Regional Anesthesia and Pain Medicine最新文献

{"title":"Ten years of transitional pain service research and practice: where are we and where do we go from here?","authors":"Hance Clarke, Anna Waisman, Andrea Aternali, Kristina Axenova, Amjaad Almohawis, Kathryn Curtis, Joseph Fiorellino, Michelle Flynn, Praveen Ganty, Alexander Huang, Zhaorong Hong, Rita Katznelson, Yuvaraj Kotteeswaran, Salima Ladak, Karim S Ladha, Anna Lomanowska, Heather Lumsden-Ruegg, Ala Mahamid, Molly McCarthy, Sarah Miles, Judith Nicholls, M Gabrielle Pagé, Miki Peer, Brittany N Rosenbloom, Daniel Santa Mina, Rachel Siegal, P Maxwell Slepian, Ainsley Sutherland, Diana Tamir, Leeping Tao, Paul Tumber, Jeffrey Wieskopf, Callon Williams, Elizabeth Woodford, Joel Katz","doi":"10.1136/rapm-2024-105609","DOIUrl":"https://doi.org/10.1136/rapm-2024-105609","url":null,"abstract":"<p><p>Chronic postsurgical pain (CPSP) is a prevalent yet unintended consequence of surgery with substantial burdens to the individual and their family, the healthcare system, and society at large. The present article briefly reviews the evidence for transitional pain services (TPSs) that have arisen in an effort to prevent and mange CPSP and persistent opioid use, and provides an update on recent novel risk factors for CPSP. Available evidence from one randomized controlled trial (RCT) and three non-randomized cohort studies suggests that TPS treatment is associated with better opioid use outcomes, including fewer opioid tablets prescribed at discharge, better opioid weaning results, a lower incidence of new-onset chronic opioid use, and lower consumption of opioids even at later time points up to 1 year after surgery. Another RCT indicates TPS treatment can be enhanced by provision of perioperative clinical hypnosis. While these preliminary studies are generally positive, large-scale, RCTs are needed to provide a more definitive picture of whether TPSs are effective in reducing opioid consumption and improving pain and mental health outcomes in the short and long term. With the expansion of TPSs across North America and globally, perioperative care focused on reducing the transition to pain chronicity has the potential to help millions of patients. With additional evidence from well-controlled RCTs, TPSs are well poised to continue to evolve and strengthen the role of multidisciplinary care teams in the immediate postdischarge period and beyond.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"188-203"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of and recommendation for measuring chronic postsurgical pain in children: an updated systematic review and meta-analysis.","authors":"Brittany N Rosenbloom, Simona Denise Frederiksen, Vienna Wang, Kathryn A Birnie, Christine S Park, Grace Gordon, Nivez Rasic, Jennifer N Stinson, Jennifer A Rabbitts","doi":"10.1136/rapm-2024-105697","DOIUrl":"10.1136/rapm-2024-105697","url":null,"abstract":"<p><strong>Background: </strong>According to the prior 2017 review (Rabbitts <i>et al</i>), approximately 20% of children and adolescents develop chronic postsurgical pain (CPSP; ie, pain persisting >3 months after surgery) after major surgeries, which is associated with adverse functional and psychological consequences. A major barrier was that definitions of CPSP applied were highly variable. Since that prior review was conducted (n=4 studies in meta-analysis), numerous relevant studies have been published warranting an update.</p><p><strong>Objective: </strong>The aims of this current review were to: (1) provide an updated prevalence estimate for pediatric CPSP and (2) examine definitions of pediatric CPSP applied in current research.</p><p><strong>Evidence review: </strong>Prospective, observational studies examining CPSP using a validated self-report pain intensity measure in children were included. 4884 unique publications were screened with 20 articles meeting inclusion criteria. Risk of bias using Quality in Prognostic Study tool ranged from low to high.</p><p><strong>Findings: </strong>The pooled prevalence of CPSP among mostly major surgeries was 28.2% (95% CI 21.4% to 36.1%). Subgroup analysis of spinal fusion surgeries identified a prevalence of 31% (95% CI 21.4% to 43.5%). Using Grading of Recommendations, Assessment, Development, and Evaluation, the certainty in prevalence estimates was moderate. Studies used a range of valid pain intensity measures to classify CPSP (eg, Numeric Rating Scale), often without pain interference or quality of life measures.</p><p><strong>Conclusions: </strong>The overall prevalence of pediatric CPSP is higher than estimated in the prior review, and quality of studies generally improved though with some heterogeneity. Standardizing the measurement of CPSP will facilitate future efforts to combine and compare data across studies.</p><p><strong>Prospero registration number: </strong>CRD42022306340.