{"title":"Intranasal Dexmedetomidine Compared With Intranasal Midazolam for Pediatric Emergence Delirium: A Systematic Review and Meta-analysis.","authors":"Ashlee M Ericksen, Terri D Kane, Tito D Tubog","doi":"10.1016/j.jopan.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.jopan.2025.01.011","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluate the effectiveness of intranasal dexmedetomidine compared with intranasal midazolam in reducing pediatric emergence delirium (ED).</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>A comprehensive search was conducted in MEDLINE (PubMed), CINAHL, the Cochrane Review Database, Google Scholar, and gray literature to identify relevant studies. Risk ratios (RR) and standardized mean differences were calculated to estimate the outcomes, using appropriate effect models. The quality of evidence was assessed using the Risk of Bias tool and evaluated according to the Grades of Recommendation, Assessment, Development, and Evaluation approach.</p><p><strong>Findings: </strong>Twelve studies (N = 1,133) were included in the review. Intranasal dexmedetomidine significantly reduced the incidence of ED (RR 0.52, 95% confidence interval [CI], 0.29 to 0.90, P = .02) compared with midazolam. Intranasal dexmedetomidine also demonstrated significantly improved sedation levels (standardized mean differences -0.48, 95% CI, -0.92 to -0.04, P = .03) compared with midazolam. However, no significant differences were observed in parental separation (RR 1.14, 95% CI, 0.94 to 1.39, P = .19), mask acceptance (RR 1.05, 95% CI, 0.83 to 1.34, P = .67), or postoperative nausea and vomiting (RR 0.84, 95% CI, 0.44 to 1.61, P = .61). The overall quality of evidence was rated as low, primarily due to the small number of studies included.</p><p><strong>Conclusions: </strong>Intranasal dexmedetomidine significantly reduces pediatric ED and improves sedation levels compared with midazolam, but both drugs show similar effects on parental separation, mask acceptance, and postoperative nausea and vomiting. Intranasal administration offers a noninvasive, effective option for pediatric sedation. Larger studies are needed to confirm these findings, as current evidence is limited.</p>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chiara Giammaria, Nicolò Panattoni, Irene Terrenato, Alessandro Spano, Aurora De Leo, Bernardino Tomei, Emanuele Di Simone, Fabrizio Petrone
{"title":"Cross-cultural Adaptation and Validation of the Italian Version of the Revised Perceived Perioperative Competence Scale.","authors":"Chiara Giammaria, Nicolò Panattoni, Irene Terrenato, Alessandro Spano, Aurora De Leo, Bernardino Tomei, Emanuele Di Simone, Fabrizio Petrone","doi":"10.1016/j.jopan.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.jopan.2025.01.009","url":null,"abstract":"<p><strong>Purpose: </strong>The nurse's role in the operating room requires essential competencies throughout the care process, such as theoretical knowledge, technical skills, and problem-solving abilities assessed by the Revised Perceived Perioperative Competence Scale (PPCS-R). The study aims to translate, cross-culturally adapt, and validate the Italian version of the scale.</p><p><strong>Design: </strong>A cross-cultural adaptation and validation of the Italian version of PPCS-R.</p><p><strong>Methods: </strong>The revised English version of the 40-item scale PPCS-R was translated into Italian according to Beaton's guidelines. The scale's internal consistency was assessed using Cronbach's α coefficient, ensuring the instrument's reliability. An exploratory factor analysis was conducted, preceded by the Kaiser-Meyer-Olkin test and Bartlett's sphericity test. Statistical analyses were performed using SPSS version 29.1 (IBM Corp.).</p><p><strong>Findings: </strong>The exploratory factor analysis of the Revised Perceived Perioperative Competence Scale-Italian Version (PPCS-R ITA) (N = 509) confirmed the 6 factors served in the original version. The final Italian version of PPCS-R comprises 40 items grouped into 6 latent factors. Each latent component showed a high consistency per Cronbach's α. The statistical analyses of the study confirm the reliability and good consistency of the tool.</p><p><strong>Conclusions: </strong>The statistical analyses of the study confirm the reliability and consistency of the tool (Revised Perceived Perioperative Competence Scale-Italian Version). By investigating the perception of Italian professionals working in the operating room through a translated and validated scale, specific training and professional development needs of a specific context can be better understood to identify appropriate learning and management strategies.</p>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mir Amirhossein Seyednazari, Mahdi Shabani, Ali Aghajanloo
