Journal of Hospital Infection最新文献

{"title":"Exploring the bactericidal efficacy of a new potassium monopersulphate-based disinfectant.","authors":"P P Barbosa, D M Leme, N G Motta, W L E Magalhães, J L Proenca-Modena, J-Y Maillard","doi":"10.1016/j.jhin.2025.04.033","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.04.033","url":null,"abstract":"<p><strong>Background: </strong>Staphylococcus aureus and Klebsiella pneumoniae are common pathogens responsible for hospital-acquired infections. Both species can survive on surfaces following desiccation and form dry surface biofilms (DSB), which complicates the disinfection process.</p><p><strong>Aim: </strong>To evaluate the efficacy of an innovative potassium monopersulphate-based nanotechnology formulation (MPS) against both planktonic and sessile S. aureus and K. pneumoniae.</p><p><strong>Methods: </strong>The bactericidal efficacy of MPS was tested in comparison with sodium hypochlorite (NaOCl) and didecyldimethylammonium chloride (DDAC), which served as controls. The assessment was performed against planktonic bacteria, hydrated biofilm, and dry surface biofilm (DSB) using standard suspension and carrier tests. Scanning electron microscopy (SEM) was employed to identify any gross structural damage.</p><p><strong>Findings: </strong>MPS (2% w/v) achieved a ≥4 log₁₀ reduction in K. pneumoniae with a short contact time, regardless of the test protocol. S. aureus proved more resilient, but the introduction of wiping reduced the contact time needed to achieve a 4 log₁₀ reduction from 15 to 5 minutes. SEM analysis revealed gross structural damage in both species following MPS treatment. The other disinfectants tested were also bactericidal, achieving ≥4 log₁₀ reduction within 1-5 minutes, with the exception of DDAC against hydrated biofilms.</p><p><strong>Conclusions: </strong>The potassium monopersulphate-based formulation was found to be an effective bactericide, including against dry surface biofilms (DSB). Its efficacy compares favourably with other biocides commonly used in healthcare settings, and its biodegradability makes it a promising candidate for further development. However, optimisation of the mechanical removal process will be essential to enhance MPS efficacy in practical applications.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the SARS-CoV-2 pandemic on hospital robustness to the spread of antibiotic-resistant bacteria in a large German university hospital","authors":"G. Donvito ,&nbsp;F. Bürkin ,&nbsp;T. Donker","doi":"10.1016/j.jhin.2025.04.032","DOIUrl":"10.1016/j.jhin.2025.04.032","url":null,"abstract":"<div><h3>Background</h3><div>Patient transfers occur frequently between hospital departments and wards, and bring with them the risk of interdepartmental transmission of antibiotic-resistant bacteria (ARB). These bacteria form a risk to patients already susceptible to colonization and infection.</div></div><div><h3>Aim</h3><div>To assess the impact of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic on the intrahospital network of a large German university hospital.</div></div><div><h3>Methods</h3><div>Using data collected from the hospital between 2019 and 2023, a model was developed to represent an intrahospital transfer network with all patient movements between all wards by creating a time-sliced temporal network for each month. The network was described, and its robustness against the spread of ARB was assessed by simulating outbreaks between wards.</div></div><div><h3>Findings</h3><div>In April 2020, when many elective surgeries were cancelled due to the SARS-CoV-2 pandemic, the robustness of the network increased strongly in comparison with all other months. Despite the network being relatively stable over the study period, it was affected by an internal change in hospital structure due to a hospital merger.</div></div><div><h3>Conclusion</h3><div>The intrahospital transfer network was affected by external influences due to the SARS-CoV-2 pandemic, slowing down the potential spread of nosocomial pathogens. The network was generally stable and recovered quickly, although an internal force affected the structure of the network. A better understanding of the influence of patient transfers will help in the design of intervention strategies against the spread of antimicrobial resistance within hospitals.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"162 ","pages":"Pages 68-75"},"PeriodicalIF":3.