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"132-143"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons learned from establishing a transitional pain service in the USA.","authors":"T Kyle Harrison, Edward R Mariano, J David Clark, Seshadri C Mudumbai, Oluwatobi O Hunter","doi":"10.1136/rapm-2024-105610","DOIUrl":"https://doi.org/10.1136/rapm-2024-105610","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"184-187"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postamputation pain: a multidisciplinary review of epidemiology, mechanisms, prevention, and treatment.","authors":"Tina L Doshi, Edward Dolomisiewicz, Michael J Caterina, Allan Belzberg, Alexander J Kastl, Steven P Cohen","doi":"10.1136/rapm-2024-105817","DOIUrl":"https://doi.org/10.1136/rapm-2024-105817","url":null,"abstract":"<p><p>Despite humanity's long experience with amputations, postamputation pain remains a highly prevalent, incompletely understood, and clinically challenging condition. There are two main types of postamputation pain: residual limb pain (including but not limited to the \"stump\") and phantom limb pain. Despite considerable overlap between the two, they also have distinct clinical features, risk factors, and pathophysiological mechanisms. Central, peripheral, and spinal mechanisms may all contribute to the protean manifestations of persistent postamputation pain; an improved understanding of these mechanisms will be essential to identify the most promising interventions for the prevention and treatment of postamputation pain. Although there are currently no standardized prevention or treatment recommendations for any type of postamputation pain, an evidence-based, multimodal strategy including pharmacological agents, nonsurgical procedures, surgery, complementary and integrative techniques, and assistive technologies may prevent the development of chronic postamputation pain after amputation and/or optimize treatment outcomes.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"175-183"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upskilling pain relief after surgery: a scoping review of perioperative behavioral intervention efficacy and practical considerations for implementation.","authors":"Beth D Darnall, Lauren Abshire, Rena E Courtney, Sara Davin","doi":"10.1136/rapm-2024-105601","DOIUrl":"https://doi.org/10.1136/rapm-2024-105601","url":null,"abstract":"<p><p>Perioperative skills-based interventions may support non-pharmacological management of pain and opioid reduction after surgery. Such interventions may target and enhance predictors for surgical recovery and possibly reduce chronic postsurgical pain. Existing meta-analyses are limited by inclusion of studies that are either non-surgical or with outcomes occurring only in the hours after surgery. Lacking is a scoping review of studies testing perioperative skills-based interventions for postsurgical pain relief and opioid reduction in the days and months after surgery. We reviewed the efficacy of perioperative behavioral interventions; over what time frame and in which surgical populations efficacy evidence exists; and whether such interventions can prevent chronic postsurgical pain. 20 randomized trials were included, with the following intervention types: hypnosis, relaxation therapy, stress management training, mindfulness, mixed-type skills interventions (mind-body skills, preoperative pain self-management, empowered relief for surgery); cognitive behavioral-therapy (CBT); and mindfulness-based CBT. We summarize study methods, treatment specifics, and analgesic effects. No studies were designed to test intervention efficacy for preventing chronic postsurgical pain. Only two studies used active controls as the study comparator. Two studies showed positive effects on postsurgical opioid use. No studies tested whether the interventions enhanced time to pain cessation after surgery. Four studies demonstrated durable analgesic effects at 3-12 months after surgery. We describe the real-world practicality of intervention integration into the perioperative pathway and provide dissemination and implementation methodologies that may increase intervention uptake and therefore fulfill calls from national agencies to better integrate behavioral pain treatments into perioperative care.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"93-101"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognizing pain phenotypes: biopsychosocial sources of variability in the transition to chronic postsurgical pain.","authors":"Kristin L Schreiber, Jenna M Wilson, Yun-Yun Kathy Chen","doi":"10.1136/rapm-2024-105602","DOIUrl":"10.1136/rapm-2024-105602","url":null,"abstract":"<p><p>Chronic postsurgical pain (CPSP) is a cause of new chronic pain, with a wide range of reported incidence. Previous longitudinal studies suggest that development of CPSP may depend more on the constellation of risk factors around a patient (pre-existing pain phenotype) rather than on the extent of surgical injury itself. The biopsychosocial model of pain outlines a broad array of factors that modulate the severity, longevity, and impact of pain. Biological variables associated with CPSP include age, sex, baseline pain sensitivity, and opioid tolerance. Psychological factors, including anxiety, depression, somatization, sleep disturbance, catastrophizing, and resilience, and social factors, like education and social support, may also importantly modulate CPSP. Prevention efforts have targeted acute pain reduction using multimodal