Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Clinical outcomes of \"massive\" acetaminophen overdose treated with standard vs. augmented dose acetylcysteine.","authors":"Joseph W Testa, Madison Bompard, Oyeyimika Oyekanmi, Brandon K Wills, Emily Kershner, John W Downs","doi":"10.1080/15563650.2026.2709730","DOIUrl":"https://doi.org/10.1080/15563650.2026.2709730","url":null,"abstract":"<p><strong>Methods: </strong>This was a single-center retrospective cohort study of acute acetaminophen overdoses reported to a regional poison center from January 2010 to March 2025. Cases were reviewed before and after the poison center adopted augmented acetycysteine dosing for massive acetaminophen overdoses in January 2020. The group who received standard acetylcysteine dosing served as the control. Cases were included if a single acute acetaminophen concentration plotted above the 300-, 450-, or 600 mcg/mL nomogram line. Standard univariate statistical analysis was conducted to describe the cohort, and a multivariate logistic model was utilized to calculate odds ratios for risk of hepatotoxicity.</p><p><strong>Results: </strong>Of 174 included cases, 107 received standard acetylcysteine dosing and 67 received augmented acetylcysteine dosing. Among cases that received acetylcysteine less than eight hours post-ingestion, the incidence of hepatotoxicity was 8.7% (4/46) in the standard dose cohort compared to 8.6% (3/35) in the augmented dose cohort (unadjusted OR 0.98, 95% CI 0.21-4.71) Among those that received acetylcysteine greater than eight hours post-ingestion, the incidence of hepatotoxicity was 34.4% (21/61) in the standard dose cohort compared to 37.5% (12/32) in the augmented dose cohort (unadjusted OR 1.14, 95% CI 0.47-2.78).<b>Discussion</b>Augmented acetylcysteine dosing did not reduce hepatoxicity compared with standard dosing in massive acetaminophen ingestions. Early initiation of acetylcysteine remains the most important factor associated with prevention of hepatotoxicity. Interpretation is limited based on small sample sizes, potentially inaccurate ingestion histories, and reliance on poison center data.</p><p><strong>Conclusion: </strong>In this cohort of massive acetaminophen overdose, there was no difference in incidence of hepatotoxicity between standard versus augmented acetylcysteine dosing when stratified by time-to-acetylcysteine post-ingestion.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842775","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":"Clinical suspicion versus toxicological findings in psychoactive substance poisonings: evidence from emergency cases in Brazil (2023-2024).","authors":"Náthaly Cristine Bueno Faria Dos Santos, Rafael Lanaro, Paula Christiane Soubhia, Karina Diniz Oliveira, Tássia Flávia Dias Castro, Marilyn Ann Huestis, Jose Luiz Costa","doi":"10.1080/15563650.2026.2714934","DOIUrl":"https://doi.org/10.1080/15563650.2026.2714934","url":null,"abstract":"<p><strong>Introduction: </strong>The emergence of new psychoactive substances and adulteration of illicit drugs complicate acute poisoning diagnosis. This study evaluated concordance between clinical suspicion and toxicological confirmation and factors associated with poisoning severity.</p><p><strong>Methods: </strong>This cross-sectional observational study was conducted at the Poison Control Center of Campinas University and the analytical toxicology laboratory, Campinas, Brazil, between January 2023 and December 2024. A total of 385 cases of suspected psychoactive substance poisoning were included. Cases without biological samples or with toxicological requests unrelated to psychoactive substances were excluded. Clinical and demographic data were extracted from the DATATOX national database, and blood and urine toxicological results were obtained by chromatographic and mass spectrometric techniques. Concordance between clinical suspicion and toxicological confirmation, and associations with demographic and toxicological variables were assessed. Clinical severity was classified by the Poison Severity Score.</p><p><strong>Results: </strong>Concordance between suspected and confirmed substances was low. Cocaine and cannabis were the most frequently suspected and confirmed illicit substances, while benzodiazepines, antidepressants, and antipsychotics were rarely suspected but frequently detected. Polysubstance exposures were highly prevalent, with a median of four substances per case. Severe or fatal cases were associated with a significantly higher number of detected substances and with older patient age. Fatalities were rare but consistently involved high-risk agents such as methanol and opioids. Neurological and cardiovascular symptoms predominated, with seizures strongly associated with stimulants and respiratory depression with sedative and opioid combinations.</p><p><strong>Discussion: </strong>The substantial discrepancy between clinical suspicion and laboratory confirmation demonstrates that symptom-based assessment alone is insufficient for the evaluation of acute poisonings involving psychoactive substances. The routine integration of comprehensive toxicological testing may improve diagnostic confidence, facilitate the identification of unsuspected co-exposures, and enhance both patient management and toxicovigilance.