Journal of mechanical ventilation最新文献

{"title":"Complex ventilation problems with no simple solution","authors":"R. C Freebairn","doi":"10.53097/jmv.10067","DOIUrl":"https://doi.org/10.53097/jmv.10067","url":null,"abstract":"Daoud and Franck in this edition of the journal proffer an eloquent disquisition on alveolar compliance and resistance and describe ways in which we could make estimates of the effect of ventilation changes, using esophageal balloon manometry measure the trans alveolar pressure, and estimating the alveolar tidal volume using volumetric capnometry. 10 The article like the subject it addresses is complex and requires an active rather than passive read. It outlines the concepts clearly and highlights the need for accurate and exacting measurement. Complicating this is the need to provide simultaneous diaphragmatic and alveolar protective ventilation, which further complicates modelling of controlled ventilation strategies. 11 It remains something to be addressed in the future.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769254","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 pilot study to evaluate the safety and efficacy of automated mechanical respiratory aid device","authors":"Gautham Pasupuleti, M. Mukund, Sharon A. George, Srimathi Bai KM","doi":"10.53097/jmv.10064","DOIUrl":"https://doi.org/10.53097/jmv.10064","url":null,"abstract":"Background: High burden of morbidity and mortality due to respiratory illnesses was witnessed during the COVID-19 pandemic. We developed a portable automated mechanical respiratory assist device (RespirAID R20) that delivers Intermittent Positive Pressure Ventilation by mechanically compressing a Bag Valve Mask. The objective of the study is to evaluate the safety and efficacy of the RespirAID R20, a mechanical ventilation device in post-operative care patients. Method: This pilot study enrolled five subjects at Yenepoya Medical College Hospital, India. Post-operative subjects were transferred from the Mindray Synovent E3 (standard ventilator) to the RespirAID R20 for 3 hours. Ventilator and physiologic parameters were recorded and compared. Result: All patients maintained normal blood pressure, heart rate, and heart rhythm. The delivered mean tidal volume (VT) and peak inspiratory pressure (PIP) was 419.64 +/- 11 ml and 20 +/- 2 cmH2O, which remained within the initial set range of 428 +/- 12 ml and 24 +/- 2 cmH2O throughout the study duration. Arterial blood gas (ABG) parameters during RespirAID R20, except PaO2, were within the normal range. PaO2 levels were greater than 300 mm Hg during the first four hours (323 +/- 163 mmHg and 344 +/- 97 mmHg). Conclusion: The findings of this study suggests that RespirAID R20 may be an alternative device in providing respiratory assistance to sedated and intubated adult patients in the postoperative period. Additional studies are required to evaluate other possible applications of the RespirAID R20. Keywords: RespirAID R20, ABG parameters, mechanical ventilation, respiratory assist","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44240044","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":"Non‐surgical pneumoperitoneum and pneumoretroperitoneum associated with mechanical ventilation","authors":"M. R. Krishna, Pramood Sood, P. Gautam","doi":"10.53097/jmv.10059","DOIUrl":"https://doi.org/10.53097/jmv.10059","url":null,"abstract":"We present two rare cases of mechanical ventilation-associated barotrauma presenting with pneumoperitoneum and pneumoretroperitoneum separately. Pneumoperitoneum and pneumoretroperitoneum are not always associated with a hollow viscous perforation and can be seen due to barotrauma as a consequence of the Macklin effect.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42044277","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":"Mechanical power in AVM-2 versus conventional ventilation modes in various ARDS lung models. Bench study","authors":"J. Yeo, Parthav Shah, M. Gozun, C. Franck, Ehab Daoud","doi":"10.53097/jmv.10056","DOIUrl":"https://doi.org/10.53097/jmv.10056","url":null,"abstract":"Introduction Mechanical power has been linked to ventilator induced lung injury and mortality in acute respiratory distress syndrome (ARDS). Adaptive Ventilator Mode-2 is a closed-loop pressure-controlled mode with an optimal targeting scheme based on the inspiratory power equation that adjusts the respiratory rate and tidal volume to achieve a target minute ventilation. Conceptually, this mode should reduce the mechanical power delivered to the patients and thus reduce the incidence of ventilator induced lung injury. Methods A bench study using a lung simulator was conducted. We constructed three passive single compartment ARDS models (Mild, Moderate, Severe) with compliance of 40, 30, 20 ml/cmH2O respectively, and resistance of 10 cmH2O/L/s, with IBW 70 kg. We compared three different ventilator modes: AVM-2, Pressure Regulated Volume Control (PRVC), and Volume Controlled Ventilation (VCV) in six different scenarios: 3 levels of minute ventilation 