JEM reports最新文献

{"title":"Not shooting blanks: A case of foreign body urinary retention","authors":"Sarah Spelsberg,&nbsp;Benjamin McMichael,&nbsp;Brianna Crosby,&nbsp;Katherine Fredlund","doi":"10.1016/j.jemrpt.2025.100193","DOIUrl":"10.1016/j.jemrpt.2025.100193","url":null,"abstract":"<div><h3>Background</h3><div>Bullet and other foreign body migration after penetrating trauma is rare. There is potential for delayed movement and migration over time. A migrating retained foreign body can cause serious complications.</div></div><div><h3>Case report</h3><div>A 51-year-old male sustained a gunshot wound to the abdomen and pelvis. The bullet initially lodged in the abdomen. Trauma imaging identified cancer and the patient required surveillance scans. The position of the bullet remained unchanged for 11 months. From 11 to 15 months, imaging showed the bullet migrating across the abdomen, into the bladder, and through the prostate, ultimately causing acute urinary retention in the urethra. The patient presented with severe pain and was found to have bladder distention and the bullet 5 mm from the urethral meatus. It was successfully removed under sedation using alligator forceps followed by Foley catheter placement.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>This case illustrates the rare but significant risk of delayed bullet migration and the need for long-term monitoring in penetrating trauma with retained foreign body.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220602","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":"Bilateral anterior shoulder dislocations after ground-level fall","authors":"Priya Shil,&nbsp;Courtney Mariner,&nbsp;Scott Gutovitz","doi":"10.1016/j.jemrpt.2025.100192","DOIUrl":"10.1016/j.jemrpt.2025.100192","url":null,"abstract":"<div><h3>Background</h3><div>Despite being the most routinely encountered joint dislocation, bilateral anterior shoulder dislocation is a rare finding in a common Emergency Department complaint of mechanical ground level fall. High energy mechanisms of injury such as trauma, seizures, and electrocution are the most common causes of bilateral shoulder dislocation.</div></div><div><h3>Case report</h3><div>A 72-year-old male presents with simultaneous anterior dislocations of both shoulders after a fall while walking his dog. He arrived in the Emergency Department with arms above his head and xray imaging identified bilateral shoulder dislocations. After procedural sedation, the shoulders were successfully reduced without any evidence of neurovascular injuries and later discharged.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>?This mechanism of injury is rare among those who are diagnosed with bilateral shoulder dislocation and therefore, more likely to be missed. Where symmetry generally represents a person's normal anatomy, the apparent symmetric appearance in bilateral shoulder dislocation is misleading. Due to the infrequent occurrence, there is low clinical suspicion among emergency physicians leading to delayed diagnosis and associated complications.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105705","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":"Teaching pediatric emergency department agitation management using a clinical pathway combined with simulation scenarios","authors":"Neehar Kundurti ,&nbsp;Rachel Tuuri ,&nbsp;Lynne Fullerton ,&nbsp;Priya Gupta ,&nbsp;Brittany Ebbing ,&nbsp;Sara Skarbek-Borowska","doi":"10.1016/j.jemrpt.2025.100191","DOIUrl":"10.1016/j.jemrpt.2025.100191","url":null,"abstract":"<div><h3>Background</h3><div>Agitation is a common cause for pediatric emergency department (ED) visits. Despite consensus guidelines and recent educational toolkits, opportunities exist to improve provider knowledge and patient care by utilizing novel teaching modules.</div></div><div><h3>Objectives</h3><div>This study aimed to develop and test a teaching module (intervention) using two clinical case simulations and a pediatric agitation pathway (decision aid). We hypothesized that the module would improve provider knowledge and comfort in managing acutely agitated pediatric patients.</div></div><div><h3>Methods/Design</h3><div>This single-center, pre-post intervention study used a multidisciplinary-developed pathway based on consensus guidelines and two simulation case scenarios.</div></div><div><h3>Subjects and Setting</h3><div>Participants, all trainees in emergency medicine, completed a knowledge test and comfort survey prior to the training. They then attended a brief teaching session on the pathway, participated in two simulation case scenarios, and subsequently repeated the test and survey. Outcome measures were the difference between knowledge and comfort scores before and after the training.</div></div><div><h3>Results</h3><div>Sixteen participants completed the module. Knowledge improved significantly, with mean test scores increasing from 4.5 out of 10 (IQR 3–5) to 8 out of 10 (IQR 7–9) (P &lt; .001). Comfort improved with using chemical (P = .002) and physical (P = .001) restraints.