</p><p><strong>Conclusion: </strong>Clinical suspicion alone is insufficient for accurate identification of psychoactive substances in acute poisonings. Comprehensive toxicological testing revealed frequent under recognition of benzodiazepines and therapeutic drugs, and a high prevalence of polysubstance use. Integration of laboratory confirmation into routine clinical practice is essential to improve patient care, inform toxicovigilance, and improve international surveillance of psychoactive substance use.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-11"},"PeriodicalIF":3.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835848","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":"Cyanide toxicity following an amygdalin and coffee \"parasite cleanse\".","authors":"Myra Khushbakht, Colleen Cowdery, Courtney Temple","doi":"10.1080/15563650.2026.2722075","DOIUrl":"https://doi.org/10.1080/15563650.2026.2722075","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835860","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":"Organophosphate pesticide poisoning: benefits and limitations of oxime therapy.","authors":"Jure Crepinsek, Doreen Stark, David Steindl, Daniel Raepple, Harald John, Alexa Wachtler, Markus Siegert, Timo Wille, Dirk Steinritz, Niko Amend","doi":"10.1080/15563650.2026.2707976","DOIUrl":"https://doi.org/10.1080/15563650.2026.2707976","url":null,"abstract":"<p><strong>Introduction: </strong>Organophosphate pesticide poisoning remains a major global health problem, accounting for more than 100,000 deaths annually. For decades, the use of oximes in treating the manifestations of organophosphate poisoning has been controversial. We report two cases of organophosphate poisoning caused by monocrotophos and parathion that clearly illustrate both the benefits and the limitations of oxime therapy. These cases highlight the importance of the assessment of acetylcholinesterase activity for identifying patients that benefit from oxime treatment.</p><p><strong>Methods: </strong>We characterized two cases of organophosphate poisoning using spectrophotometric measurements of acetylcholinesterase and butyrylcholinesterase activity, the reactivatability of patients' acetylcholinesterase, and the inhibitory potential of patients' plasma. Gas chromatography-electron ionization mass spectrometry was used to identify the respective pesticides. In addition, liquid chromatography-electrospray ionization-tandem mass spectrometry was used to quantify atropine plasma concentrations and obidoxime plasma concentrations were determined by liquid chromatography coupled with diode-array detection.</p><p><strong>Case reports: </strong>The two distinct cases of organophosphate poisoning demonstrate that an early determination of acetylcholinesterase activity, when interpreted alongside the clinical course, can guide clinical decision-making regarding oxime therapy. In the presence of completely aged acetylcholinesterase, as observed in case 1 (monocrotophos), oxime treatment is unlikely to be beneficial. In contrast, in case 2 (parathion), oxime therapy appears to be an effective therapeutic option.</p><p><strong>Discussion: </strong>Large clinical trials demonstrating a clinically relevant benefit of obidoxime and pralidoxime therapy in organophosphate poisoning are not available. Nevertheless, the present study shows that inexpensive and easy to perform spectrophotometric assessment of patient acetylcholinesterase activity and reactivatability is crucial for avoiding unnecessary oxime treatment and for clearly identifying patients who would benefit from this therapy.</p><p><strong>Conclusion: </strong>Laboratory parameter-guided management of organophosphate poisoning, based on acetylcholinesterase activity, acetylcholinesterase reactivatability, and plasma inhibitory activity, supports clinical decision-making regarding oxime therapy.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-7"},"PeriodicalIF":3.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820775","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":"Transient hepatic portal venous gas and gastric emphysema following ingestion of hydrogen peroxide and peroxyacetic acid.","authors":"Guangcai Yu, Shizhen Lv, Tianzi Jian, Wei Li, Xiangdong Jian","doi":"10.1080/15563650.2026.2718880","DOIUrl":"https://doi.org/10.1080/15563650.2026.2718880","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815362","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":"Defining risk: the case for conceptual clarity in acetaminophen poisoning.","authors":"Neeraj Chhabra, Chanell Davis, Tim Meehan, Sean M Bryant","doi":"10.1080/15563650.2026.2714941","DOIUrl":"10.1080/15563650.2026.2714941","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-4"},"PeriodicalIF":3.