Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine最新文献

{"title":"Posaconazole in the Prevention of COVID-19-associated Mucormycosis: A Concerning Contributor to the Rise in Antifungal Resistance.","authors":"Bhavana Kayarat,&nbsp;Puneet Khanna","doi":"10.5005/jp-journals-10071-23981","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23981","url":null,"abstract":"<p><p><b>How to cite this article:</b> Kayarat B, Khanna P. Posaconazole in the Prevention of COVID-19-associated Mucormycosis: A Concerning Contributor to the Rise in Antifungal Resistance. Indian J Crit Care Med 2021;25(10):1209-1210.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1209-1210"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a6/01/ijccm-25-1209.PMC8645813.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39733795","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":"Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO₂/FiO₂ Ratio a Predictor of Success.","authors":"Onkar K Jha,&nbsp;Sunny Kumar,&nbsp;Saurabh Mehra,&nbsp;Mrinal Sircar,&nbsp;Rajesh Gupta","doi":"10.5005/jp-journals-10071-23992","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23992","url":null,"abstract":"<p><p>In acute respiratory failure due to severe coronavirus disease 2019 (COVID-19) pneumonia, mechanical ventilation remains challenging and may result in high mortality. The use of noninvasive ventilation (NIV) may delay required invasive ventilation, increase adverse outcomes, and have a potential aerosol risk to caregivers. Data of 30 patients were collected from patient files and analyzed. Twenty-one (70%) patients were weaned successfully after helmet-NIV support (NIV success group), and invasive mechanical ventilation was required in 9 (30%) patients (NIV failure group) of which 8 (26.7%) patients died. In NIV success vs failure patients, the mean baseline PaO₂/FiO₂ ratio (PFR) (147.2 ± 57.9 vs 156.8 ± 59.0 mm Hg; <i>p</i> = 0.683) and PFR before initiation of helmet (132.3 ± 46.9 vs 121.6 ± 32.7 mm Hg; <i>p</i> = 0.541) were comparable. The NIV success group demonstrated a progressive improvement in PFR in comparison with the failure group at 2 hours (158.8 ± 56.1 vs 118.7 ± 40.7 mm Hg; <i>p</i> = 0.063) and 24 hours (PFR-24) (204.4 ± 94.3 vs 121.3 ± 32.6; <i>p</i> = 0.016). As predictor variables, PFR-24 and change (delta) in PFR at 24 hours from baseline or helmet initiation (dPFR-24) were significantly associated with NIV success in univariate analysis but similar significance could not be reflected in multivariate analysis perhaps due to a small sample size of the study. The PFR-24 cutoff of 161 mm Hg and dPFR-24 cutoff of -1.44 mm Hg discriminate NIV success and failure groups with the area under curve (confidence interval) of 0.78 (0.62-0.95); <i>p</i> = 0.015 and 0.74 (0.55-0.93); <i>p</i> = 0.039, respectively. Helmet interface NIV may be a safe and effective tool for the management of patients with severe COVID-19 pneumonia with acute respiratory failure. More studies are needed to further evaluate the role of helmet NIV especially in patients with initial PFR <150 mm Hg to define PFR/dPFR cutoff at the earliest time point for prediction of helmet-NIV success. <b>How to cite this article</b> Jha OK, Kumar S, Mehra S, Sircar M, Gupta R<i>.</i> Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO₂/FiO₂ Ratio a Predictor of Success. Indian J Crit Care Med 2021;25(10):1137-1146.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1137-1146"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/35/ijccm-25-1137.PMC8645804.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39821271","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":"Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience.","authors":"Pawan K Singh,&nbsp;Lokesh K Lalwani,&nbsp;Manjunath B Govindagoudar,&nbsp;Richa Aggarwal,&nbsp;Dhruva Chaudhry,&nbsp;Prashant Kumar,&nbsp;Preeti Gehlaut","doi":"10.5005/jp-journals-10071-23964","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23964","url":null,"abstract":"<p><strong>Background: </strong>The second wave of COVID-19 pandemic was not only associated with a rapid and severe surge in the number of cases but also limited availability of recommended medicines. Baricitinib has been known to reduce recovery time in COVID-19 pneumonia in association with remdesivir. Tofacitinib, with limited evidence, was used in severe COVID-19 pneumonia based on its similarity of action with baricitinib.</p><p><strong>Methods: </strong>Data of all patients admitted to the COVID-19 intensive care unit in the month of April were accessed and analyzed. Data of patients who were on other immunomodulators, invasive ventilation, or suffering from end-stage organ diseases were excluded from the analysis.</p><p><strong>Results: </strong>Out of 73 patients, data of 50 were analyzed. Twenty-five received tofacitinib and the other 25 were managed with standard of care. Age, comorbidities, and gender distribution between the two groups were similar. On day 7 of admission, the change in SpO₂/FiO₂ ratio was 1.26 ± 1 and 0.72 ± 1 in the tofacitinib group and control group, respectively. Similarly, a higher number of subjects in the control group showed worsening in the World Health Organization (WHO) ordinal scale (36 vs 12%, <i>p</i> = 0.01). The clinical objective improvement was similar in the two groups. The intubation rates in the tofacitinib group were significantly lower than that in the control group (32% vs 8%, <i>p</i> = 0.034).