Anesthesia & Analgesia最新文献

{"title":"Loss and Return of Sensation After Axillary Brachial Plexus Nerve Block: Distally or Proximally?","authors":"Hagen Bomberg,David Lorenzana,Neeti Sharma,Corsin Poltera,Urs Eichenberger","doi":"10.1213/ane.0000000000008175","DOIUrl":"https://doi.org/10.1213/ane.0000000000008175","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552643","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":"Bleeding Disorders Among Tonsillectomy Patients: Prevalence, Hemostatic Agent Use, and Sex-Related Differences.","authors":"Anna L Miller,Amir L Butt,Kenichi A Tanaka,Kenneth E Stewart","doi":"10.1213/ane.0000000000008233","DOIUrl":"https://doi.org/10.1213/ane.0000000000008233","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552680","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":"Making the Surgical Safety Checklist Even Safer: A Team Timeout Checklist to Improve Information Exchange and Interprofessional Communication Before Skin Incision.","authors":"Mona Weiss,Claudius Reimer,Alexander Budnitskiy,Christian Kleber,Sebastian N Stehr,Tobias Piegeler","doi":"10.1213/ane.0000000000008224","DOIUrl":"https://doi.org/10.1213/ane.0000000000008224","url":null,"abstract":"BACKGROUNDThe World Health Organization surgical safety checklist (WHO SSC) provides a standardized framework for preoperative safety procedures. However, studies have revealed substantial variation in adherence, with items being skipped or misunderstood and nurses likely to be less involved than other operating room (OR) professional groups. We introduce a 16-item team timeout checklist (TTOC) that clarifies and adds safety-critical items to the existing WHO before skin incision timeout and is led by nurses to improve information exchange, closed-loop communication, and encouraging participation of all professional groups.METHODSUsing a prospective pre-post interventional design, we live-coded all team communication during on-site observations in the OR focusing on the pre-incision phase. Surgical teams were first observed during a pre-intervention period without the TTOC checklist and subsequently during a post-intervention period after implementation of the TTOC checklist. The TTOC was evaluated on four communication outcomes critical for patient safety: information exchange of checklist items, measured as the percentage of the 16 items that were verbally communicated among team members (eg, team introduction, surgical site, allergies), participation rates of different professional groups, frequency of explicit coordination behaviors (eg, instruction, information request, speaking up) and the frequency of closed-loop communication sequences, defined as information request followed by information upon request within 30 seconds.RESULTSA total of 155 teams were observed, including 78 teams in the pre-intervention phase without TTOC use and 77 teams in the post-intervention phase using the TTOC, resulting in 13,127 coded communication events. The median information exchange increased from 62.5% (interquartile range [IQR] 50-68.8) in the pre-intervention phase to 100% (IQR 100-100) in the post-intervention phase (P < .001). For 15 of all 16 subitems, the odds of exchanging information were significantly higher after TTOC implementation than before TTOC implementation (odds ratios range 10.8-1896, all 95% confidence intervals [CIs] excluded 1). Participation rates increased for circulating nurses, scrub nurses, surgical residents, and anesthesia (all P < .05) but not for lead surgeons. Mean (standard deviation [SD]) closed-loop communication patterns per operation were more frequent with (20.4 [10.7]) than without the TTOC (16.4, [7.24]), P = .004.CONCLUSIONSIn our study, the nurse-led TTOC significantly improved the exchange of safety-critical items during the pre-incision phase, facilitated closed-loop communication, and empowered the participation of various professional groups. These findings suggest integrating the TTOC with the WHO SSC before-incision protocol may have important advantages.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552642","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":"Sonorheometry Quantra QPlus Characteristics in Adult Cardiac Surgical Patients: An Observational Cohort Study.","authors":"Ziyad O Knio,Charbel A Marche,Jenna Khan,John S McNeil,Karen E Singh,Michael A Mazzeffi","doi":"10.1213/ane.0000000000008139","DOIUrl":"https://doi.org/10.1213/ane.0000000000008139","url":null,"abstract":"BACKGROUNDValidation of the Quantra QPlus sonorheometry cartridge (Hemosonics Corporation) in cardiac surgical patients is limited. The primary aim of our study was to quantify the accuracy of the Quantra QPlus cartridge in detecting derangements in traditional coagulation tests. Secondarily, we explored whether the relationship between platelet contribution to clot stiffness (PCS) and