Advances in neonatal care : official journal of the National Association of Neonatal Nurses最新文献

{"title":"Clinical Team's Needs to Inform an Early Warning System for High-Risk Neonatal Conditions.","authors":"Yuying Mo, Xiaojuan Liu, Fen Zhen, Xiaolan Li, Xiaodong Zhao, Wanxiang He","doi":"10.1097/ANC.0000000000001398","DOIUrl":"10.1097/ANC.0000000000001398","url":null,"abstract":"<p><strong>Background: </strong>High-risk newborns often present with clinical deterioration that is difficult to detect. In neonatal intensive care units (NICUs), conventional physiological monitoring and manual clinical assessments are associated with substantial operational burdens and high false alarm rates. With the surge in clinical data, frontline physicians and nurses need to screen for effective information to assist in decision making. Therefore, there is an urgent need to explore the requirements for data screening and automated information support in the early warning system for newborns.</p><p><strong>Purpose: </strong>This study aimed to explore the clinical demand for an intelligent early warning system and identify the primary obstacles clinical team face in the early recognition of condition changes among high-risk neonates. These findings provide a reference for improving clinical strategies and system designs.</p><p><strong>Methods: </strong>A descriptive, qualitative research approach was used. Semi-structured interviews were conducted with 13 NICU healthcare professionals. Data were systematically analyzed using a directed content analysis method.</p><p><strong>Results: </strong>The interview content was synthesized into 3 primary themes and 8 subthemes: (1) high-risk factor profiling and early warning signals, (2) obstacles and challenges in identifying early disease changes, and (3) expectations regarding the functionalities of an information-intelligent system.</p><p><strong>Implications for practice and research: </strong>Nursing and hospital management should collaboratively advance staff training, information system upgrades, and clinical workflow optimization. Training should focus on enhancing staff's ability to identify risks, the system must ensure efficient information flow and timely alerts, and workflow optimization is crucial to ensure a rapid clinical response after risk identification.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"352-361"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440404","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":"AI in the NICU: Considerations for Nursing Practice and Advocacy in Quality Care Outcomes for Patients and Families.","authors":"Benjamin J Galatzan, Katherine M Dudding, Elizabeth Johnson","doi":"10.1097/ANC.0000000000001400","DOIUrl":"10.1097/ANC.0000000000001400","url":null,"abstract":"<p><strong>Background: </strong>Neonatal nurses and APRNs may not recognize when AI drives an alert, recommendation, or summary unless training and policy make it explicit. Nurses protect infants and practice when they treat AI output as clinical decision support, not clinical truth. Limited transparency about \"black box\" performance requires nurses to verify information, increases professional risk, and blurs practice boundaries when AI-driven recommendations conflict with clinical judgment.</p><p><strong>Purpose: </strong>Provide practical guidance to identify where AI appears in workflow, apply a \"nurse as verifier\" stance, and use clear documentation and escalation pathways when AI affects care.</p><p><strong>Methods: </strong>We describe common AI encounters in the NICU summarization tools, EHR-based clinical decision support, and embedded AI in monitors and sensors. We outline actions to verify outputs, reduce automation bias, preserve an audit trail when AI influences escalation or de-escalation, and report AI-related errors.</p><p><strong>Results: </strong>AI can strengthen situational awareness, but it does not replace nursing judgment or accountability. In a high-acuity environment with rapid physiologic change, undisclosed or poorly understood AI increases risk, especially when nurses cannot confirm data sources or limitations underlying clinical decision support outputs.</p><p><strong>Implications for practice: </strong>Nurses carry responsibility to determine when AI use supports safety and when it introduces risk within their scope of practice and standards of care. These responsibilities increasingly align with evolving legal and regulatory expectations related to AI-informed actions and documentation.</p><p><strong>Implications for research: </strong>Research is needed to determine how nurses use AI in current workflow and identify risk to nursing practice and infant safety.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"334-338"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280631","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":"Ergonomic Considerations in Neonatal Cardiopulmonary Resuscitation: Implications for Practice.","authors":"Helen Harrod Clark, Jennifer Parent-Nichols, Paula McWilliam, Brian King, Rodrigo Galindo, Louis P Halamek, Nicole K Yamada","doi":"10.1097/ANC.0000000000001361","DOIUrl":"10.1097/ANC.0000000000001361","url":null,"abstract":"<p><strong>Background: </strong>Prolonged neonatal cardiopulmonary resuscitation (CPR) is critical for survival in cases of severe bradycardia due to asphyxia. High-performance CPR, emphasizing consistent compression depth and full recoil, improves survival rates.