世界危重病急救学杂志(英文版)最新文献

{"title":"Beyond conventional care: The therapeutic potential of hemoperfusion in severe COVID-19.","authors":"John Vásquez-Torres, Ramses Dávila-Collado, Leyla Abdalah-Perez, Oscar Jarquin-Duran, José Santos Latino, Jorge Luis Espinoza","doi":"10.5492/wjccm.v13.i4.97631","DOIUrl":"10.5492/wjccm.v13.i4.97631","url":null,"abstract":"<p><strong>Background: </strong>Hemoperfusion (HP) is an extracorporeal blood purification modality utilized to remove small- to medium-sized molecules, such as toxins and cytokines, that are difficult to remove by conventional hemodialysis. In clinical practice, HP has been successfully used as a salvage therapy for drug overdose and occasionally in patients with liver failure and sepsis.</p><p><strong>Aim: </strong>To summarize the clinical outcomes of a series of patients with severe coronavirus disease 2019 (COVID-19) who received HP.</p><p><strong>Methods: </strong>Here, we summarize the clinical outcomes of a series of 18 patients with severe COVID-19 who received HP in our institution during the COVID-19 pandemic. A review of the literature was also performed.</p><p><strong>Results: </strong>HP was well-tolerated, and after an average of three sessions, respiratory and cardiovascular parameters as well as blood inflammatory markers improved in most patients. Ten patients were discharged alive. Our literature search identified a total of 20 studies (873 patients) in which HP was used for COVID-19. Nine studies reported improvements in respiratory parameters, and 13 studies (438 patients in total) reported better survival rates in patients undergoing HP.</p><p><strong>Conclusion: </strong>HP was well-tolerated in patients with severe COVID-19, and most studies reported improved clinical parameters, including better survival rates, when HP was used in patients with severe COVID-19. Further research, especially prospective studies, is needed to evaluate the utility of HP as an early and supportive therapy for critically ill patients due to infectious diseases, such as those with COVID-19 or severe sepsis.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 4","pages":"97631"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803628","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":"Regional dynamic cerebral autoregulation across anterior and posterior circulatory territories: A detailed exploration and its clinical implications.","authors":"Bahadar S Srichawla, Maria A Garcia-Dominguez","doi":"10.5492/wjccm.v13.i4.97149","DOIUrl":"10.5492/wjccm.v13.i4.97149","url":null,"abstract":"<p><p>Cerebral autoregulation (CA) is the mechanism that maintains stable cerebral blood flow (CBF) despite fluctuations in systemic blood pressure, crucial for brain homeostasis. Recent evidence highlights distinct regional variations in CA between the anterior (carotid) and posterior (vertebrobasilar) circulations. Non-invasive neuromonitoring techniques, such as transcranial Doppler, transfer function analysis, and near-infrared spectroscopy, facilitate the dynamic assessment of CBF and autoregulation. Studies indicate a robust autoregulatory capacity in the anterior circulation, characterized by rapid adjustments in vascular resistance. On the contrary, the posterior circulation, mainly supplied by the vertebral arteries, may have a lower autoregulatory capacity. in acute brain injuries such as intracerebral and subarachnoid hemorrhage, and traumatic brain injuries, dynamic CA can be significantly altered in the posterior circulation. Proposed physiological mechanisms of impaired CA in the posterior circulation include: (1) Decreased sympathetic innervation of the vasculature impairing compensatory vasoreactivity; (2) Endothelial dysfunction; (3) Increased cerebral metabolic rate of oxygen consumption within the visual cortex causing CBF-metabolism (<i>i.e.</i>, neurovascular) uncoupling; and (4) Impaired blood-brain barrier integrity leading to impaired astrocytic mediated release of vasoactive substances (<i>e.g.</i> nitric oxide, potassium, and calcium ions). Furthermore, more research is needed on the effects of collateral circulation, as well as the circle of Willis variants, such as the fetal-type posterior cerebral artery, on dynamic CA. Improving our understanding of these mechanisms is crucial to improving the diagnosis, prognosis, and management of various cerebrovascular disorders.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 4","pages":"97149"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802494","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":"Delta shock index predicts injury severity, interventions, and outcomes in trauma patients: A 10-year retrospective observational study.","authors":"Mohammad Asim, Ayman El-Menyar, Khalid Ahmed, Mushreq Al-Ani, Saji Mathradikkal, Abubaker Alaieb, Abdel Aziz Hammo, Ibrahim Taha, Ahmad Kloub, Hassan Al-Thani","doi":"10.5492/wjccm.v13.i4.99587","DOIUrl":"10.5492/wjccm.v13.i4.99587","url":null,"abstract":"<p><strong>Background: </strong>Most trauma occurs among young male subjects in Qatar. We examined the predictive values of the delta shock index (DSI), defined as the change in the shock index (SI) value from the scene to the initial reading in the emergency unit (<i>i.e.