Enfermedades infecciosas y microbiologia clinica (English ed.)最新文献

{"title":"Molecular assays for the initial diagnosis of tuberculosis in a low-prevalence setting: A comparative study","authors":"Ana Fernández-Blázquez ,&nbsp;Álvaro Leal-Negredo ,&nbsp;Christian Sabater-Cabrera ,&nbsp;Miguel Arias-Guillén ,&nbsp;José-María García-García ,&nbsp;Juan José Palacios Gutiérrez","doi":"10.1016/j.eimce.2024.11.006","DOIUrl":"10.1016/j.eimce.2024.11.006","url":null,"abstract":"<div><h3>Introduction</h3><div>The WHO's End TB Strategy promotes using rapid molecular assays as initial diagnosis to reduce tuberculosis globally. This prospective study assessed commercial molecular platforms’ effectiveness in diagnosing or ruling out tuberculosis (TB) in a low-prevalence setting.</div></div><div><h3>Methods</h3><div>One hundred clinical samples (80 respiratory/20 non-respiratory) were included among all samples routinely received in a mycobacterial laboratory. Five real-time polymerase-chain-reaction (RT-PCR) assays (Xpert-MTB/Rif-Ultra, BDMAX-MDR-TB, RealTime-MTB, FluoroType-MTBDR, Anyplex-MTB/NTM) were characterized and compared through blinded-parallel analysis. Sensitivity, specificity, likelihood ratios, and Cohen's Kappa were calculated to assess the accuracy and agreement of RT-PCR results with culture.</div></div><div><h3>Results</h3><div>Sensitivity ranged 88.89–100%, improving initial screening by 30–40%. Specificity was 96.70–98.98%. RT-PCR showed excellent discriminatory power, as TB patients were 26.9–91.0 times more likely to test positive. Cohen's Kappa showed substantial to excellent concordance (0.78–0.94).</div></div><div><h3>Conclusion</h3><div>RT-PCR improves TB initial diagnosis, offering tailored solutions for diverse laboratories, revolutionizing control strategies with its operational flexibility.</div></div>","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 5","pages":"Pages 272-276"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911759","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":"Reduction of surgical site infection rates in elective colorectal surgery by means of a nationwide interventional surveillance programme. A cohort study","authors":"Josep M. Badia ,&nbsp;Alexander Almendral ,&nbsp;Miriam Flores-Yelamos ,&nbsp;Aina Gomila-Grange ,&nbsp;David Parés ,&nbsp;Marta Pascual ,&nbsp;Domenico Fraccalvieri ,&nbsp;Ana Abad-Torrent ,&nbsp;Alejandro Solís-Peña ,&nbsp;Lucrecia López ,&nbsp;Marta Piriz ,&nbsp;Mercè Hernández ,&nbsp;Enric Limón ,&nbsp;Miquel Pujol ,&nbsp;on behalf of VINCat Colorectal Program","doi":"10.1016/j.eimce.2024.04.015","DOIUrl":"10.1016/j.eimce.2024.04.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Colorectal surgery has the highest surgical site infection (SSI) rates of all abdominal surgeries. Epidemiological surveillance is an excellent instrument to reduce SSI rates, but its effects may be time-limited and need to be monitored periodically. This study analyses the effectiveness of an interventional surveillance programme with regard to reducing SSI rates after elective colorectal surgery.</div></div><div><h3>Methods</h3><div>Cohort study analysing a SSI surveillance programme in elective colorectal surgery over a 15-year period. Prospectively collected data were stratified by 5-year periods (Periods 1, 2 and 3), and SSI rates, length of stay, readmission, mortality and microbiological aetiology were investigated.</div></div><div><h3>Results</h3><div>A total of 64,074 operations were included (42,665 colon surgery and 21,409 rectal surgery). Overall SSI incidence in colon surgery fell from 19.6% in Period 1 to 7.6% in Period 3 (rho<!--> <!-->=<!--> <!-->−0.961). Organ-space SSI (O/S-SSI) was 8.3% in Period 1 and 4.7% in Period 3 (rho<!--> <!-->=<!--> <!-->−0.815). In rectal surgery, overall SSI fell from 20.6% to 12.8% (rho<!--> <!-->=<!--> <!-->−0.839), and O/S-SSI from 8.5% to 8.3%, the latter difference being non-significant. The intervention that achieved the greatest SSI reduction was a preventive bundle comprising six measures. Hospital stay and mortality rates decreased, while SSIs after discharge and readmissions increased. An increase in Gram-positive cocci and fungi, and reductions in Gram-negative bacteria and anaerobes were detected for both incisional and O/S-SSI.</div></div><div><h3>Conclusions</h3><div>Detailed analysis of SSI rates allows the design of strategies for reducing their incidence. An interventional surveillance programme was effective in decreasing SSI rates in colorectal surgery.