{"title":"The Effect of the Neuman Systems Model on Eye Surgery Patients' Anxiety: Randomized Controlled Trial.","authors":"Mir Amirhossein Seyednazari, Mahdi Shabani, Ali Aghajanloo","doi":"10.1016/j.jopan.2024.11.008","DOIUrl":"https://doi.org/10.1016/j.jopan.2024.11.008","url":null,"abstract":"<p><strong>Purpose: </strong>Perioperative anxiety is prevalent among patients undergoing eye surgery. This study aimed to evaluate the effectiveness of the Neuman Systems Model (NSM) in reducing preoperative surgical anxiety by targeting intrapersonal, interpersonal, and extrapersonal stressors.</p><p><strong>Design: </strong>This was a single-center, randomized controlled trial.</p><p><strong>Methods: </strong>A total of 70 patients were randomly assigned into 2 groups. The patients in the intervention group (n = 35) received NSM-based intervention and the patients in the control group (n = 35) were subject to a routine care before the surgery. Anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory before and after the intervention in both groups.</p><p><strong>Findings: </strong>There is no significant statistical difference in State and Trait anxiety levels before intervention in both groups (P > .05). In the intervention group, the mean State anxiety score significantly decreased from 47.82±3.47 to 42.22±3.20 (P < .001), while no significant change was observed in the control group (47.88±3.75, P = .156). Similarly, the Trait anxiety score in the intervention group decreased from 49.05±3.79 to 47.22±3.30 (P < .001), with no significant difference in the control group (49.25±3.94, P = .431).</p><p><strong>Conclusions: </strong>The results demonstrated the effectiveness of implementing the NSM-based intervention in reducing preoperative anxiety in eye surgery patients. Therefore, it is recommended that this model be used to reduce anxiety in clinical settings.</p>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Assessment of Preoperative Fasting Duration in Pediatric Patients at a Tertiary Care Hospital.","authors":"Mayra Elvira Saucedo-Toledo, Miroslava Iliana Carrasco-González, Margarita Torres-García, Diana Moyao-García, César Galicia-Ayala","doi":"10.1016/j.jopan.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.jopan.2025.01.004","url":null,"abstract":"<p><strong>Purpose: </strong>Preoperative fasting is a widely practiced method to prevent pulmonary aspiration events, but prolonged fasting can be as harmful as insufficient fasting, particularly in pediatric settings. The aim of this study was to identify the actual duration of preoperative fasting in a tertiary pediatric hospital and the associated factors.</p><p><strong>Design: </strong>A cross-sectional study was conducted, reviewing the clinical records of 153 pediatric patients undergoing elective surgery between May and June 2023.</p><p><strong>Methods: </strong>The actual preoperative fasting time was calculated and the sample was divided into two equivalent groups: participants below the median fasting time and those above the median fasting time. Sociodemographic and health information from the preoperative period until discharge was recorded. Statistical tests, including Pearson's χ<sup>2</sup> and Mann-Whitney U, were performed for comparison.</p><p><strong>Findings: </strong>The study included a sample of participants comprising 46.4% females and 53.6% males, with a median age of 8.2 years. The median actual preoperative fasting time was 440 minutes, and significant differences were identified between participants below and above the median fasting time in several factors, including length of surgery, postoperative reingestion time, length of hospital stay, hospitalization unit, American Society of Anesthesiologists' score, and postoperative destination unit (all P < .05).</p><p><strong>Conclusions: </strong>These findings underscore the detrimental effects of prolonged fasting, and highlight the necessity for targeted interventions aimed at reducing fasting durations and associated complications, particularly within pediatric populations facing complex medical scenarios.</p>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effects of Sevoflurane and Propofol During Mechanical Ventilation: A Meta-analysis of Randomized Controlled Trials.","authors":"Peixia Yu, Lijun Bo","doi":"10.1016/j.jopan.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.jopan.2024.12.001","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the inflammatory response, hemodynamic stability, and postoperative recovery of sevoflurane versus propofol after mechanical ventilation during surgery, to provide references for rational anesthesia utility in clinical practice by meta-analysis.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>Pubmed, Web of Science, Cochrane Library, Wanfang Data, China National Knowledge Infrastructure, and Chinese BioMedical Literature Database were searched by computer for trials on the anesthetic effects of sevoflurane and propofol after mechanical ventilation during surgery. A random- or fixed-effects model was applied to analyze the clinical indicators and adverse impact based on heterogeneity.