</i>, subtracting the calculated SI at admission from SI at the scene), at a Level 1 trauma center.</p><p><strong>Aim: </strong>To explore whether high DSI is associated with severe injuries, more interventions, and worse outcomes [<i>i.e.</i>, blood transfusion, exploratory laparotomy, ventilator-associated pneumonia, hospital length of stay (HLOS), and in-hospital mortality] in trauma patients.</p><p><strong>Methods: </strong>A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021. Patients were grouped based on DSI as low (≤ 0.1) or high (> 0.1). Data were analyzed and compared using <i>χ</i> ² and Student's <i>t</i>-tests. Correlations between DSI and injury severity score (ISS), revised trauma score (RTS), abbreviated injury scale (AIS), Glasgow coma scale (GCS), trauma score-ISS (TRISS), HLOS, and number of transfused blood units (NTBU), were assessed using correlation coefficient analysis. The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI. Logistic regression analysis was performed to identify predictors of mortality.</p><p><strong>Results: </strong>This analysis included 13212 patients with a mean age of 33 ± 14 years, and 24% had a high DSI. Males accounted for 91% of the study population. The trauma activation level was higher in patients with a high DSI (38% <i>vs</i> 15%, <i>P</i> = 0.001). DSI correlated with RTS (<i>r</i> = -0.30), TRISS (<i>r</i> = -0.30), NTBU (<i>r</i> = 0.20), GCS (<i>r</i> = -0.24), ISS (<i>r</i> = 0.22), and HLOS (<i>r</i> = 0.14) (<i>P</i> = 0.001 for all). High DSI was associated with significantly higher rates of intubation, laparotomy, ventilator-associated pneumonia, massive transfusion activation, and mortality than low DSI. For mortality prediction, a high DSI had better specificity, negative predictive value, and negative likelihood ratio (77%, 99%, and 0.49%, respectively). After adjusting for age, emergency medical services time, GCS score, and ISS, multivariable regression analysis showed that DSI was an independent predictor of mortality (odds ratio = 1.9; 95% confidence interval: 1.35-2.76).</p><p><strong>Conclusion: </strong>In addition to sex-biased observations, almost one-quarter of the study cohort had a higher DSI and were mostly young. High DSI correlated significantly with the other injury severity scores, which require more time and imaging to be ready to use. Therefore, DSI is a practical, simple bedside tool for triaging and prognosis in young patients with trauma.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 4","pages":"99587"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803630","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":"Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States.","authors":"Phillip D Cohen, Renee D Boss, David C Stockwell, Meghan Bernier, Joseph M Collaco, Sapna R Kudchadkar","doi":"10.5492/wjccm.v13.i4.97145","DOIUrl":"10.5492/wjccm.v13.i4.97145","url":null,"abstract":"<p><strong>Background: </strong>There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit (NICU) to the pediatric intensive care unit (PICU) without an interim discharge home. These infants are often medically complex and have higher mortality relative to NICU or PICU-only admissions. Given an absence of data surrounding practice patterns for non-emergent NICU to PICU transfers, we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.</p><p><strong>Aim: </strong>To characterize non-emergent NICU to PICU transfer practices across the United States and query PICU providers' evaluations of their effectiveness.</p><p><strong>Methods: </strong>A cross-sectional survey was drafted, piloted, and sent to one physician representative from each of 115 PICUs across the United States based on membership in the PARK-PICU research consortium and membership in the Children's Hospital Association. The survey was administered <i>via</i> internet (REDCap). Analysis was performed using STATA, primarily consisting of descriptive statistics, though logistic regressions were run examining the relationship between specific transfer steps, hospital characteristics, and effectiveness of transfer.</p><p><strong>Results: </strong>One PICU attending from each of 81 institutions in the United States completed the survey (overall 70% response rate). Over half (52%) indicated their hospital transfers patients without using set clinical criteria, and only 33% indicated that their hospital has a standardized protocol to facilitate non-emergent transfer. Fewer than half of respondents reported that their institution's non-emergent NICU to PICU transfer practices were effective for clinicians (47%) or patient families (38%). Respondents evaluated their centers' transfers as less effective when they lacked any transfer criteria (<i>P</i> = 0.027) or set transfer protocols (<i>P</i> = 0.007). Respondents overwhelmingly agreed that having set clinical criteria and standardized protocols for non-emergent transfer were important to the patient-family experience and patient safety.