American Journal of Kidney Diseases最新文献

{"title":"The Need for Culturally Tailored CKD Education in Older Latino Patients and Their Families.","authors":"Thalia Porteny, Kristen Kennefick, Mary Lynch, Angie M Velasquez, Kelli Collins Damron, Sylvia Rosas, Jennifer Allen, Daniel E Weiner, Sean Kalloo, Katherine Rizzolo, Keren Ladin","doi":"10.1053/j.ajkd.2024.06.015","DOIUrl":"10.1053/j.ajkd.2024.06.015","url":null,"abstract":"<p><p>Older Latino adults (aged 65+years) comprise the fastest growing minoritized group among the older population in the United States and experience a disproportionate burden of kidney failure as well as disparities in kidney care compared with non-Hispanic White individuals. Despite significant need and barriers uniquely faced by this population, few educational resources or decision aids are available to meet the language and cultural needs of Latino patients. Decision aids are designed to improve knowledge and empower individuals to engage in shared decision making and have been shown to improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). In this commentary, we examine the barriers faced by older Latino people with CKD who must make dialysis initiation decisions. We conclude that there is a need for culturally concordant decision aids tailored for older Latino patients with CKD to overcome barriers in access to care and improve patient-centered care for older Latino CKD patients.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"253-261"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term Pains for Long-term Gains? In Search of More Solutions to Inequities in Kidney Transplantation.","authors":"Xingxing S Cheng","doi":"10.1053/j.ajkd.2024.10.002","DOIUrl":"10.1053/j.ajkd.2024.10.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"182-183"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Coprescribing of Gabapentinoid and Other Psychoactive Medications With Altered Mental Status and Falls in Adults Receiving Dialysis.","authors":"Rasheeda K Hall, Sarah Morton-Oswald, Jonathan Wilson, Devika Nair, Cathleen Colón-Emeric, Jane Pendergast, Carl Pieper, Julia J Scialla","doi":"10.1053/j.ajkd.2024.07.013","DOIUrl":"10.1053/j.ajkd.2024.07.013","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale & objective: &lt;/strong&gt;Prescribing psychoactive medications for patients with kidney disease is common, but for patients receiving dialysis some medications may be inappropriate. We evaluated the association of coprescribing gabapentinoids and other psychoactive potentially inappropriate medications (PPIMs) (eg, sedatives or opioids) with altered mental status (AMS) and falls and whether the associations are modified by frailty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting & participants: &lt;/strong&gt;Adults receiving dialysis represented in the US Renal Data System who had an active gabapentinoid prescription and no other PPIM prescriptions in the prior 6 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;PPIM coprescribing, or the presence of overlapping prescriptions of a gabapentinoid and≥1 additional PPIM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome: &lt;/strong&gt;Acute care visits for AMS and injurious falls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analytical approach: &lt;/strong&gt;Prentice-Williams-Petersen Gap Time models estimated the association between PPIM coprescribing and each outcome, adjusting for demographics, comorbidities, and frailty, as assessed by a validated frailty index (FI). Each model tested for interaction between PPIM coprescribing and frailty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, PPIM coprescribing was associated with increased hazard of AMS (HR, 1.66 [95% CI, 1.44-1.92]) and falls (HR, 1.55 [95% CI, 1.36-1.77]). Frailty significantly modified the effect of PPIM coprescribing on the hazard of AMS (interaction P=0.01) but not falls. Among individuals with low frailty (FI=0.15), the HR for AMS with PPIM coprescribing was 2.14 (95% CI, 1.69-2.71); for individuals with severe frailty (FI=0.34), the hazard ratio for AMS with PPIM coprescribing was 1.64 (95% CI, 1.42-1.89). Individuals with PPIM coprescribing and severe frailty (FI=0.34) had the highest hazard of AMS (HR, 3.22 [95% CI, 2.55-4.06]) and falls (HR, 2.77 [95% CI, 2.27-3.38]) compared with nonfrail individuals without PPIM coprescribing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Outcome ascertainment bias; residual confounding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Compared with gabapentinoid prescriptions alone, PPIM coprescribing