong>Objectives: </strong>Studies examining the prognostic significance of uric acid specifically in upper nonvariceal gastrointestinal bleeding (NVUGIB) are limited. We aim to investigate whether uric acid levels have prognostic value in patients diagnosed with NVUGIB.</p><p><strong>Methods: </strong>This study was retrospective. Patients aged >18 diagnosed with NVUGIB were included in the study. Patients' demographic data, vital signs, comorbid diseases, results of laboratory parameters, endoscopy findings, transfusion requirements, recurrent bleeding, and outcomes (discharge and death) were recorded. Albumin; International normalized ratio; Mental status; Shock; Age - 65 (AIMS65) score, Rockall, and Glasgow-Blatchford scores were calculated for all patients based on information obtained from patient files. Pearson correlation test, independent samples <i>t</i>-test, and simple linear regression analysis were utilized to examine the relationship between uric acid levels and various measurements. <i>P</i> < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>One hundred and eighty-nine patients, 30.7% of whom were women, were included in the study, and the mean age was 61.67 ± 19.28 years. While the mean uric acid level of discharged patients was 5.6 ± 2.04 mg/dL, the mean uric acid level of deceased patients was 6.81 ± 2.77 mg/dL. Uric acid level had a significant effect on mortality (<i>P</i> = 0.023) according to univariate analysis. There was a positive correlation between uric acid and both the AIMS65 score (<i>P</i> = 0.001) and the Rockall score (<i>P</i> = 0.001), indicating statistical significance.</p><p><strong>Conclusion: </strong>Our study suggests that elevated serum uric acid levels can serve as a valuable factor in preendoscopy risk assessment. Higher uric acid levels are associated with an increased likelihood of mortality.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"124-131"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943221","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}