</p><p><strong>Purpose: </strong>This pilot study explored how environmental and provider-specific factors-including bed height, positioning, and anthropometry-affect the consistency of neonatal CPR using the 2-thumb technique.</p><p><strong>Methods: </strong>Twenty-two neonatal intensive care unit providers performed 2-minute CPR trials on a neonatal simulator under 2 conditions: self-selected bed height (\"choice\") and standardized bed height (100 cm, \"pre-set\"). Compression depth and recoil were recorded using simulator sensors. Postural changes and onset of sway were assessed via video analysis. Results from the head-of-bed position were compared with data from a prior side-of-bed study.</p><p><strong>Results: </strong>Chest recoil decreased over time in both bed-height conditions, potentially compromising CPR effectiveness. Bed height did not impact the number of postural changes or time to sway with a head-of-bed approach. Compared to the side-of-bed position, head-of-bed placement resulted in fewer postural changes and delayed onset of sway. In the choice condition, taller providers and those with longer reach preferred higher bed heights.</p><p><strong>Implications for practice and research: </strong>The head-of-bed approach may enhance motor performance by allowing pelvic stabilization against the bed, limiting lower-joint motion, and improving stability. However, this position may impair chest recoil over time, potentially reducing CPR effectiveness. Further research is needed to optimize ergonomic factors influencing neonatal resuscitation performance.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"394-401"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694697","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":"Neonatal Intensive Care Unit Nurses' End-of-Life Care Experience: Becoming a More Empathetic Professional Caregiver.","authors":"Mi Jeong Park, Woo Joung Joung, Na Ry Chung, Sun-Mi Chae","doi":"10.1097/ANC.0000000000001380","DOIUrl":"10.1097/ANC.0000000000001380","url":null,"abstract":"<p><strong>Background: </strong>Few studies have examined how empathy develops in neonatal intensive care units (NICUs) as nurses experience negative outcomes in end-of-life care delivery (eg, burnout, moral conflict, and psychological distress). Various characteristics of neonatal care contribute to frequent infant deaths and nurse emotional strain, rendering knowledge of how empathy evolves essential for improving end-of-life care and NICU nurse well-being nationwide.</p><p><strong>Purpose: </strong>To explore the experiences of NICU nurses providing end-of-life care for infants in South Korea, focusing on the impact of recurrent exposure to infant deaths.</p><p><strong>Methods: </strong>In this qualitative descriptive study, semi-structured interviews were conducted with 11 nurses from a tertiary Level IV NICU in Seoul, South Korea, each with ≥6 months of experience caring for terminally ill infants and having experienced at least 2 infant deaths. Reflective thematic analysis of Braun and Clarke was used for analysis.</p><p><strong>Results: </strong>Three main themes emerged: (1) Providing emotionally detached end-of-life care in the NICU; (2) Developing empathy through end-of-life care; and (3) Becoming a more empathetic professional caregiver.</p><p><strong>Implications for practice and research: </strong>Empathy is critical for high-quality neonatal end-of-life care. Structured educational and emotional support is needed to foster empathy and promote compassionate, family-centered practices.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"384-393"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148348532","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":"Evidence Summary of Best Practices for Kangaroo Mother Care in Preterm Infants.","authors":"Rongdan Li, Chunmei He, Mei Luo, Meiqun He, Zhiying Li, Qiaoqing Xie","doi":"10.1097/ANC.0000000000001371","DOIUrl":"10.1097/ANC.0000000000001371","url":null,"abstract":"<p><strong>Background: </strong>Kangaroo mother care (KMC) is an effective intervention to reduce preterm infant mortality and complications. Updated review of current evidence supports revision of current neonatal guidelines.</p><p><strong>Purpose: </strong>To systematically retrieve, appraise, and synthesize the best current evidence on safe and effective KMC practices for preterm infants.</p><p><strong>Data sources: </strong>Comprehensive search (inception to December 2024) using the \"6S\" model across UpToDate, JBI, BMJ Best Practice, Cochrane Library, NICE, NGC, GIN, PubMed, CINAHL, Embase, CBM, Wanfang, CNKI, and Baidu Scholar.</p><p><strong>Study selection: </strong>Included guidelines, systematic reviews, meta-analyses, evidence summaries, expert consensuses, and clinical decision support articles focused on KMC for preterm infants/families/nurses (PIPOST model). Excluded non-Chinese/English, duplicates, and incomplete texts. Nine (9) documents were finally included from 56 full-texts screened (3 guidelines, 3 systematic reviews, 2 clinical decision supports, 1 evidence summary).</p><p><strong>Data extraction: </strong>The 6-member research team comprised 4 researchers who independently conducted quality assessments of guideline documents, while 2 researchers independently evaluated systematic reviews and evidence summaries.