platelet count was modified by cardiopulmonary bypass (CPB) and hypofibrinogenemia.METHODSWe performed a retrospective observational study of 511 cardiac surgical patients at a single academic medical center during the first year of routine sonorheometry application during and after cardiac surgery (2024-2025). Receiver operating characteristics were applied to the following Quantra QPlus parameters, with paired reference laboratory assays sampled in a 15-minute interval: clot time heparinase (CTH), fibrinogen contribution to clot stiffness (FCS), and PCS. A multivariable linear regression model was used to determine whether the relationship between PCS and platelet count was modified by CPB or hypofibrinogenemia.RESULTSA CTH value of 153 seconds discriminated elevated international normalized ratio (INR) values post-CPB, with an area under the curve (AUC) from 0.78 to 0.84 depending on the INR cutoff. An FCS of 1.5 to 2.3 hPa discriminated hypofibrinogenemia post-CPB with an AUC from 0.88 to 0.97 depending on the fibrinogen cutoff. A PCS of 6.9 to 12.2 hPa detected thrombocytopenia post-CPB with an AUC from 0.90 to 0.97, depending on the platelet cutoff. In contrast, a PCS of 9.1 to 12.1 hPa detected the same degree of thrombocytopenia on-CPB with an AUC of 0.92 to 0.98. Platelet count was observed to be higher for a given PCS during CPB (β, 1.51) and in hypofibrinogenemic states (β, 3.13 and 4.04 for FCS 1.6-2.3 hPa and ≤1.5 hPa, respectively).CONCLUSIONSCTH, PCS, and FCS demonstrated high discriminative accuracy for abnormalities in corresponding laboratory assays. CPB and hypofibrinogenemia modified the relationship between PCS and platelet count, with a higher platelet count observed for a given PCS during CPB and when fibrinogen was low.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552400","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":"Trends and Variations in Tracheal Intubation for Acute Respiration Failure in Critically Ill Patients in the United States.","authors":"Kunal Karamchandani,Alex Iancau,Eric B Rosero","doi":"10.1213/ane.0000000000008154","DOIUrl":"https://doi.org/10.1213/ane.0000000000008154","url":null,"abstract":"BACKGROUNDAcute respiratory failure (ARF) is a common indication for tracheal intubation in critically ill patients. This study sought to describe temporal trends and hospital variation in tracheal intubation among patients with ARF, identify factors associated with its use, and examine the relationship between tracheal intubation and hospital mortality.METHODSWe performed an observational cohort study of adult hospitalizations (2016-2019) for ARF using the National Inpatient Sample. We identified critically ill patients with ARF who required tracheal intubation and assessed outcomes, temporal trends in the incidence, and associated patient and hospital characteristics. Multivariable logistic regression was used to examine factors associated with the performance of tracheal intubation and to characterize the association between mortality and intubation status while controlling for type of respiratory failure, demographics, and patient comorbidities.RESULTSA total of 2017,349 admissions with a diagnosis of ARF were identified, representing 10,086,744 (95% confidence interval [CI], 9957,967-10,215,520) cases nationwide. Of those, 2153,460 (21.3%) required tracheal intubation. Intubated patients were more likely to be nonwhite men, have a higher comorbidity burden, be insured by Medicaid, and be hospitalized in large urban, teaching hospitals. Although ARF cases increased from 1872,519 in 2016 to 3194,075 in 2019, the proportion of patients undergoing tracheal intubation declined from 23.8% to 19.8% during the same period (P < .0001). Mortality rates were higher in intubated than in nonintubated patients (P < 001). Mortality remained stable in intubated patients (30.6% [95% CI, 30.2-31.1] in 2016, versus 31.0% [95% CI, 30.5-31.4] in 2019) but decreased in nonintubated patients during the same time period (8.1% [95% CI, 7.9-8.3] versus 6.6% [95% CI, 6.5-6.8]). 10.5% of the variability in intubation rates was attributable to the admitting hospital, and sepsis was the patient factor most strongly associated with tracheal intubation.CONCLUSIONSIn the National Inpatient Sample, tracheal intubation in critically ill patients with ARF has declined over time with no change in mortality. In the same period, mortality rates in nonintubated patients have fallen. Further work is needed to better understand factors affecting the decision to intubate for respiratory failure in critically ill patients.