</p><p><strong>Findings: </strong>As of April 21, 2023, 912 articles were retrieved, and 36 eligible articles were finally identified after screening, covering 2,691 surgical patients for meta-analysis. The combined results exhibited that the level of tumor necrosis factor (TNF)-α in alveolar lavage was significantly different between the 2 groups (-0.94, 95% confidence interval [CI]: -1.82 to -0.05, P = .038). Compared with sevoflurane, propofol significantly increased TNF-α levels in alveolar lavage. In plasma or serum, propofol significantly increased the levels of interleukin-10 (-0.73, 95% CI: -1.36 to -0.10, P = .023) and TNF-α (-0.65, 95% CI: -1.21 to -0.09, P = .022).</p><p><strong>Conclusions: </strong>At alveolar lavage and serum or plasma levels of inflammatory factors, the proinflammatory factor TNF-α was significantly lower in the sevoflurane group than in the propofol group. This indicates that sevoflurane has a certain role in alleviating local and systemic lung inflammation. However, more randomized controlled studies are warranted in the future to confirm whether there is a difference in hemodynamic stability and postoperative recovery of patients.</p>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Impact of Music Therapy on Preoperative Anxiety in Pediatric Patients Undergoing Anesthesia: A Systematic Review and Meta-analysis.","authors":"Haowen Li, Menghua Cheng, Shuying Jiang","doi":"10.1016/j.jopan.2024.11.016","DOIUrl":"https://doi.org/10.1016/j.jopan.2024.11.016","url":null,"abstract":"<p><strong>Purpose: </strong>Preoperative anxiety remains a critical concern in pediatric anesthesia, often worsening surgical outcomes and complicating postoperative recovery. This systematic review and meta-analysis aimed to evaluate whether music therapy, as a nonpharmacological intervention, effectively reduces preoperative anxiety in children undergoing anesthesia.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>Studies examining the impact of music therapy on preoperative anxiety in pediatric patients were systematically identified, screened, and selected for inclusion. Data from eligible studies were synthesized using a random-effects model to assess the pooled effect size, with sensitivity analyses performed to verify result stability. Publication bias across the included studies was also investigated to ensure reliability of the findings.</p><p><strong>Findings: </strong>The analysis included 7 studies comprising a total of 440 pediatric participants. Findings indicated that music therapy led to a statistically significant reduction in anxiety levels, yielding a moderate effect size (standardized mean difference = -0.48; 95% confidence interval, -0.81 to -0.15; I<sup>2</sup> = 65.6%). Sensitivity analyses demonstrated consistent results, as the removal of individual studies did not significantly alter the overall effect estimate. Additionally, no substantial publication bias was detected, supporting the validity of the meta-analysis.</p><p><strong>Conclusions: </strong>The findings strongly endorse music therapy as an effective nonpharmacological strategy for managing preoperative anxiety in pediatric patients undergoing anesthesia. With a statistically significant moderate reduction in anxiety observed, music therapy emerges as a valuable tool for improving the perioperative experience and potentially enhancing recovery outcomes in pediatric surgical care.</p>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Relationship Between Preoperative Anxiety Levels of Patients Undergoing Total Knee Arthroplasty and Postoperative Recovery.","authors":"Sevim Çelik, Rümeysa Birkanim, Sibel Altintaş, Elif Karahan","doi":"10.1016/j.jopan.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.jopan.2024.12.004","url":null,"abstract":"<p><strong>Purpose: </strong>Surgical interventions are significant factors that cause anxiety in individuals. This study aimed to determine the effect of preoperative anxiety on postoperative recovery in patients undergoing total knee arthroplasty.</p><p><strong>Design: </strong>A cross-sectional and correlational study.</p><p><strong>Methods: </strong>This study was conducted between February 2023 and September 2023 with 204 patients scheduled for total knee arthroplasty. Data were collected through face-to-face interviews using the Patient Information Form, Surgical Anxiety Questionnaire for Adult Patients, and Postoperative Recovery Index (PRI).</p><p><strong>Findings: </strong>The Surgical Anxiety Questionnaire for Adult Patients' mean score was 31.38 ± 13.91 and the PRI total score was 2.98 ± 0.76. The subscale showed that the highest scores were 12.14 ± 4.97 for health-related anxiety. The anxiety scores concerning recovery, surgical procedures, and invasive procedures were lower. Patients experienced moderate difficulty in the recovery of intestinal symptoms (2.55 ± 0.98) and psychological symptoms (2.43 ± 0.88), significant difficulty in the recovery of desire-wish symptoms (>2.5), and extreme difficulty in the recovery of physical symptoms (3.87 ± 0.81). A positive and statistically significant relationship was found between surgical anxiety levels and postoperative recovery index mean scores (P < .001).