</div></div>","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 ","pages":"Pages S28-S36"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626924","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":"Surveillance of catheter-related bacteremia in VINCat program","authors":"Oriol Gasch ,&nbsp;Alexander Almendral ,&nbsp;Marta Andrés ,&nbsp;Jordi Càmara ,&nbsp;Dolors Domenech ,&nbsp;Xavier Garcia-Alarcon ,&nbsp;M. José García-Quesada ,&nbsp;Emilio Jiménez-Martínez ,&nbsp;Anna Marrón ,&nbsp;Encarnación Moreno ,&nbsp;Virginia Pomar ,&nbsp;Montserrat Vaqué ,&nbsp;Enric Limón ,&nbsp;Miquel Pujol ,&nbsp;on behalf of VINCat Programme","doi":"10.1016/j.eimce.2024.12.010","DOIUrl":"10.1016/j.eimce.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>Catheter-related bacteremia (CRB) is one of the most frequent infections acquired during hospitalization. We summarize the results of CRB surveillance conducted by the Catalan Program of Surveillance of Nosocomial Infections (VINCat) over the past fifteen years.</div></div><div><h3>Methods</h3><div>All episodes of hospital-acquired CRB diagnosed in the 55 Catalan hospitals participating in the VINCat program (2008–2023) were recorded. Annual incidence rates per 1000 patient-days were calculated. Analyses were stratified into three relevant five-year periods: 2008–2012, 2013–2017, and 2018–2022. Incidence rate ratios (IRRs) were used to compare infection rates.</div></div><div><h3>Results</h3><div>During the study period, 10,212 episodes of nosocomial CRB were diagnosed. The global incidence rate was 0.21 episodes per 1000 patient-days (intensive care units (ICUs): 1.13; medical wards: 0.16; surgical wards: 0.15). Gram-positive bacteria caused 68.3% of the episodes. The incidence rate of CRB acquired in ICUs and that of CRB associated with central venous catheters decreased during the study period, while episodes associated with peripheral venous catheters (PVCs) and peripherally-inserted central venous catheters (PICVCs) significantly increased (<em>p</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusions</h3><div>The current study underscores the necessity for interventional programs targeting PVCs, particularly in non-ICU wards.</div></div>","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 ","pages":"Pages S19-S27"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789476","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":"Secular trends in periprosthetic joint infections following primary hip and knee arthroplasties: A 15-year cohort study from the VINCat Program (2008–2022)","authors":"Joaquín López-Contreras ,&nbsp;Pol Duch Llorach ,&nbsp;Nerea Roch Villaverde ,&nbsp;Alexander Almendral ,&nbsp;Ana Felisa López ,&nbsp;Marilo Marimon ,&nbsp;M. Angeles Domínguez-Luzón ,&nbsp;Jose Carlos Martinez-Pastor ,&nbsp;Joan Ramoneda Salas ,&nbsp;Natividad Benito ,&nbsp;Laura Morata ,&nbsp;Ricardo Zules-Oña ,&nbsp;Enrique Limón ,&nbsp;Miquel Pujol ,&nbsp;on behalf of the VINCat Orthopedic Surgery Module Team","doi":"10.1016/j.eimce.2025.02.015","DOIUrl":"10.1016/j.eimce.2025.02.015","url":null,"abstract":"<div><h3>Background</h3><div>The VINCat program, established in Catalonia, Spain, in 2006, is a comprehensive infection prevention program for healthcare-associated infections. This study aims to analyze long-term trends in periprosthetic joint infections (PJI) following primary hip and knee arthroplasties over 15-year period (2008–2022).</div></div><div><h3>Methods</h3><div>PJI was defined according to CDC-NHSN criteria and updated in 2016 to incorporate the Musculoskeletal Infection Society classification. Data on PJI following total hip arthroplasty (THA), total knee arthroplasty (TKA), and hip hemiarthroplasty (HHA) were prospectively collected and analyzed across three periods: 2008–2012, 2013–2017, and 2018–2022.</div></div><div><h3>Results</h3><div>Sixty-seven hospitals participated in the surveillance, reporting 189,063 procedures, including 61,267 THA (median age: 69 years, 47% female), 115,940 TKA (median age: 73 years, 68% female), and 11,856 HHA (median age: 86 years, 73% females). PJI incidence rates for THA were 0.9%, 1.1%, and 1.2% across the three periods (odds ratio (OR):1.14, 95% CI: 0.96–1.35). For TKA, rates were 0.9%, 1.0%, and 0.9% (OR:0.95, 95% CI: 0.83–1.09). The incidence of HHA-PJI declined from 3.4% to 2.3% and 1.8% (OR:0.77, 95% CI:0.58–1.03). Overall, the most common etiology was coagulase negative staphylococci followed by <em>Staphylococcus aureus</em>. PJIs were diagnosed after hospital discharge in 87.1% of THA, 89.6% of TKA, and 73.9% of HHA.