Anesthesia & Analgesia最新文献

{"title":"Multimodal Machine Learning Model Predicting Postoperative Delirium Based on Heart Rate Variability: A Prospective Observational Study.","authors":"Yuling Tang,Yuanhui Liu,Jiayi Tang,Yu Wang,Qing Zhong,Pengfei Li,Xiaoxia Duan","doi":"10.1213/ane.0000000000008199","DOIUrl":"https://doi.org/10.1213/ane.0000000000008199","url":null,"abstract":"BACKGROUNDPostoperative delirium is a common and serious complication after general anesthesia; its accurate prediction remains a substantial challenge in perioperative medicine. Existing models primarily rely on clinical variables and may have limited predictive accuracy. This study aimed to evaluate the added value of heart rate variability parameters in predicting postoperative delirium and construct an interpretable multimodal predictive model.METHODSIn this prospective observational study, 1418 patients undergoing general anesthesia were included. Seventy-three features, including electrocardiogram abnormalities and heart rate variability time-, frequency-, and nonlinear-domain indicators, were extracted from electrocardiogram data. Postoperative delirium was assessed using the Chinese version of the 3-Minute Diagnostic Interview for Delirium within 3 days postoperatively. Feature selection was conducted by combining least absolute shrinkage and selection operator (LASSO) regression, the Boruta algorithm, and random forests, and 10 machine learning models were developed. Model performance was evaluated through receiver operating characteristic curves and decision curve analysis, with interpretability assessed via Shapley additive explanations. Clinical prediction tools were derived from key features. We used an external validation set to further evaluate the generalization ability of the models.RESULTSPostoperative delirium occurred in 255 (18%) patients. Seventeen key predictors were identified in total. The combined clinical-electrocardiogram-heart rate variability model demonstrated the highest predictive performance (area under the curve = 0.728), outperforming clinical-only (area under the curve = 0.673) and electrocardiogram-only models (area under the curve = 0.679). Logistic regression showed the highest discrimination. In the external validation set, the model maintained robust performance with an area under the curve value of 0.836. Shapley additive explanations highlighted seven core predictors: atrial or ventricular arrhythmia, operative time, ST-segment abnormalities, age, American Society of Anesthesiologists classification, heart rate variability entropy, and overall electrocardiogram abnormalities. A nomogram and online platform enabled personalized risk assessment.CONCLUSIONSOur results indicate that integrating heart rate variability with clinical and electrocardiogram features significantly enhances the personalized predictive efficacy of postoperative delirium.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432849","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":"Manual versus Automatic Perioperative QTc Interval Assessment: A Prospective Observational Investigation.","authors":"Vijay K Ramaiah,Evan D Kharasch","doi":"10.1213/ane.0000000000008226","DOIUrl":"https://doi.org/10.1213/ane.0000000000008226","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415999","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":"Brain Sex Steroid-Mediated Intergenerational Sex-Specific Neurocognitive Effects of Paternal Sevoflurane Exposure in Rats.","authors":"Ling-Sha Ju,Zeeshan A Khan,Nikolaus Gravenstein,Barry Setlow,Anatoly E Martynyuk","doi":"10.1213/ane.0000000000008197","DOIUrl":"https://doi.org/10.1213/ane.0000000000008197","url":null,"abstract":"BACKGROUNDThe biological basis for the male-biased prevalence of many neurodevelopmental disorders remains poorly understood. We found that preconception exposure of male rats to sevoflurane induces persistent dysregulation of stress and inflammatory signaling, while their offspring, almost exclusively males, develop neurobehavioral abnormalities. These effects in both generations are prevented by paternal pretreatment with either the Na+/K+/2Cl- cotransporter inhibitor bumetanide or the glucocorticoid receptor antagonist RU486. Using offspring from the same treatment groups, we tested the hypothesis that dysregulation of male-specific, sex hormone-dependent brain masculinization processes during the perinatal critical period contributes to the observed male-biased abnormalities.METHODSSprague-Dawley F0 males were exposed to 2.1% sevoflurane for 3 hours on postnatal days (P) 56, 58, and 60. Subsets received bumetanide or RU486 30 minutes before each exposure. On P90, F0 males were mated to generate F1 offspring. On P0-P1, F1 males of sevoflurane-exposed sires received the androgen receptor (AR) antagonist flutamide, the estradiol (E2) synthesis inhibitor formestane, the estrogen receptor α (ERα) antagonist 1,3-Bis(4-hydroxyphenyl)-4-methyl-5-[4-(2-piperidinylethoxy)phenol]-1H-pyrazole