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552679","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 Retrospective Propensity-Matched Cohort Study of Intravenous Versus Oral Iron Formulations for Management of Iron Deficiency Anemia in Pregnancy.","authors":"Una E Choi,Ryan C Nicholson,Katherine E Economy,Steven M Frank,Jean M Connors,David L Hepner","doi":"10.1213/ane.0000000000008229","DOIUrl":"https://doi.org/10.1213/ane.0000000000008229","url":null,"abstract":"BACKGROUNDAnemia in pregnancy detrimentally impacts maternal and fetal health. Previous research has demonstrated faster and more robust hemoglobin (Hb) increases with intravenous (IV) iron when compared to oral iron. We aimed to characterize additional clinical impacts of IV iron and, by exploring multiple iron formulations, this study seeks to provide a comprehensive analysis of the effects, safety, and patient response to both treatment options.METHODSA retrospective propensity-matched cohort analysis was performed using a large database (TriNetX Research Network) from January 2000 to November 2025. We identified pregnant patients aged ≥18 years with iron deficiency anemia (IDA) in the second trimester with ferritin <30 ng/mL and hemoglobin <11 g/dL, constructing two cohorts: (1) patients treated with IV iron and (2) patients treated with oral iron within 2 months of their anemia diagnosis. Propensity score matching was performed by age, demographics, overweight and obesity, type 2 diabetes, lipid disorders, hypertension, heart failure, chronic ischemic heart disease, hypothyroidism, chronic kidney disease, gastro-esophageal reflux disease, high-risk pregnancy, neoplasms, nicotine dependence, alcohol use disorder, other substance use disorder, and pretreatment Hb grouped by <6.5 g/dL, 6.5 to 7.9 g/dL, 8 to 9.9 g/dL, and 10 to 10.9 g/dL. Primary outcomes were blood transfusions, maternal mortality, preeclampsia, cesarean section (CS), and preterm labor. Secondary outcomes were an adverse outcome composite (gastritis,nausea/vomiting or anaphylactic shock), Hb, and ferritin in the 3 months after treatment. Subgroup analysis of IV iron users (excluding iron sucrose) versus oral iron users was performed.RESULTSThere were 1693 postmatch patients per cohort. IV iron was associated with lower risk for preterm labor (7.7% vs 10.04%, risk ratio [RR] 0.77 [0.62-0.96]) and CS (18.67% vs 22.15%, RR 0.84 [0.74-0.96]) and higher posttreatment Hb (10.6 vs 9.7, adj. P = .0001) and ferritin (138 vs 39, adj. P = .0001). There was no difference in other outcome measures. There were 914 postmatch patients per cohort in the subgroup analysis. IV iron (excluding iron sucrose) was again associated with decreased risk of preterm labor (5.25% vs 9.30%, RR 0.57 [0.40-0.80]), higher Hb (10.7 vs 9.8, adj. P = .0001) and ferritin (175 vs 42, adj. P = .0001). All other outcomes were not significant.CONCLUSIONSThis study evaluates the differential effects of IV compared with oral iron formulations in a large cohort of matched pregnant patients. Compared to oral iron, IV iron may be preferable for increasing Hb, resolving IDA, and reducing maternal complications.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552681","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":"Repurposing the Transcranial Doppler Probe for Precordial Detection of Venous Air Embolism in Craniosynostosis Surgery: A Novel Rescue Technique.","authors":"Deep Sengupta,Subodh Raju","doi":"10.1213/ane.0000000000008183","DOIUrl":"https://doi.org/10.1213/ane.0000000000008183","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462323","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":"Sex-Specific Nonlinear Association Between Preoperative Hemoglobin and Intraoperative Oxygen Desaturation in High-Altitude Surgical Patients: A Retrospective Observational Study.","authors":"Qi Yan,Yuanbin Xu,Yimei Guo,Ronghui Li,Dawa Puzhen,Yiting Mao,Laba Ciren,Yi Feng","doi":"10.1213/ane.0000000000008115","DOIUrl":"https://doi.org/10.1213/ane.0000000000008115","url":null,"abstract":"BACKGROUNDHigh hemoglobin concentration is a compensatory adaptation to high-altitude hypoxia that theoretically increases oxygen-carrying capacity. However, the associated rise in blood viscosity may compromise microcirculatory flow and contribute to intrapulmonary shunting during anesthesia. This study investigates sex-specific associations between preoperative hemoglobin concentrations and intraoperative oxygen desaturation events in surgical patients residing at high altitude.METHODSIn this retrospective study, we analyzed data from 8010 high-altitude residents undergoing general anesthesia for noncardiothoracic surgery at People's Hospital of Xizang Autonomous Region between January 2020 and October 2024. The dataset comprised preoperative baseline characteristics, information related to surgery and anesthesia. The primary outcome was intraoperative oxygen desaturation, defined as a peripheral oxygen saturation (Spo2 <90% lasting for ≥1 minute) measured by pulse oximetry in patients receiving mechanical ventilation during general anesthesia. Patients were stratified by sex: male (n = 3622) and female (n = 4388). Nonlinear associations were analyzed using multivariable-adjusted restricted cubic splines, and piecewise logistic regression was used to identify hemoglobin thresholds.RESULTSNonlinear associations between preoperative hemoglobin concentrations and intraoperative oxygen desaturation were observed in both sexes. For males, piecewise regression identified a statistical inflection point at 20.6 g/dL (adjusted odds ratio [adjOR] per 1 g/dL increase, 1.50; 95% confidence interval [CI], 1.18-1.92; P = .001). For females, the threshold was notably lower at 14.9 g/dL, above which the risk significantly increased (adjOR per 1 g/dL increase, 1.33; 95% CI, 1.13-1.58; P < .001). However, for males, a clinically significant risk increase was observed starting at 18.0 g/dL (adjOR per 1 g/dL increase, 1.23; 95% CI, 1.05-1.45; P = .012). Sensitivity analyses validated these findings across different definitions of desaturation and imputation methods.CONCLUSIONSIn high-altitude surgical patients receiving mechanical ventilation during general anesthesia, we identified sex-specific hemoglobin thresholds associated with intraoperative oxygen desaturation. While statistical inflection points occur at higher levels, particularly in males, our data suggest that clinical caution is advised when hemoglobin exceeds 18.0 g/dL in males and 14.9 g/dL in females. These findings underscore the rheological risks of higher hemoglobin concentrations and support the adoption of sex-stratified preoperative assessment protocols to optimize perioperative oxygen delivery.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462325","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":"Beyond Hemoglobin: The Clinical Imperative for Managing Nonanemic Iron Deficiency in Perioperative Care-A Perspective.","authors":"Manuel Muñoz,Ioav Cabantchik,Rodolfo D Cançado,Caroline Evans,Domenico Girelli,Vernon Louw,Patrick Meybohm,Sherri Ozawa,Joshua Ozawa-Morriello,Dorine W Swinkels,Donat R Spahn,Aryeh Shander","doi":"10.1213/ane.0000000000008217","DOIUrl":"https://doi.org/10.1213/ane.0000000000008217","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462285","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":"Predicting Fluid Responsiveness in Mechanically Ventilated Adults: An Umbrella Review of Diagnostic Accuracy Meta-Analyses.","authors":"Massimo Meco,Enrico Giustiniano,Fulvio Nisi,Pierluigi Zulli,Emiliano Agosteo","doi":"10.1213/ane.0000000000008215","DOIUrl":"https://doi.org/10.1213/ane.0000000000008215","url":null,"abstract":"BACKGROUNDDynamic indices and maneuvers are widely used to predict fluid responsiveness in mechanically ventilated patients, yet their relative performance remains uncertain.METHODSWe conducted an umbrella review of diagnostic accuracy meta-analyses published up to August 2025. Eligible reviews evaluated pulse pressure variation (PPV), stroke volume variation (SVV), passive leg raising (PLR), end-expiratory occlusion test (EEOT), tidal volume challenge (TVC), pleth variability index (PVI), or respiratory variation in inferior vena cava diameter (ΔIVC) in mechanically ventilated adults. Redundancy across reviews was assessed using the Corrected Covered Area (CCA), with pairwise overlap explored using Jaccard coefficients. The primary umbrella-level comparative metric was pooled area under the receiver operating characteristic curve (AUC) as reported by the included meta-analyses. Pooled sensitivity, specificity, and hierarchical ROC information were extracted when available. Secondary analyses included cumulative meta-analysis, subgroup and meta-regression analyses, prediction intervals, and assessment of small-study effects/publication bias.RESULTSSeven meta-analyses were included, synthesizing 123 primary diagnostic studies and 10,300 patients. Global CCA was approximately 5.5% to 5.6%, consistent with borderline slight-to-moderate overlap across the included meta-analyses. TVC showed the highest comparative diagnostic performance (AUC 0.96, 95% CI, 0.94-0.97), followed by EEOT (AUC 0.95, 95% CI, 0.92-0.96). Passive leg raising (PLR) achieved good accuracy (AUC 0.91, 95% CI, 0.88-0.93), whereas pulse pressure variation (PPV) and stroke volume variation (SVV) showed only moderate performance (AUC 0.87-0.88). Pleth variability index (PVI) and inferior vena cava variation (ΔIVC) were the least reliable (AUC 0.82-0.83). Subgroup and moderator analyses indicated that tidal volume was the main effect modifier: TVC and EEOT remained comparatively robust.CONCLUSIONSAmong dynamic predictors of fluid responsiveness, TVC and EEOT appear to be the most accurate and robust indices. PLR retains intermediate utility, PPV and SVV show moderate reliability, whereas PVI and ΔIVC should not be used in isolation.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462286","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}