7, 10.5, and 14 Lit/min (Experiment 1, 2, and 3 respectively), each with 3 different PEEP levels 10, 15, and 20 cmH2O (Experiment A, B, and C respectively) termed 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C respectively for a total of 81 experiments. The AVM-2 mode automatically selects the optimal tidal volume and respiratory rate per the dialed percent minute ventilation with an I:E ratio of 1:1. In the PRVC and VCV (constant flow) we selected target tidal volume 6ml/kg/IBW (420 ml) and respiratory rate adjusted to match the minute ventilation for the AVM-2 mode. I:E ratio was kept 1:2. The mechanical power delivered by the ventilator for each mode was computed and compared between the three modes in each experiment. Statistical analysis was done using Kruskal-Wallis test to analyze the difference between the three modes, post HOC Tukey test was used to analyze the difference between each mode where P < 0.05 was considered statistically significant. The Power Compliance Index was calculated and compared in each experiment. Multiple regression analysis was performed in each mode to test the correlation of the variables of mechanical power to the total calculated power. Results There were statistically significant differences (P < 0.001) between all the three modes regarding the ventilator delivered mechanical power. AVM-2 mode delivered significantly less mechanical power than VCV which in turn was less than PRVC. The Power Compliance index was also significantly lower (P < 0.01) in the AVM-2 mode compared to the other conventional modes. Multiple regression analysis indicated that in AVM-2 mode, the driving pressure (P = 0.004), tidal volume (P < 0.001), respiratory rate (P = 0.011) and PEEP (P < 0.001) were significant predictors in the model. In the VCV mode, the respiratory rate (P 0< 0.001) and PEEP (P < 0.001) were significant predictors, but the driving pressure was a non-significant predictor (P = 0.08). In PRVC mode, the respiratory rate (P < 0.001), PEEP (P < 0.001) and driving pressure (P < 0.001) ","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46822228","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":"The Rise of the Machines: Why the future lies with less injurious adaptive ventilation strategies","authors":"R. C Freebairn","doi":"10.53097/jmv.10055","DOIUrl":"https://doi.org/10.53097/jmv.10055","url":null,"abstract":"It has been 60 years since Bendixen, Hedley-White, and Laver described the progressive atelectasis and resultant hypoxemia that resulted from prolonged mechanical ventilation. A proposed solution was to raise the tidal volume (VT) from those recommended by Radford’s nomogram for “proper ventilation” to 10 -15 ml/ kg. It was less than four years later that Acute Respiratory Distress Syndrome (ARDS) was first reported. Since then, clinicians and researchers have been searching for the ideal ventilation strategy to minimise the harm and optimise the outcomes from ventilatory support in the critically ill.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42737504","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":"https://www.journalmechanicalventilation.com/rapid-review-of-patient-ventilator-dyssynchrony/","authors":"D. Garner, Priyank Patel","doi":"10.53097/jmv.10058","DOIUrl":"https://doi.org/10.53097/jmv.10058","url":null,"abstract":"Patient-Ventilator Dyssynchrony (PVD) is often described as a patient “fighting” the ventilator. In fact, there are many forms of dyssynchrony some of which can very subtle. If unrecognized early, dyssynchrony can evoke patient discomfort, increase incidence of lung injury, lead to oversedation, and lengthen duration of mechanical ventilation. Since start of the COVID-19 pandemic, many clinicians without critical care experience have been compelled to manage patients requiring mechanical ventilation. Many academic centers, hospital systems, and physician groups have attempted to provide educational material in efforts to prepare clinicians on how to operate a ventilator. During this frenzied time, very few resources have been made available to clinicians to rapidly recognize ventilator dyssynchrony as it occurs when taking care of these patients. The figures presented in this article depict dyssynchrony in Volume Control Ventilation (VCV) with a decelerating ramp of flow and are hand drawn. While they may not perfectly represent waveforms seen on ventilators, the patterns shown and described below will be similar.