analgesia (regional anesthesia and intraoperative analgesic adjuvant medications). However, studies that do not measure or take phenotypic risk factors into account (either using them for enrichment or statistically as effect modifiers) likely suffer from underpowering, and thus, fail to discern subgroups of patients that preventive measures may be most helpful to. Early preoperative identification of a patient's pain phenotype allows estimation of their constellation of risk factors and may greatly enhance successful, personalized prevention of postoperative pain. Effective preoperative employment of behavioral interventions like cognitive-behavioral therapy, stress reduction, and physical and mental prehabilitation may particularly require knowledge of a patient's pain phenotype. Preoperative assessment of patients' pain phenotypes will not only inform high-quality personalized perioperative care clinically, but it will enable enriched testing of novel therapies in future scientific studies.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"86-92"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovations in acute and chronic pain biomarkers: enhancing diagnosis and personalized therapy.","authors":"Sean Mackey, Nima Aghaeepour, Brice Gaudilliere, Ming-Chih Kao, Merve Kaptan, Edward Lannon, Dario Pfyffer, Kenneth Weber","doi":"10.1136/rapm-2024-106030","DOIUrl":"https://doi.org/10.1136/rapm-2024-106030","url":null,"abstract":"<p><p>Pain affects millions worldwide, posing significant challenges in diagnosis and treatment. Despite advances in understanding pain mechanisms, there remains a critical need for validated biomarkers to enhance diagnosis, prognostication, and personalized therapy. This review synthesizes recent advancements in identifying and validating acute and chronic pain biomarkers, including imaging, molecular, sensory, and neurophysiological approaches. We emphasize the emergence of composite, multimodal strategies that integrate psychosocial factors to improve the precision and applicability of biomarkers in chronic pain management. Neuroimaging techniques like MRI and positron emission tomography provide insights into structural and functional abnormalities related to pain, while electrophysiological methods like electroencepholography and magnetoencepholography assess dysfunctional processing in the pain neuroaxis. Molecular biomarkers, including cytokines, proteomics, and metabolites, offer diagnostic and prognostic potential, though extensive validation is needed. Integrating these biomarkers with psychosocial factors into clinical practice can revolutionize pain management by enabling personalized treatment strategies, improving patient outcomes, and potentially reducing healthcare costs. Future directions include the development of composite biomarker signatures, advances in artificial intelligence, and biomarker signature integration into clinical decision support systems. Rigorous validation and standardization efforts are also necessary to ensure these biomarkers are clinically useful. Large-scale collaborative research will be vital to driving progress in this field and implementing these biomarkers in clinical practice. This comprehensive review highlights the potential of biomarkers to transform acute and chronic pain management, offering hope for improved diagnosis, treatment personalization, and patient outcomes.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"110-120"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors of chronic postsurgical pain in children and adolescents: a systematic review and meta-analysis.","authors":"Brittany N Rosenbloom, Simona Denise Frederiksen, Vienna Wang, Christine S Park, Grace Gordon, Gurpreet Brar, Nivez Rasic, Jennifer N Stinson, Kathryn A Birnie, Jennifer A Rabbitts","doi":"10.1136/rapm-2024-105696","DOIUrl":"10.1136/rapm-2024-105696","url":null,"abstract":"<p><strong>Background: </strong>Approximately 28% of children and adolescents undergoing major surgery develop chronic postsurgical pain (CPSP; pain persisting>3 months). A previous review attempted to investigate biopsychosocial prognostic factors for pediatric CPSP; however, due to lack of data, no meta-analytic techniques were employed. Since that review, numerous studies have investigated risk/protective factors that fall within an Interpersonal Fear Avoidance Model for CPSP, thus warranting a reinvestigation of prognostic factors.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to examine prognostic factors, measurement tools applied, and their effect on the development of CPSP.</p><p><strong>Evidence review: </strong>Prospective, observational studies examining prognostic factors of pediatric CPSP using validated self-report measures were included. 4884 unique publications were screened and 15 met inclusion criteria.</p><p><strong>Findings: </strong>The pooled effect size for the association between presurgical child pain intensity and the presence of child CPSP was significant, OR=0.540 (95% CI=0.184 to 0.894). Child anxiety, child pain-related anxiety, and parent pain catastrophizing were not significant prognostic factors for child CPSP. Using Grading of Recommendations, Assessment, Development, and Evaluation, the certainty in prognostic estimates was moderate. Risk of bias using Quality in Prognostic Study tool ranged from low to moderate.