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining a genomic threshold for investigating Pseudomonas aeruginosa hospital outbreak","authors":"S. Romano-Bertrand ,&nbsp;M. Virieux-Petit ,&nbsp;F. Mauffrey ,&nbsp;L. Senn ,&nbsp;D.S. Blanc","doi":"10.1016/j.jhin.2025.04.028","DOIUrl":"10.1016/j.jhin.2025.04.028","url":null,"abstract":"<div><h3>Background</h3><div>When investigating <em>Pseudomonas aeruginosa</em> (PA) outbreaks, the clonality of isolates should be demonstrated using a molecular typing method. Whole-genome sequencing (WGS) is the new gold standard for bacterial genotyping, but care should be taken in the interpretation of results regarding considering isolates as part of the same chain of transmission.</div></div><div><h3>Aim</h3><div>To determine genomic threshold to identify recent transmission events considering the spatiotemporal scale of the outbreak.</div></div><div><h3>Methods</h3><div>PA outbreaks occurring in our hospital during the past 15 years were retrospectively analysed by both core-genome MLST and single-nucleotide polymorphism (SNP) with regard to epidemiological data. Our results were discussed in the light of previous published literature employing WGS to investigate hospital outbreaks of PA.</div></div><div><h3>Findings</h3><div>Fourteen investigations of PA outbreaks in our hospital were included, lasting a few days to nine years. Isolates belonging to the same chain of transmission presented up to 13 loci differences and 25 SNPs. These results were in accordance with the 19 published outbreaks that mostly reported a similarity among epidemiologically related isolates below 15–25 SNPs. The impact of time and space on the threshold of eligible SNPs or loci differences was possibly masked by other factors including the genotype, the number of isolates included in the WGS analysis, the path of transmission and the presence of environmental reservoir.</div></div><div><h3>Conclusions</h3><div>Our study emphasizes the need to integrate genomic thresholds with epidemiological data, especially when environmental reservoirs or hypermutators are involved, to accurately assess transmission dynamics and outbreak origins.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 119-129"},"PeriodicalIF":3.9,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of tissue adhesive application on central line-associated bloodstream infections: A multi-centre retrospective study.","authors":"Yohan Kwon, Dong Jae Shim, Jae Hwan Lee, Doyoung Kim, Seung Hwan Baek, Jinoo Kim, Eun Jin Kim, Youn Jeong Kim, Tae Won Choi, Je Hwan Won","doi":"10.1016/j.jhin.2025.04.030","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.04.030","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether tissue adhesive (TA, 2-octyl blended with n-butyl cyanoacrylate) application to centrally/femorally inserted central catheters (CICCs/FICCs) exit sites could reduce the occurrence of central line-associated bloodstream infection (CLABSI).</p><p><strong>Methods: </strong>This retrospective review with historical controls was conducted in three tertiary care institutions. The TA group was established from December 2021 to July 2022 with the simultaneous initiation of TA application to the exit site of CICCs/FICCs. Patients in the control group received CICCs/FICCs before TA application between February 2021 and November 2021. Adverse event (AE) rates, including CLABSI, oozing, dislocation, and skin problems, were compared between groups. Risk factors were analysed using inverse probability of treatment weighting (IPTW)-adjusted Cox analysis.</p><p><strong>Results: </strong>The TA group comprised 1,061 patients (median age=62 years; interquartile range [IQR], 51-72; men=549), while the control group included 1,049 patients (median age=61 years; IQR, 50-72; men=516). The CLABSI rate was significantly lower in the TA group (1.84/1,000 catheter-day) compared with the control group (3.66/1,000 catheter-days), with a rate ratio of 0.5 (95% confidence interval, 0.28-0.87; p=0.01). Dislocation rates were not significantly different in the two groups (p=0.45). Pruritus and blisters at the exit-site occurred slightly more often in the TA group (TA=36, control=25, p=0.16), whereas the oozing rate was significantly lower (TA=120, control=158, p=0.01). IPTW-adjusted analysis revealed TA as risk-reducing factor (p=0.003), while age (p=0.04) and triple-lumen (p=0.04) were significant risk factors for CLABSI.</p><p><strong>Conclusion: </strong>TA application at CICCs/FICCs exit sites could significantly lower CLABSI rates without serious AEs.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silver-Based Dressings for Surgical Site Infection Prevention: Evidence from Randomized Trials.","authors":"Salma Younes, Nadin Younes, Shaden Abunasser, Faleh Tamimi, Gheyath Nasrallah","doi":"10.1016/j.jhin.2025.04.026","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.04.026","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) are a major cause of postoperative complications, increasing morbidity and healthcare costs. Silver-based dressings are commonly used due to their antimicrobial properties, but their effectiveness in reducing SSIs remains unclear.