</p><p><strong>Conclusions: </strong>The study showed that preoperative surgical anxiety negatively impacts postoperative recovery. Identifying preoperative anxiety levels and implementing interventions to reduce or eliminate surgical anxiety will be beneficial in achieving positive outcomes in the postoperative recovery process.</p>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mi-Ra Kang, Hyun-Ju Seo, Ji Sung Lee, Yoon-Kyung Jang, Soyeon Lee, Hye-Jin Kim, Seo-Jin Won, Kyungja Kim, Eunyoung Im
{"title":"The Effects of Early Oral Intake in the Postanesthesia Care Unit on Nausea and Vomiting: A Meta-analysis of Randomized Controlled Trials.","authors":"Mi-Ra Kang, Hyun-Ju Seo, Ji Sung Lee, Yoon-Kyung Jang, Soyeon Lee, Hye-Jin Kim, Seo-Jin Won, Kyungja Kim, Eunyoung Im","doi":"10.1016/j.jopan.2025.01.001","DOIUrl":"https://doi.org/10.1016/j.jopan.2025.01.001","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review and meta-analysis aimed to investigate whether early oral fluid intake after surgery compared with delayed oral intake causes nausea and vomiting in pediatric patients who underwent general anesthesia in the postanesthesia care unit (PACU).</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>Conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (version 6.4), this study searched electronic databases, including Pubmed, CINAHL, Embase, Cochrane CENTRAL, PubMed, RISS, and KoreaMed up to July 2023. The Risk of Bias 2 tool assessed the risk of bias, and R statistical software facilitated meta-analysis. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.</p><p><strong>Findings: </strong>A meta-analysis of 6 randomized controlled trials (RCTs) (2,723 patients) found early oral intake in the PACU decreased vomiting incidence by 36% compared with delayed oral fluid intake (risk ratio = 0.64, 95% confidence interval: 0.42 to 0.97, P = .040, I<sup>2</sup> = 7%) with moderate certainty of evidence. Another meta-analysis of 3 RCTs (2,185 participants) showed that early oral intake did not increase nausea compared with delayed oral intake (95% confidence interval: -0.76 to 0.07, P = .071, I<sup>2</sup> = 0%) with low certainty of evidence.</p><p><strong>Conclusions: </strong>Early oral fluid intake in the PACU decreases postoperative vomiting without raising nausea. Health care providers should consider implementing early oral fluid intake in the PACU for enhanced recovery of pediatric patients.</p>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Jaensson PhD, RN, RNA , Jakob Hedlund MSc, RN, RNA , Karin Blomberg PhD, RN
{"title":"Experience of Student Nurse Anesthetists’ Learning in the Operating Room During the COVID-19 Pandemic: A Qualitative Interview Study","authors":"Maria Jaensson PhD, RN, RNA , Jakob Hedlund MSc, RN, RNA , Karin Blomberg PhD, RN","doi":"10.1016/j.jopan.2024.04.010","DOIUrl":"10.1016/j.jopan.2024.04.010","url":null,"abstract":"<div><h3>Purpose</h3><div>This study explores student nurse anesthetists’ (SNAs) learning in the operating room during the coronavirus 2019 pandemic.</div></div><div><h3>Design</h3><div>An explorative design with semistructured interviews was used.</div></div><div><h3>Methods</h3><div>Thirteen former SNAs and 12 clinical supervisors (8 of whom were included in the final analysis) were recruited from 6 counties in Sweden. Participants were purposively recruited. Inclusion criterion for former SNAs was having completed the nurse anesthesia program in the fall of 2020 to spring 2022; and for nurse anesthetists, those who have experience in supervising SNAs. The interviews were analyzed with thematic analysis.</div></div><div><h3>Findings</h3><div>The analysis identified one theme and five subthemes. The theme was that student learning was in focus despite an ongoing pandemic. Every learning situation contributed, and learning was triggered by the challenges. Both the SNAs and the supervisors exhibited resilience by accepting the situation and striving to do their absolute best in a nonoptimal learning environment. Over time, learning and supervision returned to normal.</div></div><div><h3>Conclusions</h3><div>During the pandemic, learning was ongoing despite stress, fear, and other challenging factors. Students’ learning appears to have been prioritized. The study highlights that nurse anesthetists and SNAs were resilient, resourceful, and able to find new ways to keep learning going.</div></div>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 2","pages":"Pages 294-299"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}