</p><p><strong>Conclusion: </strong>Tofacitinib, in this retrospective single-center experience, was found to be associated with reduced intubation rates and reduced worsening in the WHO ordinal scale. There was no difference in mortality in the two groups.</p><p><strong>How to cite this article: </strong>Singh PK, Lalwani LK, Govindagoudar MB, Aggarwal R, Chaudhry D, Kumar P, et al. Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience. Indian J Crit Care Med 2021;25(10):1108-1112.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1108-1112"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/09/ijccm-25-1108.PMC8645820.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39821266","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":"Diagnostic Accuracy of e-FAST in Stable Blunt Trauma Chest: A Prospective Analysis of 110 Cases at a Tertiary Care Center.","authors":"Hannock Devadoss,&nbsp;Pawan Sharma,&nbsp;Vipin V Nair,&nbsp;Simarjit S Rehsi,&nbsp;Nilanjan Roy,&nbsp;Pankaj P Rao","doi":"10.5005/jp-journals-10071-23995","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23995","url":null,"abstract":"<p><strong>Background: </strong>Focused assessment with sonography in trauma (FAST) is an important adjunct and an extension of the clinical examination in an emergency setting for the last three decades. e-FAST visualizes the lung bases and injuries related to the lungs in addition to the intra-abdominal and pericardial bleed. In trauma patients, time is precious. Noncontrast computed tomography (NCCT) chest is the gold standard for the evaluation of blunt trauma chest. However, it is cumbersome and time-consuming and leads to increased morbidity and mortality. Therefore, evaluation of trauma patients at the trauma bay with e-FAST which is available at all times will not only save time but also the lives of trauma patients. Our endeavor is to find whether e-FAST can be substituted for NCCT for assessing injuries accurately in a stable blunt trauma patient.</p><p><strong>Patient and methods: </strong>Prospective observational study was conducted in a tertiary care trauma center during the period of November 2017 to 2019. Of the 197 patients presenting to the trauma surgeon in the trauma center, 110 were included in the study after satisfying the inclusion criteria. Eighty-seven patients being hemodynamically unstable were excluded from the study.</p><p><strong>Results: </strong>There was no statistical significance in the comparative data between the groups and all with \"<i>p</i>\" values more than 0.05. This accepts the null hypothesis and establishes the fact that there is no difference between NCCT chest which is the gold standard for chest blunt trauma and e-FAST.</p><p><strong>Conclusion: </strong>We conclude that e-FAST is a better adjunct to the diagnosis and management of blunt trauma chest patients.</p><p><strong>How to cite this article: </strong>Devadoss H, Sharma P, Nair VV, Rehsi SS, Roy N, Rao PP. Diagnostic Accuracy of e-FAST in Stable Blunt Trauma Chest: A Prospective Analysis of 110 Cases at a Tertiary Care Center. Indian J Crit Care Med 2021;25(10):1167-1172.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1167-1172"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/4e/ijccm-25-1167.PMC8645814.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732338","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":"Differential Diagnosis of Ketoacidosis in Hyperglycemic Alcoholic Diabetic Patient: Role of Insulin.","authors":"Sunil K Garg,&nbsp;Pragya Garg","doi":"10.5005/jp-journals-10071-23988","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23988","url":null,"abstract":"<p><p>It is important to differentiate between diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) in an alcoholic diabetic patient since it has significant management implications. Ketoacidosis in an alcoholic diabetic patient is a diagnostic challenge as both these clinical entities have metabolic acidosis with high anion gap. Most patients with DKA have hyperglycemia. The majority of AKA patients present with normal or low glucose levels; however, AKA may also present with high glucose levels, more so in diabetics. The situation becomes quite perplexing when an alcoholic diabetic patient presents with hyperglycemia since it can be attributed to DKA or AKA. <b>How to cite this article:</b> Garg SK, Garg P<i>.</i> Differential Diagnosis of Ketoacidosis in Hyperglycemic Alcoholic Diabetic Patient: Role of Insulin. Indian J Crit Care Med 2021; 25(10):1203-1204.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1203-1204"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/a8/ijccm-25-1203.PMC8645807.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39733792","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":"Pain Control and Opioid Use in ICU should be a Quality Parameter.","authors":"Sunil K Garg,&nbsp;Pragya Garg","doi":"10.5005/jp-journals-10071-23979","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23979","url":null,"abstract":"How to cite this article: Garg SK, Garg P. Pain Control and Opioid Use in ICU should be a Quality Parameter. Indian J Crit Care Med 2021; 25(10):1205–1206.","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1205-1206"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7b/f7/ijccm-25-1205.PMC8645817.