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46251838","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":"Mechanical power and Power Compliance Index in independent lung ventilation. New insight","authors":"Koichi Keitoku, J. Yeo, Robert Cabbat, Ehab Daoud","doi":"10.53097/jmv.10057","DOIUrl":"https://doi.org/10.53097/jmv.10057","url":null,"abstract":"Background Unilateral lung disease (ULD) requiring mechanical ventilation is a unique challenge due to individual and interactive lung mechanics. The distribution of volume and pressure may not be even due to inequities in compliance and resistance. Independent lung ventilation (ILV) is a strategy to manage ULD but is not commonly employed. We assessed the mechanical power (MP) between single lung ventilation (SLV) and ILV in a dual lung model with different compliances. Methods A passive lung model with two different compliances (30 ml/cmH2O and 10 ml/cmH2O) and a predicted body weight of 65 kg was used to simulated ULD and ILV. In SLV the ventilator was set with the following: tidal volume (VT) 400 ml, PEEP 7, RR 20, I:E 1:2. In ILV, each lung was given a separate ventilator with equivalent settings to SLV: VT 300 ml, PEEP 7, RR 20, I:E 1:2 in the more compliant lung (MCL) and VT 100 ml, PEEP 7, RR 20, I:E 1:2 in the less compliant lung (LCL). The study was repeated with different PEEP levels and different ventilator modes, volume (VCV) and pressure control (PCV). PEEP was set according to the compliance: VT 300 ml, PEEP 8, RR 20, I:E 1:2 in the MCL and VT 100 ml, PEEP 10, RR 20, I:E 1:2 in the LCL. The MP in each study and compared SLV to the combined results from each lung in ILV. MP was indexed to the compliance in all the studies Results The MP was significantly lower in VCV compared to PCV in all studies. In VCV, the total MP in SLV was 12.61 J/min compared to 11.39 J/min in the combined lungs with the same PEEP levels (8.84 MCL and 2.55 LCL) (p = < 0.001). The total MP in SLV was also higher when comparing to ILV with different PEEP levels 12.57 J/min (9.43 MCL and 3.01LCL) (p= <0.001). In PCV, the total MP was 14.25 J/min which was higher compared to 13.22 in the combined lungs with the same PEEP levels (9.88 MCL and 3.32 LCL) (p =<0.001) however, the MP was lower compared to 14.55 in the combined lungs with different PEEP levels (10.58 MCL and 3.92 LCL) (p=<0.001).The Power Compliance Index (PCI) was significantly lower in ILV with same PEEP level (0.295 MCL and0.255 LCL, compared to 0.315 in the SLV) and similar in the different PEEP levels (0.314 MCL and , 0.314 LCL, compared to 0.315 in the SLV) in VCV. The PCI was significantly lower in the ILV with the same PEEP level (0.329 MCL, 0.332 LCL compared to 0.356 in the SLV). In the different PEEP levels, the MCL was less (0.352), and higher in the LCL (0.392) compared to the SLV (0.356) in PCV. Conclusions ILV can be achieved with lower MP in VCV using the same or higher PEEP levels than SLV, however in PCV the MP was less using the same PEEP but higher using different PEEP levels. Indexing the MP to compliance can be more meaningful in interpreting the results than the MP alone. Further studies are needed to confirm our findings.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42686741","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":"Identifying asynchronies: Reverse trigger","authors":"Victor Perez, Jamille Pasco","doi":"10.53097/jmv.10052","DOIUrl":"https://doi.org/10.53097/jmv.10052","url":null,"abstract":"A variety of asynchronies between the patient’s respiratory efforts and the programed ventilatory settings have been categorized. Reverse trigger is described as an inspiratory effort occurring after a ventilator-initiated breath and may represent a form of respiratory entrainment. In other words, the ventilator triggers muscular efforts. It often appears in a repetitive, stereotyped pattern. It occurs often in mechanically ventilated patients at risk of injury, might be underrecognized at the bedside and may has adverse effects on oxygenation and ventilation, as well as potentially increasing lung injury. We can phenotype these events using the Campbell diagram (pressure–volume loop) by differentiating their occurrence during inspiration and expiration. Reverse trigger with sufficient inspiratory effort and duration can result in an additional ventilator-delivered stacked breath, which can cause large tidal volumes and increased transpulmonary pressure. Keywords: Asynchrony, ventilator, reverse trigger, entrainment, lung injury, phenotype.","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41505886","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":"4DPRR- Index for predicting mortality in COVID-19 ARDS","authors":"G. Paul, M. R. Krishna, Pl Gautam","doi":"10.53097/jmv.10048","DOIUrl":"https://doi.org/10.53097/jmv.10048","url":null,"abstract":"Abstract Background Mortality in ARDS was reduced significantly after the introduction of the low tidal volume ventilation strategy. It has been recently shown that lung-protective ventilation strategies should primarily target driving pressure rather than Vt and that ventilator induced lung injury is not just dependent on tidal volume but also other factors like respiratory rate and driving pressure. Ventilator induced lung injury is also thought to be dependent on the amount of energy transferred by the ventilator to the patient which in turn is dependent on tidal volume size (VT), plateau pressure (Pplat), respiratory rate (RR). Mechanical power can be calculated accurately through power equations which can increase their applicability in clinical practice. One