Pacing and clinical electrophysiology : PACE最新文献

{"title":"The Impact of the Spatial Distribution of Ventricular Extrasystoles on Implantable Cardioverter-Defibrillator Recipients.","authors":"Carlos Arthur Hansel Diniz da Costa, Gabriela Menichelli Medeiros Coelho, Rhanniel Theodorus Helhyas Oliveira Shilva Gomes Villar, Gabriela Rodrigues de Oliveira, Pedro Henrique Correia Filgueiras, Enia Lucia Coutinho, Claudio Cirenza, Angelo Amato Vincenzo de Paola","doi":"10.1111/pace.70033","DOIUrl":"10.1111/pace.70033","url":null,"abstract":"<p><strong>Introduction: </strong>Premature ventricular complexes (PVC) are a common phenomenon observed in both normal and pathological heart conditions. However, they do not always behave in the same way. Different PVCs present with varying QRS morphologies, mechanisms, and origin sites. These differences may imply distinct prognoses. To date, the impact of the three-dimensional distribution of PVCs across the heart on the prognosis of ICD recipients has not been adequately investigated.</p><p><strong>Material and methods: </strong>We conducted an ambidirectional cohort study. Patients underwent two twelve-lead ambulatory ECG recordings during follow-up. The spatial distribution of PVCs was analyzed using the algorithm proposed by Kuchar et al. The impact of this spatial distribution on clinical variables was assessed using mixed generalized models.</p><p><strong>Results: </strong>Fifty-five patients were enrolled, with a mean follow-up time of 41.12 ± 13.48 months. All patients underwent two 12-lead ambulatory ECG recordings. The median PVC count was 91.5. PVCs were classified according to the algorithm proposed by Kuchar et al. PVCs arising from exit sites located in the intermediate left ventricle were associated with a higher number of therapies (odds ratio [OR]: 4.78; 95% confidence interval [CI], 1.19-19.26; p = 0.028) and prolonged QRS duration. PVCs with exit sites located in the septal region were associated with higher NYHA functional classes (OR: 2.22 [95% CI: 1.08-4.44]; p = 0.030). No statistically significant interaction was found between PVC topography and gender, number of ATP episodes, ATP success rate, or number of shock episodes.</p><p><strong>Conclusion: </strong>The spatial distribution of PVCs influenced the prognosis of ICD recipients.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1157-1166"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986825","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":"Functional and Psychological Impact of Cardiac Rehabilitation in Patients With Implantable Cardiac Devices.","authors":"Christian D Adams S, Angely Paola Ceron Noriega, Leonardo Arzayus-Patiño, Carolina Castro Gomez","doi":"10.1111/pace.70048","DOIUrl":"10.1111/pace.70048","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) programs are established interventions for improving physical and psychological outcomes in patients with cardiovascular diseases. However, data on their effects in patients with cardiac implantable electronic devices (CIEDs), particularly in Latin America, remain limited.</p><p><strong>Objective: </strong>To evaluate the impact of a structured CR program on functional capacity, psychological well-being, and clinical outcomes in patients undergoing CIED implantation.</p><p><strong>Methods: </strong>This cohort study included 30 patients with CIEDs (pacemakers, implantable cardioverter defibrillators, or cardiac resynchronization therapy devices) enrolled in a CR program. Baseline assessments included the 6-minute walk test (6MWT), metabolic equivalents (METs), peak oxygen uptake (VO₂), left ventricular ejection fraction (LVEF), and Hospital Anxiety and Depression (HAD) scale scores. Patients completed a 12-week outpatient CR program, and outcomes were reassessed after program completion and at 1-year follow-up.</p><p><strong>Results: </strong>At baseline, the mean LVEF was 45.9% (±19.2), and the average 6MWT distance was 383.3 m (82.5% of predicted). Following CR, significant improvements were observed in 6MWT distance, METs, VO₂, LVEF, and HAD scale scores for anxiety and depression (p < 0.05). Subgroup analysis revealed improvements in functional capacity metrics for patients with pacemakers and CRT devices. Adverse events included one heart transplant in the ICD group and one death due to refractory heart failure in the CRT group.</p><p><strong>Conclusion: </strong>CR programs significantly improve physical capacity, psychological well-being, and functional class in patients with CIEDs, with low complication rates.</p><p><strong>Summary: </strong>This study is the first to evaluate the benefits of cardiac rehabilitation (CR) program for patients with cardiac implantable electronic devices (CIEDs) in a Latin American population. The CR programs significantly improve exercise capacity, left ventricular function, and anxiety/depression scores in patients with CIEDs. The CR programs are safe with low complication rates in patients with pacemakers and implantable cardioverter defibrillators. The study highlights the need for integrating CR into standard care for CIED patients to enhance functional and psychological outcomes.