Archives of Academic Emergency Medicine最新文献

{"title":"Quality Indicators of Pediatric Asthma Care in the Emergency Department; a Systematic Review and Meta-Analysis.","authors":"Islam E Alkhazali, Ahmad Alrawashdeh, Mohd Hashairi Fauzi, Nik Hisamuddin Nik Ab Rahman","doi":"10.22037/aaem.v12i1.2214","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2214","url":null,"abstract":"<p><strong>Introduction: </strong>The quality of healthcare for pediatric asthma patients in the emergency department (ED) is of growing importance. This systematic review aimed to identify and describe existing quality indicators (QIs) designed for use in the ED for pediatric asthma care.</p><p><strong>Methods: </strong>We systematically searched three main electronic databases in May 2023 for all English-language qualitative and quantitative publications that suggested or described at least one QI related to pediatric asthma care in the ED. Two reviewers independently selected the included studies and extracted data on study characteristics, all relevant QIs reported, and the rates of compliance with these indicators when available. The identified QIs were classified according to Donabedian healthcare quality framework and the Institute of Medicine (IOM) framework. When feasible, we aggregated the compliance rates for the QIs reported in observational studies using random effects models. The quality assessment of the included studies was performed using various Joanna Briggs Institute (JBI) tools.</p><p><strong>Results: </strong>We identified twenty studies, including six expert panels, 13 observational studies, and one trial. Together, these studies presented 129 QIs for use in EDs managing pediatric asthma. Among these QIs, 66 were pinpointed by expert panel studies, whereas 63 were derived from observational studies. Within the Donabedian framework, most indicators (86.8%) concentrated on the process of care. In contrast, within the Institute of Medicine (IOM) domain, the predominant focus was on indicators related to effectiveness and safety. Observational studies reported varying compliance rates for the 36 QIs identified in the expert studies. The included studies showed a wide range of bias risks, suggesting potential methodological variances.</p><p><strong>Conclusions: </strong>A significant number of QIs in pediatric asthma care have been proposed or documented in literature. Although most of these indicators prioritize the process of care, there is a conspicuous absence of outcome and structure indicators. This meta-analysis uncovered significant disparities in compliance to the identified QIs, highlighting the urgent necessity for targeted interventions to enhance pediatric asthma care in ED.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e26"},"PeriodicalIF":5.4,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10988188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular Septal Defect and Mitral Regurgitation Due to Penetrating Cardiac Trauma; a Case Report and Review of Literature.","authors":"Hojjat Mortezaeian, Avisa Tabib, Hamidreza Pouraliakbar, Mohsen Anafje, Pouya Ebrahimi, Parnian Soltani","doi":"10.22037/aaem.v12i1.2267","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2267","url":null,"abstract":"<p><p>Penetrating cardiac trauma is a fatal condition and can result in the injury of various parts of the heart. Ventricular Septal Defect (VSD) following these traumas occurs only in 1-5% of cases. The patients' conditions depend on location, size, and concomitant injuries. One of the uncommon coincidences with the VSD is Mitral Regurgitation (MR) due to injury to sub-valvular structures. In this study, we report a case of concomitant traumatic-induced VSD and MR in a 14-year-old boy following a stab wound to his chest. The patient was a teenage boy coming to the Rajaei Cardiology Hospital emergency room following a stab wound to the anterior and left part of his chest. Despite primary urgent surgery, his breathlessness had continued for three more months. Evaluations with Transthoracic Echocardiography (TTE) revealed VSD with concomitant MR, but there was no papillary muscle rupture. Cardiac Magnetic Resonance Imaging (MRI) and angiographic evaluation confirmed the provisional diagnosis. The Amplatzer VSD occluder repaired the VSD, and the patient was discharged following the resolution of his symptoms. Although the MR has been present in the follow-up echocardiography, the patient has been asymptomatic. Since the initial presenting symptoms and signs of VSD and MR might be subtle or delayed, imaging modalities such as TTE and Transesophageal Echocardiogram (TEE) are beneficial in determining the diagnosis and the optimal treatment.