</p><p><strong>Results: </strong>Quality appraisal revealed high-quality evidence overall. Twenty-four (24) best practice recommendations were synthesized into 6 domains: (1) Support System, (2) Staff Training, (3) Recipient Assessment, (4) Timing of Intervention, (5) Implementation Key Points, and (6) Outcome Evaluation.</p><p><strong>Implications for practice and research: </strong>Provides an updated, evidence-based reference for clinical KMC implementation. Clinicians should adapt recommendations to local contexts. Future research should focus on high-quality primary studies and addressing evidence-practice gaps.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"402-410"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280640","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":"Predicting Neonatal Respiratory Outcomes Using Machine Learning: A Systematic Review Through a Life Course Lens.","authors":"Janet Northcote, Sawyer Olson, Tamara G R Macieira, Leslie A Parker, Mei Liu, Lisiane Pruinelli","doi":"10.1097/ANC.0000000000001392","DOIUrl":"10.1097/ANC.0000000000001392","url":null,"abstract":"<p><strong>Background: </strong>Neonatal respiratory outcomes remain leading drivers of neonatal intensive care unit (NICU) morbidity, mortality, and prolonged hospitalization, underscoring the need for accurate early risk prediction through artificial intelligence (AI) and machine learning (ML) approaches.</p><p><strong>Purpose: </strong>To conduct a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review synthesizing AI/ML models predicting neonatal respiratory outcomes through a Life Course Health Development (LCHD) lens, examining whether models incorporate developmental timing, cumulative processes, and contextual factors.</p><p><strong>Data sources: </strong>PubMed, Embase, and Web of Science were searched from January 1, 2014, to July 18, 2025.</p><p><strong>Study selection: </strong>Included peer-reviewed studies developing or validating AI/ML prediction models for neonatal respiratory outcomes with performance metrics. Excluded non-ML regression, non-original research, and non-English studies. Of 4319 records initially identified, 1780 unique records were screened, 33 underwent full-text review (0.76%); 16 met selection criteria (0.37%).</p><p><strong>Data extraction: </strong>Two reviewers independently extracted study characteristics, inputs, algorithms, validation strategies, and performance metrics. Risk of bias was assessed using PROBAST + AI. Disagreements were resolved by consensus.</p><p><strong>Results: </strong>Studies addressed bronchopulmonary dysplasia (n = 8), respiratory distress syndrome (n = 4), apnea of prematurity (n = 3), and massive pulmonary hemorrhage (n = 1). Discrimination was strong in internal validation (several models with an area under the receiver operating characteristic curve ≥0.85). External validation was rare (2/16); calibration reporting was sparse. No studies predicted postdischarge respiratory outcomes or included comprehensive determinants of health.</p><p><strong>Implications for practice and research: </strong>Although ML models show promise for NICU risk stratification, responsible clinical adoption requires multisite external validation, routine calibration, and nursing-informed designs incorporating development context. See Video Abstract, Supplemental Digital Content.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"339-351"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440633","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":"Impact of Kangaroo Care on Premature Infants' Circadian Rhythm, Growth, Physiological Stability, and Maternal Milk Hormones: RCT Protocol.","authors":"Fatma Ertürk, Sibel Küçükoğlu","doi":"10.1097/ANC.0000000000001376","DOIUrl":"10.1097/ANC.0000000000001376","url":null,"abstract":"<p><strong>Background: </strong>Kangaroo care (KC) is considered to be an effective intervention in establishing circadian rhythms and human milk hormone profiles in premature infants.</p><p><strong>Purpose: </strong>This study protocol has 2 main objectives: to assess the effects of regular KC on circadian rhythm, growth, and physiological parameters in premature infants, and to evaluate human milk cortisol and melatonin levels as secondary outcomes.</p><p><strong>Methods: </strong>This trial is a parallel-group, single-blind, randomized controlled experimental study. Sample of the study will consist of 56 premature infants. The experimental group (n = 28) will receive KC for 1 hour, twice daily, during designated day and night intervals over 3 consecutive days. The control group (n = 28) will receive routine incubator/cot care. The daytime and nighttime circadian rhythms of both groups will be monitored. Human milk samples will be collected from both groups to determine cortisol and melatonin levels in human milk.</p><p><strong>Results: </strong>Protocol results are expected to advance knowledge by providing the first integrated assessment of circadian rhythm development in neonatal intensive care unit infants using noninvasive neurophysiological measures and human milk cortisol and melatonin. By linking these indicators to KC and assessing growth and physiological stability, the study will provide evidence on whether KC supports circadian rhythm maturation.