</p><p><strong>Aim: </strong>This systematic review and meta-analysis aim to evaluate the efficacy of silver-based dressings compared to non-silver dressings in preventing SSIs in randomized controlled trials (RCTs) METHODS: A systematic search was conducted in PubMed, Cochrane Library, and Embase to identify RCTs comparing silver-based to non-silver dressings for SSI prevention. The study protocol was registered in PROSPERO (CRD42024592966). Meta-analysis using random-effects models calculated pooled risk ratios (RR) with 95% confidence intervals (CI). Heterogeneity was assessed with the I² statistic, and publication bias evaluated through funnel plots and Egger's test.</p><p><strong>Results: </strong>12 RCTs with 2,928 participants were included in the meta-analysis. Silver-based dressings significantly reduced SSI risk by 40% compared to non-silver dressings (RR: 0.60, 95% CI: 0.41-0.89, p<0.05), with moderate heterogeneity (I² = 53%) CONCLUSIONS: : Silver-based dressings significantly reduce the risk of SSIs; however, further high-quality RCTs are needed to confirm their benefits across different surgical contexts and patient populations.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical site infections complicating coronary artery bypass graft surgery in Australia: time trends in infection rates, surgical antimicrobial prophylaxis, and pathogens using a comprehensive surveillance network, 2010–2023","authors":"S.K. Tanamas ,&nbsp;L.L. Lim ,&nbsp;A.L. Bull ,&nbsp;M.J. Malloy ,&nbsp;J. Brett ,&nbsp;Z. Dickson ,&nbsp;L.J. Worth ,&nbsp;N.D. Friedman","doi":"10.1016/j.jhin.2025.04.027","DOIUrl":"10.1016/j.jhin.2025.04.027","url":null,"abstract":"<div><h3>Background</h3><div>In cardiac surgery, surgical site infection (SSI) is associated with increased morbidity and mortality, reoperations, lengthy antimicrobial treatment, increased hospital length of stay, and increased healthcare costs.</div></div><div><h3>Aim</h3><div>To report trends in SSI epidemiology complicating coronary artery bypass graft (CABG) surgery and to record changes in surgical antimicrobial prophylaxis (SAP) compliance and causative pathogens over time.</div></div><div><h3>Methods</h3><div>Data on CABG procedures from 2010 to 2023 submitted to the Victorian healthcare-associated infection surveillance coordinating centre were analysed. Trends in the SSI rate and choice, timing, and duration of SAP were modelled using Poisson regression. The most common pathogens causing SSI and their change over time were assessed.</div></div><div><h3>Findings</h3><div>A total of 32,446 CABG procedures were reported during the study period. Sternal SSI rate decreased from 2.7 per 100 procedures in 2010 to 1.6 per 100 procedures in 2023, representing a 15% annual decrease, when the model was adjusted for the number of years of participation in surveillance. This decrease was most marked during the first decade (IRR 0.70 [95% CI 0.64, 0.76]) followed by stable rates between 2020 and 2023 (IRR 1.08 [95% CI 0.93, 1.27]). Compliance with SAP choice was consistently &gt;98%, while compliance with timing increased by an average of 1% per year to 83%, and compliance with duration fluctuated between 75% and 86%. The most frequent pathogens responsible for SSI were <em>Staphylococcus aureus</em>, <em>Serratia marcescens</em>, <em>Staphylococcus epidermidis</em>, and <em>Klebsiella pneumoniae.</em> The proportion of sternal and donor site SSIs involving Gram-negative pathogens increased from 38% to 59%.</div></div><div><h3>Conclusion</h3><div>This analysis of 14 years of surveillance data for SSI complicating CABG procedures highlighted a reduction in rates of SSI, high rates of compliance with antimicrobial choice for SAP, and the predominance of <em>S. aureus</em> as a causative pathogen of SSI in our region. Notably, we observed Gram-negative pathogens, particularly <em>S. marcescens</em>, to be responsible for a larger proportion of SSIs over recent years.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"162 ","pages":"Pages 44-52"},"PeriodicalIF":3.9,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the PEN-FAST tool to safely administer cephalosporins to patients with ‘low risk’ penicillin allergy","authors":"K.K. Badyal ,&nbsp;K. Bhatt ,&nbsp;A.J. Plant","doi":"10.1016/j.jhin.2025.04.031","DOIUrl":"10.1016/j.jhin.2025.04.031","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 130-131"},"PeriodicalIF":3.9,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fighting antimicrobial resistance in a resource-limited setting: an integrated approach to infection prevention and antimicrobial stewardship is the ‘best buy’","authors":"B.D. Fofanah ,&nbsp;I.F. Kamara ,&nbsp;R.Z. Kamara ,&nbsp;R. Musoke ,&nbsp;S.M. Tengbe ,&nbsp;L. Kabego ,&nbsp;S. Lakoh","doi":"10.1016/j.jhin.2025.02.023","DOIUrl":"10.1016/j.jhin.2025.02.023","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 132-134"},"PeriodicalIF":3.