was associated with an increased risk of AMS and falls. Clinicians should consider these risks when coprescribing PPIMs to patients receiving dialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain-language summary: &lt;/strong&gt;Among people on dialysis, gabapentinoids may lead to confusion and falls. Often they are prescribed with other sedatives drugs or opioids, which can increase these risks. This study of adults with kidney failure receiving maintenance dialysis in the United States found that those who were prescribed both gabapentinoids and other psychoactive drugs were more likely to have confusion and falls compared with those who only took gabapentinoids. These relationships were seen at all levels of frailty although the relative risk of confusion related to an add","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"215-225.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Among Circle-Based Kidney Allocation, Center Waiting Time, and Likelihood of Deceased-Donor Kidney Transplantation.","authors":"David C Cron, Arnold E Kuk, Layla Parast, S Ali Husain, Kristen L King, Miko Yu, Sumit Mohan, Joel T Adler","doi":"10.1053/j.ajkd.2024.07.014","DOIUrl":"10.1053/j.ajkd.2024.07.014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale & objective: &lt;/strong&gt;The kidney allocation system (KAS250), using circle-based distribution, attempts to address geographic disparities through broader sharing of deceased-donor kidney allografts. This study evaluated the association between KAS250 and likelihood of deceased-donor kidney transplantation (DDKT) among wait-listed candidates, and whether the policy has differentially affected centers with shorter versus longer waiting time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting & participants: &lt;/strong&gt;160,941 candidates waitlisted at 176 transplant centers between March 2017 and March 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;KAS250 allocation policy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome: &lt;/strong&gt;Rate of DDKT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analytical approach: &lt;/strong&gt;Multivariable Cox regression, modeling KAS250 as a time-dependent variable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;KAS250 was not independently associated with likelihood of DDKT overall (HR, 1.01 vs pre-KAS250 [95% CI, 0.97-1.04]). KAS250's association with likelihood of DDKT varied across centers from HR, 0.18 (DDKT less likely after KAS250), to HR, 17.12 (DDKT more likely) and varied even among neighboring centers. KAS250 was associated with decreased DDKT at 25.6% and increased DDKT at 18.2% of centers. Centers with previously long median waiting times (57+months) experienced increased likelihood of DDKT after KAS250 (HR, 1.20 [95% CI, 1.15-1.26]) whereas centers with previously short median waiting times (6-24 months; HR, 0.88 [95% CI, 0.84-0.92]) experienced decreased likelihood of DDKT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Retrospective study of allocation policy changes, confounded by multiple changes over the study time frame.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Association between KAS250 and DDKT varied across centers. For 1 in 4 centers, DDKT was less likely after KAS250 relative to pre-KAS250 trends. Candidates at centers with previously long waiting times experienced an increased likelihood of DDKT after KAS250. Thus, broader distribution of kidneys may be associated with improved equity in access to DDKT, but additional strategies may be needed to minimize disparities between centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain-language summary: &lt;/strong&gt;This study examines how a recent policy change, KAS250, aimed at broadening the geographic sharing of deceased-donor kidneys, has impacted likelihood of kidney transplantation in the United States. Historically, kidney allocation occurred within local geographic boundaries, leading to unequal rates of transplantation across regions. KAS250, implemented in March 2021, replaced this system with a broader allocation radius of 250 miles around the donor hospital. Using national registry data, the study found that while there was no overall significant increase in the likelihood of transplantation nationally under KAS250, the policy's effect varied widely even among neighboring transplant centers. One quarter of center","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"187-195"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142374970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metformin in People With Diabetes and Advanced CKD: Should We Dare?","authors":"Jung-Im Shin, Antoine Créon, Juan-Jesus Carrero","doi":"10.1053/j.ajkd.2024.10.004","DOIUrl":"10.1053/j.ajkd.2024.10.