</p><p><strong>Conclusions: </strong>Presurgical pain was the only presurgical risk factor at the meta-analytic level that significantly predicted pediatric CPSP, highlighting the importance of prioritizing pain management throughout the perioperative experience, starting before surgery. Depressive symptoms and sleep disturbance were the two potential risk/protective factors that were unable to be assessed due to insufficient data or use of an unvalidated measure indicating a critical need for future research.</p><p><strong>Prospero registration number: </strong>CRD42022306340.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"144-152"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic postsurgical pain and transitional pain services: a narrative review highlighting European perspectives.","authors":"Eleni Moka, José Alejandro Aguirre, Axel R Sauter, Patricia Lavand'homme","doi":"10.1136/rapm-2024-105614","DOIUrl":"https://doi.org/10.1136/rapm-2024-105614","url":null,"abstract":"<p><strong>Background/importance: </strong>Chronic postsurgical pain (CPSP) is a significant, often debilitating outcome of surgery, impacting patients' quality of life and placing a substantial burden on healthcare systems worldwide. CPSP (pain persisting for more than 3 months postsurgery) leads to both physical and psychological distress. Recognized as a distinct chronic pain entity in International Classification of Diseases, 11th Revision, CPSP enables better reporting and improved management strategies. Despite advancements in surgical care, CPSP remains prevalent, affecting 5%-85% of patients, with higher rates following thoracotomies, amputations, mastectomies and joint replacements.</p><p><strong>Objective: </strong>The acute to chronic pain transition involves complex interactions between peripheral and central mechanisms, with central sensitization playing a key role. Identifying high-risk patients is crucial for prevention, with factors such as surgical type, nerve injury, neuropathic elements in acute postoperative pain, and psychosocial conditions being significant contributors.</p><p><strong>Evidence review: </strong>Current pain management strategies, including multimodal therapy and regional anesthesia, show limited effectiveness in preventing CPSP. Neuromodulation interventions, though promising, are not yet established as preventive modalities.</p><p><strong>Findings: </strong>Transitional pain services (TPSs) offer a comprehensive, multidisciplinary approach to managing CPSP and reducing opioid dependence, addressing both physical and psychosocial aspects of functional recovery. While promising results have been seen in Canada and Finland, TPSs are not yet widely implemented in Europe. There is also growing interest in pain biomarkers, through initiatives such as the A2CPS program, aiming to improve CPSP prediction and develop targeted interventions.</p><p><strong>Conclusions: </strong>Future research should focus on large-scale studies integrating various factors to facilitate CPSP prediction, refine prevention strategies and reduce its long-term impact.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"205-212"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence for regional anesthesia in preventing chronic postsurgical pain.","authors":"Hesham Elsharkawy, J David Clark, Kariem El-Boghdadly","doi":"10.1136/rapm-2024-105611","DOIUrl":"https://doi.org/10.1136/rapm-2024-105611","url":null,"abstract":"<p><p>Chronic postsurgical pain (CPSP) is a common adverse outcome following surgical procedures. Despite ongoing research, the risk factors and effective strategies for mitigating CPSP remain uncertain. Regional anesthesia is a potentially beneficial yet debated intervention for mitigating the risk of CPSP. This review will delve into the mechanistic aspects of regional anesthesia and critically assess the current literature to provide a thorough understanding of its role and effectiveness. The incidence and severity of CPSP are linked to nerve damage, neuroplastic changes and immunological responses. Although numerous mechanisms contributing to CPSP have been identified, translational research is sparse, and findings are often inconsistent. Evidence suggests that regional anesthetic techniques could have a role in reducing CPSP risk across various clinical scenarios. Techniques studied include wound infiltration, peripheral nerve blocks, fascial plane blocks, thoracic paravertebral blocks and epidural anesthesia. Current data indicate that epidural anesthesia might decrease CPSP risk following thoracotomy, wound infiltration may be effective after major breast surgery and cesarean delivery, and serratus anterior plane block or pectoralis/interpectoral plane blocks might be beneficial in breast surgery. However, the existing evidence is limited and marked by several constraints especially the multifactorial causes, underscoring the need for further research in this area.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"153-159"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}