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VanB transposon analysis detects horizontal gene transfer in vancomycin resistant Enterococcus faecium: description of two outbreaks.","authors":"Heleen J Schuster, Rosa van Mansfeld, Wil A van der Reijden, Robin van Houdt, Sébastien Matamoros","doi":"10.1016/j.jhin.2025.04.021","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.04.021","url":null,"abstract":"<p><strong>Background: </strong>Outbreaks with vancomycin resistant Enterococcus faecium (VRE) are common in hospitals worldwide. Whole genome MLST (wgMLST) is often used to identify outbreak strains, but VRE typing can still be challenging due to their limited genomic variation.</p><p><strong>Aim: </strong>Developing a method for sequence analysis of vancomycin resistance genes in parallel to wgMLST and application of this new method for real-time investigation of two parallel VRE outbreaks.</p><p><strong>Methods: </strong>We developed a bioinformatics pipeline to compare the sequences of transposons containing vanB resistance genes. We used this pipeline in addition to wgMLST to investigate two separate ongoing VRE outbreaks. We also sequenced five separate colonies from 15 different samples and 10 vancomycin sensitive isolates.</p><p><strong>Findings: </strong>Of 46 strains collected during two outbreaks, we identified 26 and 9 strains to be part of the two outbreaks based on wgMLST clustering. In 6 strains we identified an identical vanB transposon but a different wgMLST cluster, indicating horizontal gene transfer. This potential outbreak spread would have been missed without transposon analysis. We found no variability in vanB transposon sequence or wgMLST profiles within different colonies from the same sample. We identified 1 vancomycin sensitive E. faecium in blood culture with a similar wgST as one of the outbreak strains.</p><p><strong>Conclusions: </strong>Real-time analysis of transposons containing vancomycin resistance genes provides additional information for analysis of vanB-VRE outbreaks. It detects possible horizontal gene transfer which would not be detected using conventional methods. Transposon analysis is a valuable addition to whole genome sequence analysis during vanB-VRE outbreaks.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cellular and material-specific responses of Candida parapsilosis biofilms to biocides","authors":"J.K.S. Dourado ,&nbsp;C.M. Álvarez-Ormeño ,&nbsp;G. Benard ,&nbsp;R.H. Pires","doi":"10.1016/j.jhin.2025.04.023","DOIUrl":"10.1016/j.jhin.2025.04.023","url":null,"abstract":"<div><h3>Background</h3><div><em>Candida parapsilosis</em> biofilms pose significant challenges in clinical settings due to their resilience to biocides and the presence of persister cells. This study evaluated the efficacy of amphotericin B (AmB), chlorhexidine (CLX), and ortho-phthalaldehyde (OPA) against biofilms formed by fluconazole-resistant <em>C. parapsilosis</em> isolates and examined the role of persister cells and catheter materials in biofilm resilience.</div></div><div><h3>Methods</h3><div>Clinical isolates of <em>C. parapsilosis</em> from hospital surfaces were exposed to CLX (0.5%) and OPA (0.55%). Minimum inhibitory concentrations (MICs) were determined by broth microdilution. Biofilm susceptibility was assessed using the crystal violet assay and total plate counts. Scanning electron microscopy (SEM) analysed biofilm structural changes on different catheter materials.</div></div><div><h3>Findings</h3><div>AmB demonstrated high efficacy with low MIC and MFC values. CLX showed moderate efficacy, with higher MICs and MFCs in clinical isolates compared with the standard strain. OPA exhibited the lowest efficacy, with higher MIC, MFC, and SMIC₈₀ values. Persister cells were confirmed in isolate CBL 1031, while isolates 17D, 26E, and ATCC 90019 displayed significant SMIC80 reductions, indicating high susceptibility. PTFE materials showed significant biofilm reductions post-biocide exposure, while HDPE displayed the greatest biofilm resilience with higher residual cell counts. SEM revealed material-specific biofilm disruption, with greater structural damage on HDPE and silicone-coated latex (SCL) compared with PTFE.</div></div><div><h3>Conclusions</h3><div>These findings underscore the importance of optimizing cleaning protocols, selecting appropriate medical materials, and addressing persister cells to mitigate biofilm-related infections in healthcare settings.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"162 ","pages":"Pages 84-94"},"PeriodicalIF":3.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}