dihydrochloride (MPP), or the estrogen receptor β (ERβ) antagonist 4-[2-Phenyl-5,7-bis(trifluoromethyl)pyrazolo[1,5-a]pyrimidin-3-yl]phenol (PHTPP) (n = 18/group). Sex steroid concentrations and hippocampal mRNA expression of enzymes and receptors involved in brain masculinization were measured in P0 F1 males from control sires (F1M_C), sevoflurane-exposed sires (F1M_S), or sires pretreated with bumetanide (F1M_BS) or RU486 (F1M_RS) (n = 6-8/group). Behavioral and stress-responsivity outcomes were assessed in adulthood.RESULTSCompared with F1M_C, P0 F1M_S exhibited increased hippocampal testosterone (mean ± standard error of the mean [SEM]: 1.979 ± 0.527 vs 0.524 ± 0.122 ng/mg; P = .008) and E2 levels (10.997 ± 3.756 vs 2.793 ± 0.719 ng/mg; P = .027). Hippocampal mRNA expression of the testosterone-synthesizing enzyme 17β-hydroxysteroid dehydrogenase (1.629 ± 0.135 vs 1.000 ± 0.066; P = .001) and the E2-synthesizing enzyme aromatase (1.617 ± 0.093 vs 1.000 ± 0.070; P = .001) was also increased. In contrast, serum testosterone levels and hippocampal Ar, Erα, and Erβ mRNA expression were unchanged. F1M_BS and F1M_RS did not differ from F1M_C in any of these measures. Perinatal flutamide treatment reduced stress and neuroinflammatory markers and improved sociability, anxiety-like behavior, sensorimotor gating, and spatial memory in adulthood. Formestane normalized inflammatory and behavioral abnormalities; MPP improved sociability and spatial memory; and PHTPP improved spatial memory only.CONCLUSIONSThese findings suggest that male-specific neurodevelopmental abnormalities following paternal preconception sevoflurane exposure arise from stress- and inflammation-program","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416003","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":"Prehospital Pain Management in Trauma Treated by Helicopter Emergency Medical Services: Association of Patient and Physician Sex.","authors":"Benedick Satari,Julian Klug,Janine Uhr,Roland Albrecht,Alexander Fuchs,Urs Pietsch","doi":"10.1213/ane.0000000000008164","DOIUrl":"https://doi.org/10.1213/ane.0000000000008164","url":null,"abstract":"BACKGROUNDPain in trauma patients is frequent and associated with adverse physiological and psychological outcomes. Despite the recognized importance of early and effective analgesia, prehospital pain management remains insufficient in a substantial proportion of cases. Emerging evidence suggests sex-related differences in analgesic treatment, with both patient and physician sex potentially influencing therapy. This study investigates whether specific physician-patient sex pairings, alongside clinical and operational factors, are associated with the efficacy of prehospital pain management and explores how these factors interrelate to contribute to inadequate analgesia.METHODSWe conducted an observational cohort study of trauma patients treated by a Swiss physician-staffed Helicopter Emergency Medical Service between September 7, 2020, and July 24, 2025. We included patients with a Glasgow Coma Scale (GCS) ≥13, a National Advisory Committee for Aeronautics (NACA) Score <VI, on-scene pain of ≥3 on a patient-reported numeric rating scale (NRS), and a second pain assessment at hospital arrival. Patient and physician demographics, injury characteristics, and pain management were extracted. The primary outcome was sufficient pain management at hospital arrival, defined as NRS ≤3 at hospital arrival. Analgesic administration was evaluated for associations with insufficient pain control (NRS >3), persistent untreated pain, and pain reduction.RESULTSOf the 43,024 prehospital missions analyzed, 5168 met the inclusion criteria. The cohort was predominantly male (3097/5168; 59.9%); the median age was 47 [29-62] years. Extremity trauma was most common (3514/5168; 68%). In 32.2% (1663/5168; 95% confidence interval [CI], 30.9-33.3) of cases, analgesia was insufficient. While male physicians achieved greater NRS reduction (Coef. 0.20; 95% CI, 0.12-0.28), male patients reported less pain relief (Coef. -0.13; 95% CI, -0.21 to -0.05). Higher initial NRS scores (odds ratio [OR] = 1.45; 95% CI, 1.39-1.51) and omission of analgesics (OR = 5.70; 95% CI, 4.54-7.15) were associated with insufficient analgesia. The use of a combination of opioid and ketamine was associated with improved analgesia (OR = 0.69; 95% CI, 0.58-0.83). The greatest pain reduction was observed with ketamine or combination therapy. The median ΔNRS was 5 (interquartile range [IQR] 3-6) for ketamine and 5 (IQR 4-6) for combination therapy.CONCLUSIONSIn this large cohort, we found sex-related differences in patient-reported analgesia: male patients were more likely than female patients to report insufficient analgesia. Treatment by male physicians was associated with better patient-reported analgesia. Ketamine and its combination with opioids were associated with greater patient-reported NRS reduction compared to opioid monotherapy in a prehospital setting.