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e25"},"PeriodicalIF":5.4,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10988181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned from COVID-19 Pandemic Management in Iran; a Commentary.","authors":"Reza Gharebaghi, Fatemeh Heidary, Ali Asghar Pourezzat","doi":"10.22037/aaem.v12i1.2241","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2241","url":null,"abstract":"","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e24"},"PeriodicalIF":5.4,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10988177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Optimizing the Functioning of Emergency Departments; a Systematic Review of Current Solutions.","authors":"Szymczyk Aleksandra, Krion Robert, Krzyzaniak Klaudia, Lubian Dawid, Sieminski Mariusz","doi":"10.22037/aaem.v12i1.2110","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2110","url":null,"abstract":"<p><strong>Introduction: </strong>The burgeoning burden on emergency departments is a global challenge that we have been confronting for many years. Emerging artificial intelligence (AI)-based solutions may constitute a critical component in the optimization of these units. This systematic review was conducted to thoroughly examine and summarize the currently available AI solutions, assess potential benefits from their implementation, and identify anticipated directions of further development in this fascinating and rapidly evolving field.</p><p><strong>Methods: </strong>This systematic review utilized data compiled from three key scientific databases: PubMed (2045 publications), Scopus (877 publications), and Web of Science (2495 publications). After meticulous removal of duplicates, we conducted a detailed analysis of 2052 articles, including 147 full-text papers. From these, we selected 51 of the most pertinent and representative publications for the review.</p><p><strong>Results: </strong>Overall the present research indicates that due to high accuracy and sensitivity of machine learning (ML) models it's reasonable to use AI in support of doctors as it can show them the potential diagnosis, which could save time and resources. However, AI-generated diagnoses should be verified by a doctor as AI is not infallible.</p><p><strong>Conclusions: </strong>Currently available AI algorithms are capable of analysing complex medical data with unprecedented precision and speed. Despite AI's vast potential, it is still a nascent technology that is often perceived as complicated and challenging to implement. We propose that a pivotal point in effectively harnessing this technology is the close collaboration between medical professionals and AI experts. Future research should focus on further refining AI algorithms, performing comprehensive validation, and introducing suitable legal regulations and standard procedures, thereby fully leveraging the potential of AI to enhance the quality and efficiency of healthcare delivery.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e22"},"PeriodicalIF":5.4,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10988184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Look at Archives of Academic Emergency Medicine Journal in 2023.","authors":"Mehrnoosh Yazdanbakhsh, Somayeh Saghaei Dehkordi","doi":"10.22037/aaem.v12i1.2250","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2250","url":null,"abstract":"","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e21"},"PeriodicalIF":5.4,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10988183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infected Ruptured Pseudo-aneurysm in Descending Aorta; a Case Report.","authors":"Morteza Sanei Taheri, Sayyed Mojtaba Nekooghadam, Zahra Sadat Tabatabaei, Sahar Rezaei","doi":"10.22037/aaem.v12i1.2203","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2203","url":null,"abstract":"<p><p>Aortitis is the inflammation of the aortic wall. It can be caused by both infectious and non-infectious etiologies. Mycotic aneurysm is a rare, serious medical condition and typically requires prompt treatment with antibiotics, surgical intervention, or endovascular procedures to prevent rupture and complications. Here we reported, a 66-year-old male patient with a medical history of diabetes and hypertension, who presented to the emergency department (ED) with left-sided hemiplegia. Brain magnetic resonance imaging (MRI) revealed infarction in the right parietooccipital and left occipital lobes, demonstrating an embolic pattern. laboratory analysis revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC). In order to investigate the possibility of sepsis, a non-contrast chest computed tomography (CT) scan was performed, which showed a soft tissue density surrounded by gas in the posterior mediastinum; for which the rupture of esophagus and infected aorta pseudoaneurysm were among differential diagnoses. To confirm the diagnosis, CT angiography was ordered. The infected ruptured pseudo-aneurysm(s) was confirmed and patient underwent thoracotomy surgery.