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39733793","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":"COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study.","authors":"Bharat Mehra,&nbsp;Mukul Pandey,&nbsp;Dhiren Gupta,&nbsp;Tania Oberoi,&nbsp;Nameet Jerath,&nbsp;Rachna Sharma,&nbsp;Naresh Lal,&nbsp;Chandrasekhar Singha,&nbsp;Bhavana Malhotra,&nbsp;Vinamra Manocha,&nbsp;Ashish K Simalti,&nbsp;Yogesh Arya,&nbsp;Sandeep K Dugaya,&nbsp;Swati Kalra,&nbsp;Amar J Chitkara,&nbsp;Anil Sachdev,&nbsp;Neeraj Gupta","doi":"10.5005/jp-journals-10071-23996","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23996","url":null,"abstract":"<p><strong>Background: </strong>Multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new entity affecting a small percentage of children during the COVID-19 pandemic.</p><p><strong>Materials and methods: </strong>Demography, clinical, and laboratory variables of children admitted from April to September 2020 with MIS-C were studied retrospectively at eight hospitals in Delhi, India.</p><p><strong>Results: </strong>We identified 120 patients [median age: 7 years (interquartile range (IQR): 4-10)] with male-to-female ratio of 2.3:1. Overall, 73 out of 120 children (60.8%) presented with shock, 63 (52.5%) required inopressor support, and 51 (43%) required respiratory support. We categorized the cohort into three observed clinical phenotypes: MIS-C with shock (<i>n</i> = 63), MIS-C with Kawasaki disease (KD) (<i>n</i> = 23), and MIS-C without shock and KD (<i>n</i> = 34). Atypical presentations were hypothermia, orchitis, meningoencephalitis, demyelination, polyneuropathy, pancreatitis, and appendicitis. Ninety-four percent had laboratory evidence of SARS-CoV-2 (78.3%, seropositive and 15.8%, RT-PCR positive). The median C-reactive protein (CRP) was 136 mg/L (IQR, 63.5-212.5) and ferritin was 543 ng/mL (IQR, 225-1,127). More than 90% received immunomodulatory therapy (intravenous immunoglobulins and/or steroids) with an excellent outcome (96% survived). CRP and absolute neutrophil count (ANC) were correlated statistically with severity.</p><p><strong>Conclusion: </strong>MIS-C data from Delhi are presented. Rising CRP and ANC predict the severe MIS-C.</p><p><strong>How to cite this article: </strong>Mehra B, Pandey M, Gupta D, Oberoi T, Jerath N, Sharma R<i>, et al.</i> COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study. Indian J Crit Care Med 2021;25(10):1176-1182.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1176-1182"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/3d/ijccm-25-1176.PMC8645810.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732340","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":"Mucormycosis: A Case Series of Patients Admitted in Non-COVID-19 Intensive Care Unit of a Tertiary Care Center during the Second Wave.","authors":"Sangam Yadav,&nbsp;Ankur Sharma,&nbsp;Nikhil Kothari,&nbsp;Pradeep K Bhatia,&nbsp;Shilpa Goyal,&nbsp;Amit Goyal","doi":"10.5005/jp-journals-10071-23986","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23986","url":null,"abstract":"<p><p>Rhino-orbital-cerebral mucormycosis is an invasive fungal infection associated with mortality of 25-62%. There has been a surge in the number of cases during this second wave of coronavirus disease-2019 (COVID-19) in India. We report 10 cases of mucormycosis admitted to our adult intensive care unit. After reviewing the patient's information, we found that 60% of patients had received steroids, and most had uncontrolled blood sugar levels. Most patients received treatment with surgical debridement and antifungal, although the mortality rate was as high as 40%. We report two unique cases of renal and gastrointestinal mucormycosis as well. We concluded that poor glycemic control was the primary etiology behind the rise in the number of cases. Our report also stresses the importance of early surgical intervention and suggests further research comparing the efficacy of combination antifungal therapy versus single antifungal (amphotericin B) to help resource-limited settings in these times of drug crisis. <b>How to cite this article:</b> Yadav S, Sharma A, Kothari N, Bhatia PK, Goyal S, Goyal A. Mucormycosis: A Case Series of Patients Admitted in Non-COVID-19 Intensive Care Unit of a Tertiary Care Center during the Second Wave. Indian J Crit Care Med 2021;25(10):1193-1196.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1193-1196"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/4d/ijccm-25-1193.PMC8645818.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732343","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":"Use of Tofacitinib in the Management of COVID-19 Pneumonia.","authors":"Balasaheb D Bande","doi":"10.5005/jp-journals-10071-24004","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24004","url":null,"abstract":"<p><p><b>How to cite this article:</b> Bande BD. Use of Tofacitinib in the Management of COVID-19 Pneumonia. Indian J Crit Care Med 2021; 25(10):1089-1090.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1089-1090"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c2/05/ijccm-25-1089.PMC8645822.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732959","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":"Critically Ill Pediatric Oncology Patients: A Difficult-to-treat Population.","authors":"Banani Poddar","doi":"10.5005/jp-journals-10071-24017","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24017","url":null,"abstract":"<p><p><b>How to cite this article:</b> Poddar B<i>.</i> Critically Ill Pediatric Oncology Patients: A Difficult-to-treat Population. Indian J Crit Care Med 2021;25(10):1091-1092.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"1091-1092"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/e8/ijccm-25-1091.PMC8645824.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732961","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}