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416005","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":"An Analysis of Quality Assurance Events in Nonoperating Room Anesthetizing Locations: A Qualitative Retrospective Cohort Study.","authors":"Anastasia P Piersa,A Taylor Thomas,Richard D Urman,Marc Philip T Pimentel,Rafael Vazquez","doi":"10.1213/ane.0000000000008187","DOIUrl":"https://doi.org/10.1213/ane.0000000000008187","url":null,"abstract":"BACKGROUNDNonoperating room anesthesia (NORA) poses unique challenges to the anesthesia clinician, yet existing evidence on patient safety in NORA is limited. The aim of this study was to characterize NORA quality assurance (QA) events at a large academic health system based on a validated qualitative framework to provide insights and suggest potential safety interventions.METHODSThis two-center qualitative retrospective cohort study included all adult NORA cases performed between August 1, 2018, and December 31, 2022. QA event reporting was mandatory for every anesthetic during the study. The analyzed dataset included anesthesia clinician QA event reports associated with an optional free response comment, and each comment was coded using both deductive and inductive approaches in parallel. Each QA event was categorized in an inductive fashion, and the System Engineering Initiative for Patient Safety (SEIPS) framework was used to categorize event descriptions deductively. Emerging categories and representative scenarios were summarized.RESULTSA total of 497,175 cases were performed during the study period, of which 106,476 (21.4%) were performed in NORA locations. After applying exclusion criteria, 984 QA report free-response comments were analyzed. Diverse subcategories emerged among the QA event categories (eg, employee safety concerns, patient positioning issues, unclear protocols). Some of the commonly identified SEIPS categories were \"Organization\" and \"Tools and technology.\" From deductive and inductive analyses, challenges with teamwork, communication, care processes, variability in access to equipment, and equipment malfunctions were identified in the NORA setting. In addition to patient outcomes, negative organizational and employee outcomes were described on account of NORA-specific complexities.CONCLUSIONSThis large qualitative study characterized NORA QA events across multiple dimensions. Our findings highlight that QA events in NORA are complex and often due to a combination of factors, underscoring both clinical and systems-level vulnerabilities. These findings may provide a framework for targeted quality improvement interventions.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388600","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":"Operating Room Energy Usage Assessment at a Tertiary Academic Medical Center in the United States.","authors":"Evan M Chen,Kaiyi Wang,Jacob Huth,Anna Levitt,Alexander L Clarke,Seema Gandhi","doi":"10.1213/ane.0000000000008200","DOIUrl":"https://doi.org/10.1213/ane.0000000000008200","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393596","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":"Advancing Perioperative Medication Safety: Consensus Recommendations From the 2024 Anesthesia Patient Safety Foundation Stoelting Conference.","authors":"Aubrey Samost-Williams,Elizabeth Rebello,Patricia Meyer,Arnoley Abcejo,Emily Methangkool,Dan Lovinaria,Ken B Johnson,Daniel J Cole","doi":"10.1213/ane.0000000000008203","DOIUrl":"https://doi.org/10.1213/ane.0000000000008203","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388602","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":"Patient Beliefs and Experiences of Adhering to Medical Therapies for Cardiovascular Comorbidities, Before Noncardiac Elective Surgery in South Africa: A Mixed-Methods Study.","authors":"Oluwanilo Awoloto,Hilary L Bekker,Christella Alphonsus,Simphiwe Gumede,Khulile Singata,Elzanne Jansen van Rensburg,Simon J Howell,Bruce Biccard","doi":"10.1213/ane.0000000000008110","DOIUrl":"https://doi.org/10.1213/ane.0000000000008110","url":null,"abstract":"BACKGROUNDCardiovascular comorbidities increase perioperative risk in patients undergoing noncardiac surgery. Optimizing medication adherence in this population is critical; yet adherence remains low in many low- and middle-income countries (LMICs), where health beliefs, systemic barriers, and healthcare communication bring significant challenges. This study aimed to explore the acceptability of validated patient-reported questionnaires and to investigate the beliefs and experiences influencing adherence to cardiovascular medication before surgery in a South African tertiary hospital.METHODSA mixed-methods study was conducted using semistructured interviews with 21 patients taking cardiovascular medication before vascular surgery. Participants completed four validated self-report questionnaires: Brief Illness Perception Questionnaire (BIPQ), Beliefs about Medicines Questionnaire (BMQ), SHARED decision-making questionnaire, and SURE decisional conflict scale. Questionnaire responses were summarized with descriptive statistics. Thematic analysis of interview data was conducted using Braun and Clarke's six-step framework.RESULTSMost participants perceived their illness as chronic (15/20, 75%) and their treatment as effective (18/21, 86%), yet 15 of 21 (71%) reported high concern and 9 of 21 (43%) reported emotional distress. Belief in the need for medication was strong (21/21, 100%), but 14 of 21 (67%) worried about long-term side effects and 10 of 21 (47%) described their medication as a \"mystery.