</p><p><strong>Conclusion: </strong>Most hospitals lacked any clinical criteria or protocols for non-emergent NICU to PICU transfers. More positive perceptions of transfer effectiveness were found among those with set criteria and/or transfer protocols.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 4","pages":"97145"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803646","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":"Driving pressure: A useful tool for reducing postoperative pulmonary complications.","authors":"Domenico Posa, Fabio Sbaraglia, Giuliano Ferrone, Marco Rossi","doi":"10.5492/wjccm.v13.i3.96214","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.96214","url":null,"abstract":"<p><p>The operating room is a unique environment where surgery exposes patients to non-physiological changes that can compromise lung mechanics. Therefore, raising clinicians' awareness of the potential risk of ventilator-induced lung injury (VILI) is mandatory. Driving pressure is a useful tool for reducing lung complications in patients with acute respiratory distress syndrome and those undergoing elective surgery. Driving pressure has been most extensively studied in the context of single-lung ventilation during thoracic surgery. However, the awareness of association of VILI risk and patient positioning (prone, beach-chair, park-bench) and type of surgery must be raised.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 3","pages":"96214"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302139","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":"Why do thoracic epidurals fail? A literature review on thoracic epidural failure and catheter confirmation.","authors":"Kamal Kumar, Fuhazia Horner, Mohamed Aly, Gopakumar S Nair, Cheng Lin","doi":"10.5492/wjccm.v13.i3.94157","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.94157","url":null,"abstract":"<p><p>Thoracic epidural anesthesia (TEA) has been the gold standard of perioperative analgesia in various abdominal and thoracic surgeries. However, misplaced or displaced catheters, along with other factors such as technical challenges, equipment failure, and anatomic variation, lead to a high incidence of unsatisfactory analgesia. This article aims to assess the different sources of TEA failure and strategies to validate the location of thoracic epidural catheters. A literature search of PubMed, Medline, Science Direct, and Google Scholar was done. The search results were limited to randomized controlled trials. Literature suggests techniques such as electrophysiological stimulation, epidural waveform monitoring, and x-ray epidurography for identifying thoracic epidural placement, but there is no one particular superior confirmation method; clinicians are advised to select techniques that are practical and suitable for their patients and practice environment to maximize success.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 3","pages":"94157"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302162","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":"Reimagining critical care: Trends and shifts in 21^st century medicine.","authors":"Sai Doppalapudi, Bilal Khan, Muhammad Adrish","doi":"10.5492/wjccm.v13.i3.94020","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.94020","url":null,"abstract":"<p><p>Critical care medicine has undergone significant evaluation in the 21^st century, primarily driven by advancements in technology, changes in healthcare delivery, and a deeper understanding of disease processes. Advancements in technology have revolutionized patient monitoring, diagnosis, and treatment in the critical care setting. From minimally invasive procedures to advances imaging techniques, clinicians now have access to a wide array of tools to assess and manage critically ill patients more effectively. In this editorial we comment on the review article published by Padte S <i>et al</i> wherein they concisely describe the latest developments in critical care medicine.