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"184-186"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodialysis Vascular Access: Core Curriculum 2025.","authors":"Charmaine E Lok, Theodore Yuo, Timmy Lee","doi":"10.1053/j.ajkd.2024.05.021","DOIUrl":"10.1053/j.ajkd.2024.05.021","url":null,"abstract":"<p><p>The majority of patients with kidney failure requiring replacement therapy will need the support of hemodialysis during their journey with kidney failure. A reliable functioning vascular access is required to provide hemodialysis. This Core Curriculum reviews the major forms of vascular access (arteriovenous fistula, arteriovenous graft, and central venous catheter) as well as the planning, preparation, creation, use, and maintenance of vascular access, requiring a P-L-A-N (Patient ESKD Life-Plan first then Access Needs) for each patient. The end-stage kidney disease Patient Life-Plan focuses on a strategy for kidney replacement modalities, while the Access Needs are the corresponding dialysis access(es) and management plans. The Access Needs include a vessel preservation plan, creation plan, contingency (complications) plan, and access succession plan. Stenosis and thrombosis are common problems with arteriovenous accesses, and dysfunction and infection are common problems with central venous catheters. Underrecognized and underreported but potentially life-threatening situations include arteriovenous access rupture and high-output cardiac failure. Effective management of these and other vascular access problems requires a coordinated multidisciplinary effort that is patient centered while preserving vascular access.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"236-252"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stopping Versus Continuing Metformin in Patients With Advanced CKD: A Nationwide Scottish Target Trial Emulation Study.","authors":"Emilie J Lambourg, Edouard L Fu, Stuart McGurnaghan, Bryan R Conway, Neeraj Dhaun, Christopher H Grant, Ewan R Pearson, Patrick B Mark, John Petrie, Helen Colhoun, Samira Bell","doi":"10.1053/j.ajkd.2024.08.012","DOIUrl":"10.1053/j.ajkd.2024.08.012","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Despite a lack of supporting evidence, current guidance recommends against the use of metformin in people with advanced kidney impairment. This observational study compared the outcomes of patients with type 2 diabetes who continued versus stopped metformin after developing stage 4 chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR]<30mL/min/1.73m²).</p><p><strong>Study design: </strong>Nationwide observational cohort study.</p><p><strong>Setting & participants: </strong>All adults with type 2 diabetes and incident stage 4 CKD in Scotland who were treated with metformin between January 2010 and April 2019.</p><p><strong>Exposure: </strong>Stopping versus continuing metformin within 6 months following incident stage 4 CKD.</p><p><strong>Outcome: </strong>Primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiovascular events (MACE).</p><p><strong>Analytical approach: </strong>Target trial emulation with clone-censor-weight design and marginal structural models fit for sensitivity analyses.</p><p><strong>Results: </strong>In a population of 371,742 Scottish residents with a diagnosis of type 2 diabetes before April 30, 2019, 4,278 were identified as prevalent metformin users with incident CKD stage 4. Within 6 months of developing CKD stage IV, 1,713 (40.1%) individuals discontinued metformin. Compared with continuing metformin, stopping metformin was associated with a lower 3-year survival (63.7% [95% CI, 60.9-66.6] vs 70.5% [95% CI, 68.0-73.0]; HR, 1.26 [95% CI, 1.10-1.44]), and the incidence of MACE was similar between both strategies (HR, 1.05 [95% CI, 0.88-1.26]). Marginal structural models confirmed the higher risk of all-cause mortality and similar risk of MACE in patients who stopped versus continued metformin (all-cause mortality: HR, 1.34 [95% CI, 1.08-1.67]; MACE: HR, 1.04 [95% CI, 0.81-1.33]).</p><p><strong>Limitations: </strong>Residual confounding.</p><p><strong>Conclusions: </strong>The continued use of metformin may be appropriate when eGFR falls below 30mL/min/1.73m². Randomized controlled trials are needed to confirm these findings.