</div></div><div><h3>Conclusion</h3><div>The findings suggest that a teaching module for pediatric agitation which uses a decision aid in simulation scenarios is feasible and effective in improving overall knowledge and comfort associated with pediatric chemical and physical restraint use. It fills a well-known gap in pediatric agitation training and has the potential to be replicated in teaching programs for other emergent conditions.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100191"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916371","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":"Right atrial compression secondary to diaphragmatic rupture and liver displacement: A case report","authors":"Carlos Rodriguez,&nbsp;Elizabeth Reynolds,&nbsp;Brian Chang","doi":"10.1016/j.jemrpt.2025.100190","DOIUrl":"10.1016/j.jemrpt.2025.100190","url":null,"abstract":"<div><h3>Background</h3><div>Diaphragmatic rupture, a rare condition, can be categorized as traumatic or nontraumatic in origin. Traumatic diaphragmatic rupture (TDR) occurs in 0.8–5 % (Rossetti et al., 2005) of cases involving high-impact blunt or penetrating trauma to the chest or abdomen. Nontraumatic etiologies include congenital defects, acute elevations in intra-abdominal pressure, endometriosis, diaphragmatic abscess, or diaphragmatic eventration. Early recognition and management are critical due to its potential complications, including obstructive shock and organ herniation (Rossetti et al., 2005; Keyes et al., 2024).</div></div><div><h3>Case report</h3><div>We report a case of a 70-year-old woman presenting to the emergency department (ED) following cardiac arrest. Imaging revealed a diaphragmatic rupture with herniation of the liver into the thoracic cavity, causing right atrial compression and obstructive shock. Definitive management required transfer to a center with specialized cardiothoracic services for potential surgical repair after hemodynamic stabilization.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>Diaphragmatic rupture is an uncommon diagnosis that can mimic other conditions, delaying lifesaving treatment. Prompt imaging with CT is essential for accurate diagnosis, as chest radiography has low sensitivity. Emergency physicians must maintain a high index of suspicion in cases of undifferentiated shock to avoid fatal outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841734","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":"Expedited evaluation of atypical aortic dissection with point of care ultrasound: A case report","authors":"Reginald J. Myles ,&nbsp;Addison B. Smartt ,&nbsp;Patrick Kishi ,&nbsp;Lauren B. Querin ,&nbsp;Douglas Rappaport ,&nbsp;Cody Petrie","doi":"10.1016/j.jemrpt.2025.100189","DOIUrl":"10.1016/j.jemrpt.2025.100189","url":null,"abstract":"<div><h3>Background</h3><div>Aortic dissection (AD) is a vascular emergency with substantial morbidity and mortality. Aortic dissections have been classically categorized into two subtypes: Stanford Type A aortic dissections involve the ascending aorta and/or aortic arch and require emergent surgical intervention. Stanford Type B aortic dissections involve the aortic arch distal to the left subclavian artery and descending aorta and can be managed medically. Despite its dire consequences, Type A dissections remain challenging to diagnose due to highly variable clinical presentations. While imaging modalities such as magnetic resonance imaging (MRI), computed tomography angiography (CTA), and transesophageal echocardiography (TEE) have high diagnostic sensitivity, they are time-intensive and may delay treatment initiation.</div></div><div><h3>Case report</h3><div>This case report describes the rapid diagnosis and management of a 47-year-old male patient presenting with atypical symptoms of aortic dissection, including vague chest tightness and progressive global encephalopathy. Bedside point-of-care ultrasound (POCUS) played a pivotal role in initiating timely diagnosis, intervention, and improving the clinical outcome of this patient with a Stanford Type A aortic dissection.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>POCUS can provide valuable early diagnostic insights and expedite further evaluation of Stanford Type A aortic dissection. Especially in cases of atypical presentation, POCUS is a rapid and inexpensive diagnostic tool for this highly emergent and morbid condition, accelerating further definitive imaging and treatment.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100189"},"PeriodicalIF":0.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721000","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":"Elevated lung cancer screening needs among emergency department patients","authors":"Beau Abar,&nbsp;George Ashji,&nbsp;David Adler","doi":"10.1016/j.jemrpt.2025.100188","DOIUrl":"10.1016/j.jemrpt.2025.100188","url":null,"abstract":"<div><h3>Background</h3><div>More than 10 % of Emergency Department (ED) cancer-related visits are for lung cancer<strong>.