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e23"},"PeriodicalIF":5.4,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10988175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carnitine in Alleviation of Complications Caused by Acute Valproic Acid Toxicity; an Exprimental Study on Mice.","authors":"Akram Jamshidzadeh, Reza Heidari, Mahdie Shams, Melika Ebrahimi-Sharghi, Sayed Mahdi Marashi","doi":"10.22037/aaem.v12i1.2146","DOIUrl":"10.22037/aaem.v12i1.2146","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperammonemia and hepatotoxicity are well-known complications of valproic acid (VPA) poisoning. The objective of this study is to evaluate the potential role of carnitine in mitigating the adverse effects of acute VPA toxicity in mice.</p><p><strong>Methods: </strong>54 male mice (25-30 g) were randomly assigned to one of three categories, including acute, sub-acute, and chronic poisoning. Each category contained 3 groups, each consisting of 6 mice (Group 1: control, Group 2: VPA treated, and Group 3: VPA + carnitine treated). The animals were sacrificed 24 hours after the initial injection, and their blood, liver, and brain samples were compared between groups of each category regarding liver function biomarkers, oxidative stress markers, ammonia level, and liver histopathologic changes using one-way ANOVA followed by Tukey's multiple comparison test.</p><p><strong>Results: </strong>The administration of VPA increased the serum level of aspartate aminotransferase (AST) (p=0.003) and alanine aminotransferase (ALT) (p=0.001), as well as serum, and brain level of ammonia (p=0.0001 for both) in the intervention group. Elevated levels of lipid peroxidation and oxidative stress (p=0.0001 for both) in the liver tissue, decreased liver glutathione (p=0.0001) and ferric ion-reducing antioxidant power (FRAP) (p=0.0001), and histopathologic changes in the form of moderate to severe inflammation were observed. Administration of VPA + carnitine reduced AST (p=0.05) and ALT (p=0.01), increased the FRAP, reduced free oxygen radicals and liver lipid peroxidation (p=0.0001 for all), and decreased tissue damage in the form of moderate inflammation. The administration of carnitine was ineffective in reducing brain or plasma ammonia levels in acute VPA-treated animals (p = 0.0115).</p><p><strong>Conclusions: </strong>Although the administration of carnitine has been suggested as a protective remedy in cases of VPA toxicity, according to the present study, it did not have an antidotal effect and did not prevent encephalopathy or liver injury in acute VPA toxicity.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e20"},"PeriodicalIF":5.4,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10871053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Serum Calcium Level Changes Following Non-Massive Blood and Blood Product Transfusion in Emergency Department; a Cross-sectional Study.","authors":"Halil Emre Koyuncuoglu, Basak Yuksek, Sırma Karamercan, Mehmet Akif Karamercan","doi":"10.22037/aaem.v12i1.2225","DOIUrl":"10.22037/aaem.v12i1.2225","url":null,"abstract":"<p><strong>Introduction: </strong>The specific impact on calcium dynamics after non-massive blood transfusions remains relatively unexplored. This study aimed to compare pre- and post-transfusion calcium levels in patients receiving blood and blood product in the emergency department.</p><p><strong>Methods: </strong>This is a single-center, prospective, cross-sectional study conducted at the Emergency Department of Gazi University Health Research and Application Center Hospital in Ankara, Turkey, from January 1, 2020, to August 31, 2020. The study included adult patients who underwent blood and blood product transfusions, and serum calcium levels were measured and compared from samples taken before and after transfusion.</p><p><strong>Results: </strong>A total of 292 participants were enrolled in the study, with 242 participants included in the final analysis. The mean total calcium level was 8.41 ± 0.76 mg/dL before transfusion and 8.34 ± 0.71 mg/dL after transfusion (p=0.012). When examining the corrected calcium values after receiving blood products based on the type of blood products, participants who received apheresis platelets had a post-transfusion corrected calcium value of 8.26 ±0.41 mg/dL, with a pre-transfusion value of 9.09 ±0.49 mg/dL (p<0.01). The post-transfusion ionized calcium value for participants receiving apheresis was 1.04 ±0.08 mg/dL, compared to 1.15 ±0.09 mg/dL for those who did not receive apheresis (p=0.049). There was a significant relationship between receiving fresh frozen plasma and post-transfusion ionized calcium values (p=0.024).</p><p><strong>Conclusion: </strong>This study demonstrated that transfusion-associated hypocalcemia can occur even at mild levels in patients receiving blood and blood product transfusions in the emergency department. However, it is suggested that the clinical effects of hypocalcemia, even when occurring based on the type and quantity of blood products, are minimal and negligible.