\" Shared decision-making appeared limited: only 7 of 21 (33%) recalled being asked for their views. Thematic analysis revealed seven major themes: understanding illness and treatment, health professional interactions, service access, social support, individual factors, routines, and habits.CONCLUSIONSPatient-reported tools were acceptable and highlighted complex, interrelated factors associated with adherence. Integrating these tools into preoperative care may help identify at-risk patients and support person-centered perioperative planning in LMICs.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365583","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":"Impact of Epidural-Related Maternal Fever on Neonatal Outcomes: A Single-Center Retrospective Case-Control Study Excluding Confirmed Histological Chorioamnionitis.","authors":"Yu Yamazaki,Shunsuke Hyuga,Hitoshi Isohata,Hiroyuki Goto,Yoshihiro Yoshimura,Kyoko Hattori,Takao Shimaoka,Hiroaki Kondo,Tomoe Fujita,Jun Oikawa,Yoko Onishi,Daigo Ochiai","doi":"10.1213/ane.0000000000008176","DOIUrl":"https://doi.org/10.1213/ane.0000000000008176","url":null,"abstract":"BACKGROUNDMaternal fever during labor analgesia may arise from infectious causes (such as chorioamnionitis) or noninfectious causes (such as epidural-related maternal fever [ERMF]). While chorioamnionitis is associated with neonatal outcomes, the impact of isolated ERMF remains controversial. This is due, in part, to the potential for occult intrauterine infection, which may not be clinically apparent during labor. Consequently, inadequate consideration of histological chorioamnionitis has limited the scope and validity of previous studies. This study aimed to evaluate the effects of ERMF on neonatal outcomes by excluding confirmed histological chorioamnionitis and minimizing suspected infection using predefined clinical criteria.METHODSThis retrospective study included women with singleton term deliveries under labor analgesia between January 2017 and July 2023. Cases with fetal anomalies or growth restriction were excluded. Placental pathological examination was performed when any of the predefined risk-based criteria were met, irrespective of maternal fever: clinical suspicion of chorioamnionitis, prolonged rupture of membranes, and neonatal asphyxia. Among febrile cases, short-term neonatal outcomes were first compared between those with and without histological chorioamnionitis. Subsequently, outcomes were compared between mothers with intrapartum fever (≥38 °C) and those without fever using propensity score matching. Long-term infant development was assessed using a Maternal and Child Health Handbook-based questionnaire.RESULTSOverall, 186 matched pairs were included. All matched covariate standardized mean differences were <0.1, confirming acceptable balance. Compared with the nonfever group, the fever group had longer mean ± standard deviation durations from rupture of membranes to delivery (12.9 ± 9.4 vs 8.7 ± 10.9 hours; difference 4.2 hours; 95% confidence interval [CI], 2.17-6.33), first stage of labor (13.2 ± 6.7 vs 9.6 ± 6.3 hours; difference 3.6 hours; 95% CI, 2.32-4.99), and duration of labor analgesia (14.9 ± 9.6 vs 8.6 ± 6.7 hours; difference 6.3 hours; 95% CI, 4.62-8.01), along with a higher incidence of fetal tachycardia (36.0 vs 10.7%; absolute risk difference 25.3%; 95% CI, 12.3-37.2). In contrast, maternal fever was not associated with adverse neonatal outcomes, including umbilical artery pH <7.2, Apgar score <7 at 1 and 5 minutes, or neonatal intensive care unit admission. Growth and developmental milestones assessed at long-term follow-up using the Maternal and Child Health Handbook questionnaire were within the normal range in both groups.CONCLUSIONSFollowing exclusion of histological chorioamnionitis, ERMF was associated with prolonged labor and fetal tachycardia but was not associated with adverse short-term neonatal outcomes or impaired long-term development.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365582","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 Administrative Indices: Allostatic Load and Autonomic Dyshomeostasis as Biological Mediators of Intraoperative Cardiac Arrest.","authors":"Yi Shen,Weiqin Huang","doi":"10.1213/ane.0000000000008204","DOIUrl":"https://doi.org/10.1213/ane.0000000000008204","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365605","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}