</strong> Timely lung cancer screening is an effective mechanism to decrease lung cancer morbidity and mortality, but only 16 % of eligible patients in the general population are up-to-date with lung cancer screening recommendations. Furthermore, many characteristics found predictive of non-adherence with screening are over-represented within the ED patient population.</div></div><div><h3>Objective</h3><div>The goal of this study is to determine risk for non-adherence with USPSTF lung cancer screening guidelines among the ED patient population.</div></div><div><h3>Methods</h3><div>Data on smoking history and lung cancer screening were abstracted from the medical charts of patients 50–80 years old presenting to the University of Rochester Medical Center ED during 2023. Adherence with guidelines among eligible patients was determined by documentation of lung cancer screening in the year prior to ED presentation. We also evaluated any screening that occurred within 120 days of their ED visit.</div></div><div><h3>Results</h3><div>A total of 559 patient charts were reviewed, with 354 having a documented history of tobacco use (63 %). Pack year estimates were available for 252 patients, and 116 patients had a 20+ pack year smoking history documented (e.g., eligible for lung cancer screening). Among those, 14 individuals received LCS in the past year, representing a screening adherence rate of 12 % at presentation. By 120 days post-visit, the rate declined to 9 %.</div></div><div><h3>Conclusion</h3><div>ED patients are at elevated risk for non-adherence with LCS guidelines, supporting previous work that demonstrates the potential value of ED-based intervention efforts.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720925","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":"Point-of-care ultrasound stratified by the wells score for the diagnosis of proximal deep vein thrombosis: A prospective study","authors":"Nicolás Rojas Muñoz ,&nbsp;Hans Clausdorff Fiedler ,&nbsp;Felipe Riquelme Morales ,&nbsp;Victor Vidal Zamorano ,&nbsp;Francisca Seydewitz Osses ,&nbsp;Sofía Rivera Gonzalez ,&nbsp;Carlos Basaure Verdejo","doi":"10.1016/j.jemrpt.2025.100187","DOIUrl":"10.1016/j.jemrpt.2025.100187","url":null,"abstract":"<div><h3>Background</h3><div>Deep vein thrombosis (DVT) affects 1 in 1000 people, with complications associated both in under and over diagnosis. Duplex ultrasound is the gold standard but its use in emergency settings is limited. Two-point Point-of-Care ultrasound protocol performed by emergency physicians can foster its diagnosis. However, 6 % of cases can be missed and its performance stratified by clinical pre-test probability is unknown.</div></div><div><h3>Objective</h3><div>To evaluate the diagnostic performance of an extended compression ultrasound (ECUS) protocol performed by emergency physicians when stratified by Wells score.</div></div><div><h3>Methods</h3><div>We conducted a prospective diagnostic accuracy study. Adult patients (≥18 years) with suspected DVT were stratified by Wells score (low, intermediate, high risk) and underwent ECUS by trained emergency physicians or residents. Results were compared to complete duplex ultrasound (CDUS) performed by radiologists within 24 h.</div></div><div><h3>Results</h3><div>Among 194 patients analyzed (54 % female, mean age 61 ± 18 years), the overall prevalence of proximal DVT was 17 %. The ECUS protocol demonstrated a global sensitivity of 97 % (95 % CI: 84.2–99.9), specificity of 94.4 % (95 % CI: 89.7–97.4), positive predictive value of 78.6 % (95 % CI: 63.2–89.4), and negative predictive value of 99.3 % (95 % CI: 96.4–100). In the low-risk group, sensitivity was 100 % (95 % CI: 29.2–100) with a negative predictive value of 100 % (95 % CI: 90.7–100).</div></div><div><h3>Conclusion</h3><div>The combined use of Wells score stratification and ECUS can reliably exclude proximal DVT in low and intermediate-risk patients, potentially optimizing emergency department resources and facilitating timely clinical decisions. In low-risk patients, this strategy may yield results comparable to comprehensive Doppler ultrasound.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721112","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":"A rare complication of thoracotomy: thoracodorsal artery pseudoaneurysm","authors":"Mustafa Koyun ,&nbsp;Bahadir Reis","doi":"10.1016/j.jemrpt.2025.100186","DOIUrl":"10.1016/j.jemrpt.2025.100186","url":null,"abstract":"<div><h3>Background</h3><div>Pseudoaneurysms are pathological formations that can develop after trauma, inflammation, or surgery, with symptoms sometimes emerging following a latent period.</div></div><div><h3>Case report</h3><div>This paper examines a 66-year-old female patient with a history of thoracotomy for descending aortic aneurysm repair who presented to the emergency department with swelling and loco-regional pain in the left lateral chest wall. The patient was referred to the radiology unit with suspected abscess in the left chest wall. Ultrasonography (US) and color Doppler US (CDUS) revealed a thoracodorsal artery pseudoaneurysm in the area thought to be an abscess. This paper presents the radiological findings of this previously undocumented late complication of thoracotomy and emphasizes the importance of considering vascular complications in patients presenting with chest wall swelling.