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1184-1190"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071599","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":"Progressive Paced QRS Widening: An Electrocardiographic Marker for Predicting Cardiac Resynchronization Therapy Upgrade.","authors":"Takayuki Shimizu, Keijiro Nakamura, Naohiko Nemoto, Hidehiko Hara","doi":"10.1111/pace.70050","DOIUrl":"10.1111/pace.70050","url":null,"abstract":"<p><strong>Background: </strong>Chronic right ventricular (RV) pacing may lead to left ventricular dysfunction requiring cardiac resynchronization therapy (CRT) upgrade. This study aimed to determine whether paced QRS duration (pQRSd) and its progression over time predict the need for CRT upgrade.</p><p><strong>Methods: </strong>In this retrospective study of 410 RV pacing-dependent patients who underwent device surgery at two centers between 2017 and 2022, we analyzed pQRSd immediately after pacemaker implantation and before potential CRT upgrade. ΔpQRSd was defined as the difference between these measurements.</p><p><strong>Results: </strong>Among 410 patients, 51 (12.4%) underwent CRT upgrade. Multiple regression analysis revealed that CRT upgrade was significantly associated with age (p = 0.004), pQRSd before upgrade (p < 0.0001), and baseline left ventricular ejection fraction (LVEF) (p < 0.0001). ΔpQRSd was significantly larger in CRT upgrade patients (16 ms vs. 0.6 ms, p < 0.0001). ROC analysis established optimal cut-off values: pQRSd > 154 ms post-pacemaker insertion (sensitivity 80%, specificity 45%, AUC = 0.62), pQRSd > 166 ms before CRT upgrade (sensitivity 88%, specificity 73%, AUC = 0.83), and ΔpQRSd > 6 ms (sensitivity 73%, specificity 69%, AUC = 0.72).</p><p><strong>Conclusion: </strong>Progressive widening of pQRSd represents a novel, clinically accessible marker for identifying patients at high risk for CRT upgrade. Monitoring pQRSd trends through routine electrocardiogram (ECG) provides an effective strategy for early identification of patients who might benefit from CRT before developing advanced heart failure.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1094-1102"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083251","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":"Hemothorax Caused by Delayed Pacing Lead Perforation: A Case Report.","authors":"Shanshan Cheng, Min Hu, Xin Wang, Xingsheng Cheng","doi":"10.1111/pace.70049","DOIUrl":"10.1111/pace.70049","url":null,"abstract":"<p><p>Pacing lead perforation is a rare but life-threatening complication of pacemaker implantation, and timely diagnosis remains challenging for clinicians. We report a case of delayed pacing lead perforation identified by echocardiography with massive bloody pleural effusion. This case emphasizes that careful, timely imaging evaluation can improve the detection rate of complications and guide clinical decision-making.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1123-1126"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083268","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":"High-Precision Hemodynamic and Echocardiographic Assessment of Pacing in Obstructive Hypertrophic Cardiomyopathy.","authors":"Jagdeep S Mohal, Matthew J Shun-Shin, Kayla Chiew, Alejandra A Miyazawa, Florentina Simader, Pannathorn Tangkongpanich, Rahul Bahl, Ji-Jian Chow, James P Howard, Akriti Naraen, Keenan Saleh, Jack W Samways, Daniel Keene, S M Afzal Sohaib, Mark Tanner, Kevin M W Leong, Norman A Qureshi, David C Lefroy, Prapa Kanagaratnam, Darrel P Francis, Amanda Varnava, Zachary I Whinnett, Ahran D Arnold","doi":"10.1111/pace.70024","DOIUrl":"10.1111/pace.70024","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular outflow obstruction drives symptoms and outcomes in obstructive hypertrophic cardiomyopathy (oHCM). Right ventricular pacing (RVP) can desynchronize the left ventricle to relieve this and allows control of atrioventricular delay (AVD) but may impair ventricular function. We used high-precision assessment to quantify the hemodynamic and echocardiographic effects of RVP in oHCM.</p><p><strong>Methods: </strong>Patients with oHCM and implanted dual-chamber pacing devices underwent continuous recording of ECG, beat-by-beat outflow tract continuous wave Doppler, and beat-by-beat, noninvasive finger-cuff blood pressure while pacing was alternated between atrium-only pacing and AV-sequential RVP at a range of AVDs at 5 bpm above resting heart rate and 100 bpm. Changes in systolic blood pressure (∆SBP) and left ventricular outflow tract gradient (∆LVOTg) were fitted to parabolas to produce reproducible, narrow confidence interval estimates of effects.