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709293","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":"Pediatric scorpion and snake envenomation in Türkiye: clinical features, management, and outcomes.","authors":"Gamze Gökulu, Merve Havan","doi":"10.1080/15563650.2026.2714935","DOIUrl":"https://doi.org/10.1080/15563650.2026.2714935","url":null,"abstract":"<p><strong>Introduction: </strong>Scorpion stings and snake bites are significant public health problems in Türkiye, particularly among children. In Türkiye, <i>Androctonus crassicauda</i> and <i>Mesobuthus eupeus</i> scorpions often cause systemic neurotoxic effects, while <i>Vipera</i> species snake bites mainly result in local tissue injury and hematological abnormalities. These envenomations may lead to serious complications if not promptly recognized and managed. We describe the clinical features, treatment, and outcomes of pediatric envenomations caused by scorpions and snakes.</p><p><strong>Methods: </strong>This retrospective study included pediatric patients admitted to a tertiary care center's emergency department from January 2020 to April 2022 due to scorpion stings and snake bites, with follow-up data reviewed through early 2023. Demographics, clinical symptoms, laboratory results, treatment modalities, antivenom use, intensive care unit admissions, and outcomes were analyzed. Length of stay was recorded from admission to discharge in full calendar days as documented in the electronic medical record.</p><p><strong>Results: </strong>Ninety-five pediatric patients were included: 74 with scorpion stings and 21 with snake bites. The median age was nine years (IQR 5-14 years), with 35% female. Scorpion stings primarily caused systemic manifestations including vomiting, sinus tachycardia, supraventricular tachycardia, and sweating, while snake bites mostly led to local symptoms including redness, edema, and ecchymosis, along with hematologic abnormalities. Of the 11 pediatric patients who received antivenom, six had snake bites and five had scorpion stings. Twelve underwent pediatric intensive care admission. Median hospital stay was two days, and no mortality occurred.</p><p><strong>Discussion: </strong>Snake bites primarily resulted in local manifestations, whereas scorpion stings more frequently produced systemic symptoms. Pediatric intensive care admission and the need for supportive interventions differed according to both the type and severity of envenomation. The overall favorable clinical course observed in our patients likely reflects early presentation and the timely application of standardized supportive management.</p><p><strong>Conclusions: </strong>Pediatric envenomations by indigenous scorpions and snakes in Türkiye had good outcomes. A minority received scorpion or snake antivenom. Most children were managed in a general pediatric ward. Systemic symptoms characterized scorpion stings, while local tissue injury typified snake bites.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-7"},"PeriodicalIF":3.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709301","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":"Scorpion stings and broken hearts: an underdiagnosed etiology of inverted Takotsubo cardiomyopathy.","authors":"Rim Karray, Olfa Chakroun-Walha, Hana Ksentini, Nada Boujelben, Fedi Ben Ali, Amine Bahloul, Islem Kharrat, Mahdi Walha, Leila Abid, Noureddine Rekik","doi":"10.1080/15563650.2026.2711081","DOIUrl":"https://doi.org/10.1080/15563650.2026.2711081","url":null,"abstract":"<p><strong>Introduction: </strong>Severe cases of scorpion envenomation are commonly characterized by pulmonary oedema and heart failure. One mechanism of this acute heart failure is Takotsubo cardiomyopathy. The inverted type is reported less, and its management remains controversial.</p><p><strong>Case reports: </strong>We present six patients diagnosed with inverted Takotsubo cardiomyopathy following scorpion envenomation. They were aged 5-55 years and presented with clinical signs of acute heart failure. Echocardiography revealed apical hyperkinesia and basal hypokinesis, consistent with inverted Takotsubo cardiomyopathy. Management included supportive care and dobutamine infusion. All patients demonstrated significant improvement within one week.</p><p><strong>Discussion: </strong>We report six cases of inverted Takotsubo cardiomyopathy in scorpion envenomation, a pattern commonly underdiagnosed. Clinical presentation mimics acute coronary syndromes, with chest pain, dyspnea, and pulmonary edema. Echocardiography remains the gold standard. The management is controversial, as catecholamine infusion may exacerbate heart ballooning, and the use of beta-blockers or non-catecholamine alternatives, used by some experts, is unsafe in patients with a very low ventricular ejection fraction.</p><p><strong>Conclusion: </strong>Inverted Takotsubo cardiomyopathy is a rare but reversible cardiac complication of scorpion envenomation. The management protocol requires further investigation.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-5"},"PeriodicalIF":3.3,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687567","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":"Dextromethorphan-associated neurotoxicity with cerebellar edema (DANCE) syndrome.","authors":"Suresh Kumar Angurana, Sujatha Manjunathan, Renu Suthar, Prasanna Samynathan, Pradeep Babu Uppaluri, Shubham Raj, Arushi Gahlot Saini","doi":"10.1080/15563650.2026.2707982","DOIUrl":"https://doi.org/10.1080/15563650.2026.2707982","url":null,"abstract":"<p><strong>Introduction: </strong>Dextromethorphan-associated neurotoxicity with cerebellar edema syndrome is a recently described clinico-radiological condition resembling pediatric opioid use-associated neurotoxicity with cerebellar edema syndrome.