</p><p><strong>Plain-language summary: </strong>Current guidance recommends against the use of metformin in people with advanced kidney impairment despite a lack of evidence. It is therefore currently unclear how the decision to stop versus continue metformin in patients who reach stage 4 CKD impacts their risk of mortality and cardiovascular events. This study showed that stopping metformin after reaching stage 4 CKD was associated with reduced survival that did not appear to be mediated by an increase in adverse cardiovascular outcomes. These findings may support the continued use of metformin in patients with advanced kidney impairment, but further research is needed to confirm these observations.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"196-204.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Suitability and Willingness for Living Kidney Donation Among Older Adults.","authors":"Cédric Villain, Natalie Ebert, Richard J Glassock, Nina Mielke, Tim Bothe, Muhammad Helmi Barghouth, Anna Pöhlmann, Anne-Katrin Fietz, John S Gill, Elke Schaeffner","doi":"10.1053/j.ajkd.2024.07.010","DOIUrl":"10.1053/j.ajkd.2024.07.010","url":null,"abstract":"<p><strong>Rationale & objective: </strong>The benefits of kidney transplantation compared with treatment with dialysis, including in older adults, are primarily limited by the number of donated kidneys. We studied the potential to expand the use of older living kidney donors.</p><p><strong>Study design: </strong>Secondary analysis of the Berlin Initiative Study, a population-based cohort.</p><p><strong>Setting & participants: </strong>2,069 adults aged≥70 years in Germany.</p><p><strong>Exposure: </strong>Age and sex.</p><p><strong>Outcome: </strong>Suitability for living donation assessed by the absence of kidney-related exclusions for donation including albuminuria and low estimated glomerular filtration rate (eGFR) as well as absence of other medical exclusions. Willingness for living and deceased kidney donation assessed by participant survey.</p><p><strong>Analytical approach: </strong>Descriptive analysis.</p><p><strong>Results: </strong>Among the 2,069 participants (median age 80 years, 53% women, median eGFR 63mL/min/1.73m²), 93% had≥1 medical contraindication for living donation at study entry unrelated to eGFR or albuminuria. Using 2 published eGFR and albuminuria thresholds for donor acceptance, 38% to 54% of participants had kidney-related exclusions for donation. Among the 5% to 6% of participants with neither medical nor kidney-related exclusions for living donation at baseline, 11% to 12% remained suitable for donation during 8 years of follow-up. Willingness for living or deceased donation was high (73% and 60%, respectively).</p><p><strong>Limitations: </strong>GFR was not measured, and medical exclusions unrelated to eGFR and albuminuria were assessed using a cohort database complemented by claims data.</p><p><strong>Conclusions: </strong>One in 20 older adults were potentially suitable for living kidney donation, and willingness for living donation was high. Further studies are warranted to define the feasibility of expanding living kidney donation among older adults.</p><p><strong>Plain-language summary: </strong>Although potentially beneficial, kidney transplantation remains infrequent among older adults aged≥70 years with kidney failure. Study evaluated the potential to increase living kidney donation among older adults, including their medical suitability as well as willingness to donate. Among 2,069 community-dwelling older adults (median age 80 years), 5% to 6% had no exclusion to donation. Among these individuals, 11% to 12% remained suitable for donation during 8 years of follow-up. Most exclusions were not related to eGFR and albuminuria. Willingness to living donation was high (73%). These findings highlight the potential benefits from expanding the pool of transplantable kidneys through the use of living donation in older adults.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"205-214.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Herbal Supplementation in Kidney Disease Ever Allowable?","authors":"Chia-Ter Chao","doi":"10.1053/j.ajkd.2024.05.019","DOIUrl":"10.1053/j.ajkd.2024.05.019","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"A11"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging the End-Stage Renal Disease Patient Life Goals Survey (PaLS) to Improve Quality of Care: Avoiding a \"Checkbox Measure\".","authors":"Samantha L Gelfand, Joshua R Lakin, Mallika L Mendu","doi":"10.1053/j.ajkd.2024.07.008","DOIUrl":"10.1053/j.ajkd.2024.07.008","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":"177-181"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}