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e19"},"PeriodicalIF":5.4,"publicationDate":"2023-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10871048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associated Factors of Leaked Repair Following Omentopexy for Perforated Peptic Ulcer Disease; a Cross-sectional Study.","authors":"Aloysius Ugwu-Olisa Ogbuanya, Uche Emmanuel Eni, Daniel A Umezurike, Akputa A Obasi, Somadina Ikpeze","doi":"10.22037/aaem.v12i1.2169","DOIUrl":"10.22037/aaem.v12i1.2169","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies have reported numerous clinico-pathologic risk factors associated with increased risk of leaked repair following omental patch for perforated peptic ulcer disease (PPUD). This study aimed to analyze the risk factors associated with leaked repair of omental patch and document the management and outcome of established cases of leaked repair in a resource-poor setting.</p><p><strong>Methods: </strong>This is a multicenter cross-sectional study of leaked repair after omental patch of PPUD between January 2016 to December 2022. Following primary repair of PPUD with omental pedicle reinforcement, associated factors of leaked repair were evaluated using univariate and multivariate analyses.</p><p><strong>Results: </strong>Overall, 360 cases were evaluated (62.8% male). Leaked repair rate was 11.7% (42 cases). Those without immunosuppression were 3 times less likely to have leaked repair (aOR= 0.34; 95% CI: 0.16 - 0.72; p = 0.003) while those with sepsis were 4 times more likely to have leaked repair (aOR=4.16; 95% CI: 1.06 - 12.36; p = 0.018). Patients with delayed presentation (>48 hours) were 2.5 times more likely to have leaked repair than those who presented in 0 - 24 hours (aOR=2.51; 95% CI: 3.62 - 10.57; p = 0.044). Those with Perforation diameter 2.1-3.0 cm were 8 times (aOR=7.98; 95% CI: 2.63-24.21; p<0.0001), and those with perforation diameter > 3.0cm were 33 times (aOR=33.04; 95% CI: 10.98-100.25; p<0.0001) more likely to have leaked repair than those with perforation diameter of 0-1.0 cm. Similarly, in those with no perioperative shock, leaked repair was 4 times less likely to develop than those with perioperative shock (aOR= 0.42; 95% CI: 0.41-0.92; p = 0.041). There was significant statistical difference in morbidity (p = 0.003) and mortality (p < 0.0001) rates for cases of leaked repairs and successful repairs.</p><p><strong>Conclusion: </strong>Leaked repair following omentopexy for peptic ulcer perforation was significantly associated with large perforation diameter, delayed presentation, sepsis, immunosuppressive therapy, and perioperative shock.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e18"},"PeriodicalIF":5.4,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10871054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MONTH Score in Predicting Difficult Intubations in Emergency Department; a Prognostic Accuracy Study.","authors":"Nitis Hongthong, Sorravit Savatmongkorngul, Chaiyaporn Yuksen, Thanakorn Laksanamapune","doi":"10.22037/aaem.v12i1.2178","DOIUrl":"10.22037/aaem.v12i1.2178","url":null,"abstract":"<p><strong>Introduction: </strong>MONTH Difficult Laryngoscopy Score was developed for effectively identifying difficult intubations in the emergency department (ED). This study aimed to evaluate the accuracy of MONTH Score in predicting difficult intubations in ED.</p><p><strong>Methods: </strong>We prospectively collected data on all patients undergoing intubation in the ED of Ramathibodi Hospital, Bangkok, Thailand. The screening performance characteristics of the MONTH score in identifying the difficult intubation in ED were analyzed. All data were analyzed using STATA software version 18.0.</p><p><strong>Results: </strong>324 intubated patients with the median age of 73 (63-82) years were studied (63.58% male). The proportion of difficult intubations was 19.44%. The sensitivity and specificity of MONTH in predicting difficult intubations were 74.6% (95% CI: 61.6%-85.0%) and 92.8% (95% CI: 89.0%-95.6%), respectively. These measures in subgroup of patients with Intubation Difficulty Scale (IDS) score ≥ 6 were 44.1% (95%CI: 31.2-57.6) and 98.5% (95% CI: 96.2%- 99.6%), respectively. The area under the receiver operation characteristic (ROC) curve of MONTH in predicting difficult intubations was 0.895 (95% CI: 0.856- 0.926).</p><p><strong>Conclusions: </strong>It seems that the MONTH Difficult Laryngoscopy Score could be considered as a tool with high specificity and positive predictive values in identifying cases with difficult intubations in ED.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e17"},"PeriodicalIF":5.4,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10871049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}