</p><p><strong>Methods: </strong>To describe two children with dextromethorphan-associated neurotoxicity with cerebellar edema syndrome from a tertiary care hospital in North India. The clinical details were obtained from the medical case records of the children admitted with dextromethorphan-associated neurotoxicity with cerebellar edema syndrome during the month of August and September 2025.</p><p><strong>Results: </strong>We report two children (3 years and 13 months) who presented with encephalopathy following ingestion of dextromethorphan-containing cough syrup for viral prodrome. Magnetic resonance imaging showed T2/FLAIR hyperintensities in bilateral cerebellar hemispheres with diffusion restriction, suggestive of cytotoxic edema. With supportive treatment and intravenous methylprednisolone, both patients recovered rapidly with no residual neurologic deficits.</p><p><strong>Discussion: </strong>These two cases highlight the occurrence of dextromethorphan-associated neurotoxicity with cerebellar edema syndrome in young children. Sensitization of healthcare providers about dextromethorphan-associated neurotoxicity with cerebellar edema syndrome, early clinical suspicion, confirmation of diagnosis with neuroimaging, and supportive care, may be associate with good neurological recovery.</p><p><strong>Conclusion: </strong>Dextromethorphan-associated neurotoxicity with cerebellar edema syndrome is a new clinico-radiological condition that occurs following ingestion of dextromethorphan in young children. Similar to the recently published report and cases presented here, early identification and treatment may be associated with favorable neurological recovery. Therefore, this syndrome should be considered in the differential diagnosis at an early stage. There is a need to increase awareness among healthcare providers to avoid prescribing dextromethorphan-containing cough syrups to younger children.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-4"},"PeriodicalIF":3.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687585","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":"Prediction of severe caffeine intoxication: a bedside clinical model with implications for extracorporeal therapy.","authors":"Yasuhiro Nakajima, Hideki Sugita, Hiroki Yamaga, Mariko Kurihara, Mariko Sato, Asuka Kaizaki-Mitsumoto, Jun Sasaki, Satoshi Numazawa, Kenji Dohi","doi":"10.1080/15563650.2026.2709002","DOIUrl":"10.1080/15563650.2026.2709002","url":null,"abstract":"<p><strong>Introduction: </strong>Severe caffeine intoxication can cause life-threatening complications, yet serum caffeine measurements are rarely available at presentation. We aimed to develop a simple clinical prediction model using readily available clinical parameters to predict severe caffeine intoxication.</p><p><strong>Methods: </strong>This retrospective study involved patients with acute caffeine intoxication admitted between April 2016 and March 2022. Data on clinical variables at presentation were collected. Severe intoxication was defined as serum caffeine concentration ≥ 80 mg/L (412 μmol/L). Candidate predictors included heart rate and serum potassium and bicarbonate levels. A ridge logistic regression model was developed and evaluated using the area under the receiver operating characteristic curve, calibration plots, and Hosmer-Lemeshow test. Internal validation was performed using bootstrap resampling and leave-one-out cross-validation. Conventional logistic regression was performed as a sensitivity analysis. Clinical utility was assessed using decision curve analysis.</p><p><strong>Results: </strong>Of 30 patients included, 13 (43%) had serum caffeine concentration ≥ 80 mg/L (412 μmol/L). Patients with severe intoxication had higher ingested doses, shorter time to presentation, higher heart rates and respiratory rates, lower bicarbonate and potassium levels, and more frequent use of hemodialysis and activated charcoal. The ridge model retained heart rate and bicarbonate and potassium levels as predictors. Internal validation demonstrated excellent discrimination and good calibration. Decision curve analysis indicated net clinical benefit across a range of threshold probabilities. Sensitivity analysis using conventional logistic regression revealed consistent results, with heart rate remaining a significant predictor.</p><p><strong>Discussion: </strong>The selected predictors are biologically plausible and reflect key pathophysiological features of severe caffeine intoxication. Internal validation demonstrated excellent discrimination and calibration, supporting the robustness of the model.</p><p><strong>Conclusion: </strong>We developed a practical bedside prediction model for caffeine intoxication using heart rate and bicarbonate and potassium levels. The model demonstrated excellent discrimination and calibration. It may support early risk stratification and guide intensive monitoring or extracorporeal therapy.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-7"},"PeriodicalIF":3.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681940","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}