</p><p><strong>Results: </strong>Twenty two patients were recruited (60% male, mean resting LVOTg 53 mmHg). At just above resting heart rate (mean 75 bpm), RVP produced mean peak ∆SBP from AAI to DDD of 2.47 mmHg (95% confidence interval: 0.19-4.76, p = 0.04). The mean AVD for peak ∆SBP was 173.2 ms. Mean LVOTg reduction at this AVD was 8.31 mmHg (2.43-14.18, p < 0.001). Apart from the hemodynamically optimum AVD, no other AVDs produced statistically significant increases in SBP. At 100 bpm, greater increases in SBP and reductions in LVOTg were seen at hemodynamically optimal AVD.</p><p><strong>Conclusion: </strong>Multiple alternation assessment allows precise, reproducible, narrow confidence interval quantification of hemodynamic and echocardiographic pacing effects. RVP can reduce LVOTg while preserving or improving cardiac output, but AVD is a key modifier of this relationship.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1138-1147"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986763","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":"Evolution of Extravascular ICD Implantation: Shift Toward Local Anesthesia and Nurse-Led Sedation Without Propofol.","authors":"Andre Briosa E Gala, Fazlullah Wardak, Jordan Evans, Arthur Yue, John Paisey","doi":"10.1111/pace.70054","DOIUrl":"10.1111/pace.70054","url":null,"abstract":"<p><p>We describe the first successful implantation of an extravascular implantable cardioverter-defibrillator (EV-ICD) performed under local anesthetic with nurse-led sedation, without the use of propofol or anesthetic support. The procedure was well tolerated in a carefully selected, motivated patient. Although this is a single case, the patient's experience and procedural metrics were comparable to those performed under general anesthesia. This approach may offer a safe and resource-efficient alternative for individuals for whom general anesthesia is high risk or unavailable. It marks a potential shift in practice, mirroring transitions in S-ICD implantation, which expanded to include nerve block, local anesthesia, and sedation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1203-1207"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071607","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":"Risk Factors and Costs Associated With 1-Year Mortality and Readmission After Leadless Pacemaker Implantation.","authors":"Peter G Brodeur, Enrico G Ferro, Timothy G Maher, Jonathan W Waks, Andre d' Avila, ZhaoNian Zheng, Peter J Zimetbaum, Gregory F Michaud, Shu Yang, Patricia Tung, Robert W Yeh, Andrew H Locke, Daniel B Kramer","doi":"10.1111/pace.15207","DOIUrl":"10.1111/pace.15207","url":null,"abstract":"<p><strong>Background: </strong>Leadless pacemakers (LPM) have been shown to be safe and effective alternatives to transvenous pacing systems. Few studies have evaluated the incidence and associated costs of post-implant complications. The objectives of this study were to assess risk factors and causes for 1-year mortality and all-cause readmission, as well as characterize the total cost of care associated with index procedures and readmissions.</p><p><strong>Methods: </strong>LPM procedures, including inpatient and outpatient encounters, were captured in the Healthcare Cost and Utilization Project data in Florida, Maryland, and New York from 2016 to 2020 with 1-year follow-up through 2021. Cox proportional hazards regression was used to identify patient demographics, facility volume, and comorbid risk factors for 1-year all-cause readmission and in-hospital mortality. Costs of inpatient cases and readmission were captured.</p><p><strong>Methods: </strong>Among 7127 patients receiving LPM, 3% died during the initial episode of care. The 1-year all-cause readmission rate was 45.9%, and the in-hospital mortality rate was 8.8%. Comorbid heart failure (CHF), atrial fibrillation/flutter, chronic kidney disease, and diabetes increased the risk of 1-year all-cause readmission and in-hospital mortality (p < 0.05). CHF was the most common cause of readmission (17%). Inpatient cases resulted in a cost of $257 million, with readmissions increasing costs by 44.4%.</p><p><strong>Conclusions: </strong>The large healthcare expenditure derives from high rates of readmission and in-hospital mortality, with readmissions potentially representing a modifiable target. CHF is a prominent cause of poor outcomes, which suggests the need to consider the overlapping roles of conduction system pacing, goal-directed medical therapy, and close clinical follow-up.