simple composite equation (driving pressure multiplied by four plus respiratory rate [4DPRR]) has been recently suggested as a simple surrogate for the power equation. This equation also doesn’t include PEEP as it has been theorized that it is the only elastic dynamic component of driving energy which affects the outcome and not the elastic static component (i.e., PEEP) and the resistive power (related to flow and airway resistance). Objectives To assess the mechanical power as measured by 4DPRR in mechanically ventilated patients who have moderate to severe COVID-19 ARDS. Methods: We obtained data on ventilatory variables and mechanical power from the patients who were admitted with moderate to severe COVID ARDS in our hospital from March 2021 to June 2021. Results We included 34 patients (28% women; mean age, 57 ± 17 yrs.). The average ΔP was 21.44 ± 3.98 cmH2O, the RR was 23.8 ± 3.84 breaths/min, and the mean driving pressure was 21.4 cmH2O. 28% (n = 10) of patients expired. There was no significant association of 4DPRR (P 0.72), Pplat (P 0.79).and RR (P 0.21) with mortality as predicted by area under ROC curves. Conclusions Driving power and plateau pressure were associated with mortality during controlled mechanical ventilation in COVID ARDS, but a simpler model of mechanical power using only the driving pressure and respiratory rate was found to be a poor predictor of mortality. Keywords: COVID-19, ARDS, Mechanical power, Driving pressure, Plateau pressure","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44676528","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":"Mechanical power in AVM-2 versus conventional ventilation modes in a normal lung model: A bench study","authors":"Parthav Shah, J. Yeo, W. Techasatian, Franck Claudio, Ehab Daoud","doi":"10.53097/jmv.10047","DOIUrl":"https://doi.org/10.53097/jmv.10047","url":null,"abstract":"Introduction Recent studies suggested that the energy delivered by the mechanical ventilator to the lungs termed the mechanical power can induce and increase the risks of ventilator induced lung injury. The components of the mechanical power include the variables delivered by the ventilator: tidal volume, respiratory rate, inspiratory flow, airway pressure. Adaptive Ventilator Mode-2 (AVM-2) is a pressure-controlled mode with an optimal targeting scheme based on the inspiratory power equation that adjusts the respiratory rate and tidal volume to achieve a target minute ventilation. This mode conceptually should reduce the mechanical power delivered to the patients and thus reduce the incidence of ventilator induced lung injury. Methodology A bench study using a lung simulator (TTL, Michigan Instruments, Michigan, USA) was conducted. We constructed a passive single compartment normal respiratory mechanics model with compliance of 50 ml/cmH2O, and resistance of 10 cmH2O/L/s, with IBW 70 kg. We compared three different ventilator modes: Adaptive Ventilation Mode-2 (AVM-2), Pressure Regulated Volume Control (PRVC), and Volume Controlled Ventilation (VCV) in four different scenarios: 2 levels of minute ventilation 7 and 10.5 Lit/min (Experiment 1 and 2 respectively), each with 2 different PEEP levels 5 and 10 cmH2O (Experiment A and B respectively) termed Experiments 1A, 1B, 2A, and 2B respectively. The AVM-2 mode automatically selects the optimal tidal volume, and respiratory rate per the dialed percent minute ventilation with an I:E ratio of 1:1. In the PRVC, VCV we selected target tidal volume 6ml/kg/IBW (420 ml), and respiratory rate adjusted to match the minute ventilation for the AVM-2 mode. I:E ratio was kept 1:2 to avoid intrinsic PEEP. The study was conducted using a bellavista™ 1000 e Ventilator (Vyaire Medical, Illinois, USA). The mechanical power delivered by the ventilator for each mode was computed and compared between the three modes in each experiment. Statistical analysis was done using Kruskal-Wallis test to analyze the difference between the three modes, post HOC Tukey test was used to analyze the difference between each mode with the confidence intervals, P < 0.05 was considered statistically significant. Results There were statistically significant differences between all the three modes regarding the ventilator delivered mechanical power. The AVM-2 mode delivered significantly less mechanical power than VCV which in turn was less than PRVC. Experiment 1A: AVM-2 8.76 土 0.05, VCV 9.78 土 0.04, PRVC 10.82 土 0.08, P < 0.001 Experiment 1B: AVM-2 11.27 ± 0.09 VCV 12.81 ± 0.05, PRVC 13.88 ± 0.06, P < 0.001. Experiment 2A: AVM-2 14.76 ± 0.05, VCV 15.79 ± 0.05, PRVC 18.29 ± 0.07, P < 0.001, Experiment 2B: AVM-2 18.76 ± 0.04, VCV 20.56 ± 0.04, PRVC 21.17 土 0.03, P < 0.001. Discussion AVM2 mode delivered less mechanical power compared to two conventional modes using low tidal volume in a normal lung model. This might reduce the incidence of ","PeriodicalId":73813,"journal":{"name":"Journal of mechanical ventilation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45212277","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}