</p><p><strong>Implications for practice and research: </strong>Research will guide clinicians in evaluating the effects of kangaroo care administered during daytime and nighttime intervals for 3 consecutive days on circadian rhythm, growth, physiological parameters, and human milk cortisol and melatonin levels, while also providing a foundation for future research.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"e5-e14"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148202052","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":"Nicolau Syndrome in an Extremely Premature Neonate: A Case Report.","authors":"Alaina R Miller, Nzingha-Mosi C Whyte, Elias W Abebe","doi":"10.1097/ANC.0000000000001365","DOIUrl":"10.1097/ANC.0000000000001365","url":null,"abstract":"<p><strong>Background: </strong>Nicolau syndrome (NS) is a rare iatrogenic dermatologic reaction following intramuscular (IM) injections that is not well understood. It is especially uncommon in the extremely preterm neonatal population with this case being the first to document additional vascular findings.</p><p><strong>Clinical findings: </strong>A 24-week female infant weighing 623 g presented with a large, violaceous oval patch measuring 4.5 cm × 2.5 cm with an erythematous border on the left lateral thigh accompanied by dusky toes shortly after receiving routine IM injection of vitamin K.</p><p><strong>Primary diagnosis: </strong>Once differential diagnoses were ruled out, an investigation of the IM vitamin K injection method and proximity of injection to initial onset of symptoms showed administration to be the cause. After review of the literature, NS was determined to be the most plausible diagnosis.</p><p><strong>Interventions: </strong>To restore perfusion to the toes, the left leg was elevated, and a warm compress was applied to the contralateral foot. Bacitracin was administered topically, and the lesion was monitored over time.</p><p><strong>Outcomes: </strong>The lesion healed, leaving a linear scar circumscribed by a hypopigmented patch without secondary complications.</p><p><strong>Practice recommendations: </strong>As this is an iatrogenic event, development of standardized practice guidelines for IM injections in premature infants is recommended, especially in the extremely preterm and low birth-weight population. Vitamin K should continue to be administered through IM route as recommended by the American Academy of Pediatrics.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"378-383"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475552","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":"Effects of Musical Stimulation During Retinopathy Examination on Pain and Comfort Levels of Premature Infants: A Randomized Controlled Study.","authors":"Gizem Kivrak, Semra Köse","doi":"10.1097/ANC.0000000000001373","DOIUrl":"10.1097/ANC.0000000000001373","url":null,"abstract":"<p><strong>Background: </strong>Retinopathy of Prematurity (ROP) examination is a procedure associated with pain, discomfort, and physiological changes in premature newborns.</p><p><strong>Purpose: </strong>Explore effects of exposure to different types of auditory stimulation during ROP examination on pain, comfort, and physiological parameters of premature infants.</p><p><strong>Methods: </strong>The study was conducted in the neonatal intensive care unit between January 2023 and June 2024. A stratified randomization method was used for sample selection, and a total of 75 premature infants participated. Intervention comparisons included a rain stick (n = 25), white noise (n = 25), and control (n = 25). The sound of a rain stick is often considered musical. Premature infants in the intervention groups were exposed to the rain stick or white noise 3 minutes before, during the entire ROP examination, and 3 minutes after. The infants in the control group underwent routine ROP examination and nursing care.</p><p><strong>Results: </strong>Neonatal Pain Agitation and Sedation Scale and comfort scores were significant in the rain stick group than in the white noise and control groups before, during, and after the examination. In both the rain stick and white noise groups, mean SpO 2 and peak heart rate differed significantly between during- and post-procedure measurements ( P < .05).</p><p><strong>Implications for practice and research: </strong>Musical stimulation, as a noninvasive and accessible intervention, can be used in neonatal intensive care unit care to reduce pain and enhance infant comfort. Neonatal nurses may safely integrate gentle auditory stimuli into routine care. Future studies should determine optimal music types, durations, and methods, and evaluate their long-term and cross-cultural effects to support standardized neonatal music therapy practices.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"411-420"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280696","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":"Shaping the Future of Technology-Enhanced Wisdom for Neonatal Care.","authors":"Sheila M Gephart","doi":"10.1097/ANC.0000000000001413","DOIUrl":"10.1097/ANC.0000000000001413","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":"26 4","pages":"327-328"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671719","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}