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Emergency physicians must recognize that post-thoracotomy chest wall swellings could be pseudoaneurysms rather than abscesses or hematomas. Careful physical examination detecting pulsation or bruit should prompt vascular imaging. Familiarity with characteristic ultrasonographic findings (\"yin-yang\" sign, \"to-and-fro\" flow pattern) facilitates accurate diagnosis. Mismanagement, such as incision of a misdiagnosed pseudoaneurysm, may cause catastrophic hemorrhage. Maintaining high suspicion in patients with thoracic surgical history ensures appropriate vascular surgery referral.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702955","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":"When the scan tells a different story","authors":"Matthew S. Berniard,&nbsp;Monika Krzak,&nbsp;Richard Slama,&nbsp;Charles Dalton Hardesty,&nbsp;Carlo Zamora,&nbsp;Christina Cartwright","doi":"10.1016/j.jemrpt.2025.100185","DOIUrl":"10.1016/j.jemrpt.2025.100185","url":null,"abstract":"<div><h3>Background</h3><div>Point-of-care ultrasound (POCUS) has become a standard in emergency care for its rapid, accurate bedside diagnostics and procedural guidance. Our institution developed a tailored, comprehensive POCUS course aligned with American Board of Emergency Medicine guidelines. Unlike many physician-only programs, our course also trains Advanced Practice Providers (APPs) alongside their supervising physicians. Two weeks after completing the course, an APP applied this training in a rare case, directly contributing to a life-saving intervention. While not a substitute for residency-based ultrasound training, this experience highlights the powerful impact of structured ultrasound education for all emergency providers.</div></div><div><h3>Case report</h3><div>A 33-year-old male presented to the emergency department (ED) with progressively worsening, atraumatic, right knee and calf pain over a two-week period leading to difficulty ambulating. Initially evaluated by an APP in the low-acuity area, a supervising physician was consulted to proctor and perform a proximal lower extremity POCUS for suspected deep vein thrombosis (DVT). While no DVT was identified, the scan revealed a 3.8 cm arterial structure consistent with a massive popliteal artery aneurysm. Computed Tomography Angiography confirmed the diagnosis and raised concern for rupture. The patient was taken emergently for bypass surgery. Investigation revealed the aneurysm was secondary to tertiary syphilis in the setting of undiagnosed human immunodeficiency virus (HIV).</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Emergency Medicine physicians should embrace the broad utility of ultrasound as a rapid, accurate, and cost-effective diagnostic tool that enhances patient care, especially in resource-limited settings. This case underscores ultrasound's role in the timely diagnosis and treatment of vascular emergencies, while highlighting the need for comprehensive ultrasound training programs inclusive of all provider types.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100185"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679293","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":"Immune checkpoint inhibitor-associated polyneuropathy in malignant pleural mesothelioma: A case report","authors":"Mehdi Kashani ,&nbsp;Colleen Leu-Turner ,&nbsp;Douglas E. Rappaport ,&nbsp;James Kelley (Senior Author)","doi":"10.1016/j.jemrpt.2025.100184","DOIUrl":"10.1016/j.jemrpt.2025.100184","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICIs), such as nivolumab and ipilimumab, have revolutionized treatment for malignant pleural mesothelioma (MPM) but may cause rare, immune-related neurological adverse events.</div></div><div><h3>Case presentation</h3><div>A 71-year-old man with recurrent MPM developed rapidly progressive weakness, sensory loss, and neuropathic pain following his second cycle of nivolumab/ipilimumab. Workup ultimately revealed inflammatory demyelinating and axonal polyradiculoneuropathy. Cerebrospinal fluid analysis supported an autoimmune process. High-dose corticosteroids and intravenous immunoglobulin (IVIG) were initiated, resulting in functional improvement. He was discharged on a steroid taper with outpatient follow-up.</div><div>Why should an emergency physician be aware of this?</div><div>This case highlights the importance of recognizing immune-mediated polyneuropathy as a potential complication of ICI therapy. Timely diagnosis, multidisciplinary care, and early immunosuppressive treatment can lead to meaningful recovery.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100184"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679294","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}