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 3","pages":"94020"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302145","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":"Impact of different intravenous bolus rates on fluid and electrolyte balance and mortality in critically ill patients.","authors":"Mutaz I Othman, Emad M Mustafa, Moayad Alfayoumi, Mohamad Y Khatib, Abdulqadir J Nashwan","doi":"10.5492/wjccm.v13.i3.95781","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.95781","url":null,"abstract":"<p><p>The effect of intravenous bolus rates on patient outcomes is a complex and crucial aspect of critical care. Fluid challenges are commonly used in critically ill patients to manage their hemodynamic status, but there is limited information available on the specifics of when, how much, and at what rate fluids should be administered during these challenges. The aim of this review is to thoroughly examine the relationship between intravenous bolus rates, fluid-electrolyte balance, and mortality and to analyze key research findings and methodologies to understand these complex dynamics better. Fluid challenges are commonly employed in managing hemodynamic status in this population, yet there is limited information on the optimal timing, volume, and rate of fluid administration. Utilizing a narrative review approach, the analysis identified nine relevant studies that investigate these variables. The findings underscore the importance of a precise and individualized approach in clinical settings, highlighting the need to tailor intravenous bolus rates to each patient's specific needs to maximize outcomes. This review provides valuable insights that can inform and optimize clinical practices in critical care, emphasizing the necessity of meticulous and exact strategies in fluid administration.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 3","pages":"95781"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302141","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":"Outcome of COVID-19 infection in patients on antihypertensives: A cross-sectional study.","authors":"Sakthivadivel Varatharajan, Gopal K Bohra, Pradeep K Bhatia, Satyendra Khichar, Mahadev Meena, Naveenraj Palanisamy, Archana Gaur, Mahendra K Garg","doi":"10.5492/wjccm.v13.i3.96882","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.96882","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronavirus disease 2019 (COVID-19) infection frequently have hypertension as a co-morbidity, which is linked to adverse outcomes. Antihypertensives may affect the outcome of COVID-19 infection.</p><p><strong>Aim: </strong>To assess the effects of antihypertensive agents on the outcomes of COVID-19 infection.</p><p><strong>Methods: </strong>A total of 260 patients were included, and their demographic data and clinical profile were documented. The patients were categorized into nonhypertensive, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), calcium channel blocker (CCB), a combination of ACEI/ARB and CCB, and beta-blocker groups. Biochemical, hematological, and inflammatory markers were measured. The severity of infection, intensive care unit (ICU) intervention, and outcome were recorded.</p><p><strong>Results: </strong>The mean age of patients was approximately 60-years-old in all groups, except the nonhypertensive group. Men were predominant in all groups. Fever was the most common presenting symptom. Acute respiratory distress syndrome was the most common complication, and was mostly found in the CCB group. Critical cases, ICU intervention, and mortality were also higher in the CCB group. Multivariable logistic regression analysis revealed that age, duration of antihypertensive therapy, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, and interleukin 6 were significantly associated with mortality. The duration of antihypertensive therapy exhibited a sensitivity of 70.8% and specificity of 55.7%, with a cut-off value of 4.5 years and an area under the curve of 0.670 (0.574-0.767; 95% confidence interval) for COVID-19 outcome.</p><p><strong>Conclusion: </strong>The type of antihypertensive medication has no impact on the clinical sequence or mortality of patients with COVID-19 infection. However, the duration of antihypertensive therapy is associated with poor outcomes.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 3","pages":"96882"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302144","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":"Traumatic brain injury and variants of shock index.","authors":"Sai Doppalapudi, Muhammad Adrish","doi":"10.5492/wjccm.v13.i3.93478","DOIUrl":"https://doi.org/10.5492/wjccm.v13.i3.93478","url":null,"abstract":"<p><p>Traumatic Brain Injury is a major cause of death and long-term disability. The early identification of patients at high risk of mortality is important for both management and prognosis. Although many modified scoring systems have been developed for improving the prediction accuracy in patients with trauma, few studies have focused on prediction accuracy and application in patients with traumatic brain injury. The shock index (SI) which was first introduced in the 1960s has shown to strongly correlate degree of circulatory shock with increasing SI. In this editorial we comment on a publication by Carteri <i>et al</i> wherein they perform a retrospective analysis studying the predictive potential of SI and its variants in populations with severe traumatic brain injury.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 3","pages":"93478"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302147","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}