</div></div><div><h3>Conclusions</h3><div>The incidence of PJI remains low despite an aging population undergoing orthopedic surgery, highlighting the effectiveness of current infection prevention strategies. A robust, long-term surveillance system is crucial for monitoring epidemiological trends and guiding the implementation of evidence-based preventive measures.</div></div>","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 ","pages":"Pages S44-S51"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890495","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":"Similar risk of hospitalization and lethality from COVID-19 in transplant recipients and waitlisted patients: A comparative analysis","authors":"Abelardo Claudio Fernández Chávez ,&nbsp;Guillermo Yovany Ordoñez León ,&nbsp;Eva Elisa Álvarez León ,&nbsp;Paloma Moreno Núñez ,&nbsp;José Porto Tomás ,&nbsp;Jesús María Aranaz Andrés","doi":"10.1016/j.eimce.2025.02.005","DOIUrl":"10.1016/j.eimce.2025.02.005","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2022, Spanish health authorities recommended passive immunisation against COVID-19 for solid organ transplant recipients (SOT), due to their deficient post-vaccination humoral response. Patients on the transplant waiting list (SOTwl) were excluded from this strategy.</div></div><div><h3>Objective</h3><div>To compare the risk of hospitalisation, ICU admission, and mortality due to COVID-19 between SOT and SOTwl patients.</div></div><div><h3>Methodology</h3><div>Patients seen in the Preventive Medicine Department at Ramón y Cajal Hospital between 03/14/2020 and 04/13/2022. The relative risk (RR) of hospitalisation, ICU admission, and mortality was estimated among SOT and SOTwl patients, adjusted for age, sex, and vaccine doses.</div></div><div><h3>Results</h3><div>A total of 1292 patients were analyzed. SOT patients (n<!--> <!-->=<!--> <!-->1153) were older and had similar risks of hospitalisation (RR 0.97, 95% CI 0.57–1.64), ICU admission (RR 1.74, 95 % CI 0.44–6.86), and death (RR 0.89, 95% CI 0.45–1.77) compared to SOTwl patients (n<!--> <!-->=<!--> <!-->139).</div></div><div><h3>Conclusions</h3><div>The risks of hospitalisation, ICU admission, and mortality were similar between SOT and SOTwl patients.</div></div>","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 5","pages":"Pages 277-281"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538116","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":"Diagnostic accuracy of LIAISON MeMed VB® for bacteremia in the Emergency Department","authors":"Laura Serrano Martín ,&nbsp;Elena de Rafael González ,&nbsp;Javier Cabañas Morafraile ,&nbsp;Agustín Julián-Jiménez ,&nbsp;En nombre del grupo URGEN-LABQMIC del CHUT del Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM)","doi":"10.1016/j.eimce.2025.01.007","DOIUrl":"10.1016/j.eimce.2025.01.007","url":null,"abstract":"","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 5","pages":"Pages 302-303"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911762","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":"Surveillance of device-associated infection rates at adult intensive care units in the VINCat program (2010–2022)","authors":"Xavier Nuvials ,&nbsp;Inmaculada Fernández ,&nbsp;Alexander Almendral ,&nbsp;Enric Limón ,&nbsp;Miquel Pujol ,&nbsp;Emili Diaz ,&nbsp;on behalf of VINCat Programme ICU group","doi":"10.1016/j.eimce.2024.09.013","DOIUrl":"10.1016/j.eimce.2024.09.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Surveillance is an essential part of the control of device-related nosocomial infections (NI) in intensive care units (UCIs). The aim of this study was to analyze the evolution of device-related infection rates in ICUs over the last 13 years, including ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI).</div></div><div><h3>Material and methods</h3><div>Patients admitted to the 44 ICUs at 43 participating hospitals of the VINCat Program from 2010 to 2022 were included, taking into account three periods: first period (2010–2013), second period (2014–2017) and third period (2018–2022). Hospitals were classified into three groups according to their size: small (&lt;200 beds), medium (200–500 beds) and large (&gt;500 beds). Complexity was assessed based on the use of invasive mechanical ventilation. The incidence rate of VAP, CRBSI and CAUTI was recorded at least during three consecutive months/year in each unit by an intensivist with extensive experience.