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1127-1137"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088842","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":"Cardiac Resynchronization Therapy in Single-Ventricle Physiology: A Case Report of cc-TGA Managed With Fontan Strategy.","authors":"Merve Maze Aydemir, Mustafa Nalbant, Hasan Candaş Kafalı, Fatma Sevinç Şengül, Celal Akdeniz, Okan Yıldız","doi":"10.1111/pace.70030","DOIUrl":"10.1111/pace.70030","url":null,"abstract":"<p><p>Cardiac resynchronization therapy (CRT) has been widely used in adult patients with heart failure and ventricular dyssynchrony, but its application in pediatric patients with congenital heart disease (CHD), particularly those with single-ventricle physiology, remains limited. We report the case of a male patient with congenitally corrected transposition of the great arteries (cc-TGA) and single-ventricle physiology who developed complete atrioventricular block and underwent single-chamber epicardial pacing at the age of four. A dual-chamber pacemaker was later implanted at the time of Glenn surgery. By age 12, in the pre-Fontan period, the patient showed signs of systemic ventricular dysfunction and electromechanical dyssynchrony, including a QRS duration of 167 ms, reduced left ventricular ejection fraction (35%-40%), and elevated NT-proBNP (1507 pg/mL). CRT upgrade was performed simultaneously with extracardiac Fontan completion. Postoperative improvement was significant, with QRS narrowing to 130 ms, normalization of ventricular function (EF: 50%), and NT-proBNP reduction to 146 pg/mL. This case illustrates the feasibility and potential benefits of CRT in patients with single-ventricle physiology, particularly when timed strategically with Fontan completion. It also supports emerging guideline recommendations for CRT use in systemic single-ventricle patients with symptomatic heart failure despite medical therapy.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1114-1118"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877954","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":"Addition of Atrial Myopathy to HATCH Score for Predicting New-Onset Atrial Fibrillation After Ablation of Atrial Flutter.","authors":"Teerapat Nantsupawat, Yanhui Li, Stephanie Li, Neeraj Sathnur, Supavit Chesdachai, Selcuk Adabag, David G Benditt, Venkatakrishna N Tholakanahalli","doi":"10.1111/pace.70044","DOIUrl":"10.1111/pace.70044","url":null,"abstract":"<p><strong>Background: </strong>The available risk prediction models are inadequate to identify a true low-risk patient for developing new-onset atrial fibrillation (AF) after typical atrial flutter (AFL) ablation. We aimed to determine whether adding markers of atrial myopathy to HATCH score (hypertension, age ≥75 years, transient ischemic attack/stroke, chronic obstructive pulmonary disease, and heart failure) can improve prediction of new-onset AF after ablation of typical AFL.</p><p><strong>Methods: </strong>The study included 208 consecutive patients who underwent successful ablation of typical AFL at Minneapolis VA Medical Center and University of Minnesota Medical Center. Patients with history of AF prior to ablation were excluded.</p><p><strong>Results: </strong>Among the 208 patients, 76 (36.5%) developed new-onset AF post AFL ablation. Mean follow-up duration was 62 ± 31.8 months. HATCH score was not associated with new-onset AF. When adding atrial myopathy (presence of at least one of the following: PTFV₁ > 5000 µV*ms, interatrial block determined by biphasic inferior p wave with duration >120 ms, left atrium (LA) diameter ≥44 mm, or LA index ≥3 cm/m²) to HATCH score (HATCH-A₂), the combination was independently associated with new-onset AF. The AF incidence between HATCH-A₂ score of 0-1 and ≥2 were 6.7% and 40.5%, respectively (Odds ratio 9.04, 95% confidence interval: 2.05-39.81, p = 0.004). Particularly, when HATCH-A₂ score was 0, none of the patients developed AF.</p><p><strong>Conclusions: </strong>Adding atrial myopathy to HATCH score improved predictability and could be used to delineate a true low-risk patient of new-onset AF after typical AFL ablation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1167-1175"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035103","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":"Bradycardia-Dependent Transient Rise in the Atrial Lead Capture Threshold 21 Years After the Lead Implantation.","authors":"Mitsuhiko Shoda, Kimitake Imamura, Mitsuru Takami, Koji Fukuzawa","doi":"10.1111/pace.70041","DOIUrl":"10.1111/pace.70041","url":null,"abstract":"<p><p>We present a man with an implantable cardioverter defibrillator implanted for Brugada syndrome. Twenty-one years later, he underwent catheter ablation of atrial fibrillation and tachycardia. Bradycardia-dependent transient loss of atrial capture was observed 3 months post-ablation, undetected by the automatic pacing threshold adjustment algorithm performed at a pacing rate higher than the programmed setting. We report a transient bradycardia-dependent rise in the capture threshold over 20 years post-implantation, along with its mechanism.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1119-1122"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035105","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}