</div></div><div><h3>Results</h3><div>The device utilization ratio (DUR) of mechanical ventilation was 0.39, varying between 0.38 in large hospitals and 0.42 in small hospitals. The DUR of central venous catheter was 0.6, ranging from 0.59 (large hospitals) to 0.64 (small). The DUR of urinary catheter was 0.66, with a range of 0.65 (large hospitals) to 0.68 (small). The complexity of the different ICUs influenced the DUR of the different devices and the infections associated with them. The average rates of VAP, CRBSI, and CAUTI were 6.4, 1.9, and 3.4 episodes per 1000 device days respectively.</div></div><div><h3>Conclusions</h3><div>Surveillance systems provide information on intra-ICU infections. ICU complexity, measured in terms of the use of mechanical ventilation, influences device-associated infections.</div></div>","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 ","pages":"Pages S52-S59"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626929","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":"VINCat program: Impact of a surveillance program on alcohol-based hand rub consumption in acute care facilities in Catalonia, Spain","authors":"Esther Moreno ,&nbsp;Montse Blasco ,&nbsp;Charo Porrón ,&nbsp;Gemina Santana ,&nbsp;Maria Sardà ,&nbsp;Ana Felisa López ,&nbsp;Alexander Almendral ,&nbsp;Enric Limón ,&nbsp;Miquel Pujol ,&nbsp;on behalf of VINCat Programme Hand Hygiene Group","doi":"10.1016/j.eimce.2025.02.012","DOIUrl":"10.1016/j.eimce.2025.02.012","url":null,"abstract":"<div><h3>Aim</h3><div>Hand hygiene is regarded as the cornerstone for preventing healthcare-associated infections. This study assesses trends in alcohol-based hand rub (ABHR) consumption for hand hygiene and availability of dispensers at the point of care (POC) in acute care hospitals in Catalonia, as part of the VINCat program.</div></div><div><h3>Methods</h3><div>Data were collected from 2014 to 2022 in 69 hospitals, categorized by size and type, including large, medium, small, and specialized facilities. ABHR consumption was measured in liters per 1000 patient-days, with data segmented into intensive care units (ICUs) and non-ICU wards. Hospital infection control personnel determined the availability of ABHR solutions at the POC through yearly point prevalence surveys.</div></div><div><h3>Results</h3><div>The study found a significant increase in ABHR consumption over time, with usage rising from 22.8<!--> <!-->L/1000 patient-days in the 2014–2017 period to 39.9<!--> <!-->L in 2018–2022, representing a 75% increase. The most significant growth was observed in ICUs, where ABHR use nearly doubled. ABHR consumption also spiked during the COVID-19 pandemic in 2020, with large hospitals showing the highest levels of usage. Additionally, the availability of ABHR dispensers at the POC increased, particularly in non-ICU wards and small hospitals.</div></div><div><h3>Conclusions</h3><div>The findings underscore the role of sustained hand hygiene efforts, including increased ABHR availability at the POC, as essential components of infection prevention. These efforts are especially crucial in high-risk units such as ICUs and in smaller hospitals, where resources and compliance may be limited.</div></div>","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 ","pages":"Pages S98-S105"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789505","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":"Papular lesions and pancytopenia in a patient with severe immunosuppression due to HIV","authors":"Laia Arbós Junyent ,&nbsp;Antonio Casabella Pernas ,&nbsp;Granada Olga Perea Duran ,&nbsp;Marta Navarro Vilasaró","doi":"10.1016/j.eimce.2024.12.005","DOIUrl":"10.1016/j.eimce.2024.12.005","url":null,"abstract":"","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 5","pages":"Pages 291-292"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899436","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":"Tuberculosis infection diagnosis: Current prospects","authors":"Fernando Alcaide ,&nbsp;Luis Anibarro","doi":"10.1016/j.eimce.2025.02.014","DOIUrl":"10.1016/j.eimce.2025.02.014","url":null,"abstract":"","PeriodicalId":72916,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica (English ed.)","volume":"43 5","pages":"Pages 239-241"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911756","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}