CHEST critical care最新文献

{"title":"Implementing Large Language Models in Critical Care","authors":"Khalil El Gharib MD","doi":"10.1016/j.chstcc.2025.100180","DOIUrl":"10.1016/j.chstcc.2025.100180","url":null,"abstract":"<div><div>Large language models are artificial intelligence tools that have emerged in a supportive role in various fields, and we are on the cusp of witnessing their true potential in critical care medicine. In this article, we highlight the anticipated applications of these models in this setting, as well as the barriers that separate us from actualizing their deployment, ranging from pragmatic concerns, such as doubts in clinical decision-making, to ethical trustworthiness, along with means to attempt to mitigate these challenges.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904075","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":"Association of Musculoskeletal Indexes With 1-Year Outcomes After ≥ 7 Days of Mechanical Ventilation","authors":"Hannah Wozniak MD ,&nbsp;Erminio Santangelo ,&nbsp;Micheal McInnis ,&nbsp;Laura Dragoi ,&nbsp;Priscila Robles ,&nbsp;Leslie M. Chu ,&nbsp;Andrea Matte ,&nbsp;Margaret S. Herridge","doi":"10.1016/j.chstcc.2025.100176","DOIUrl":"10.1016/j.chstcc.2025.100176","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In critically ill patients, musculoskeletal indexes have been associated with short-term outcomes such as in-hospital mortality and discharge disposition. Their influence on long-term outcomes in chronically critically ill patients remains unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Research Question&lt;/h3&gt;&lt;div&gt;Does an association exist between musculoskeletal indexes and 1-year mortality in chronically critically ill patients? Are these indexes also associated with 7-day post-ICU functional independence measure (FIM) and discharge disposition?&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design and Methods&lt;/h3&gt;&lt;div&gt;This study used the Canadian Outcomes and Needs Assessment in Intensive Care Unit (ICU) Survivors of Prolonged Mechanical Ventilation and Their Caregivers (RECOVER) phase 1 cohort of patients requiring mechanical ventilation for ≥ 7 days. Patients who underwent abdominal CT imaging within the first 14 days of ICU admission were included. Skeletal muscle index (SMI), psoas muscle index (PMI), and trabecular bone density (BD) were measured at the L3 vertebral level. Multivariable logistic regression assessed the association between each index and 1-year mortality; multivariable linear regression assessed the association with 7-day post-ICU FIM. A Kruskal-Wallis H test compared musculoskeletal indexes across 4 discharge disposition groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;One hundred patients were included; the median age was 57 years (interquartile range [IQR], 45-65 years), and 43% were female. Those who did not survive by 1 year showed lower musculoskeletal indexes than survivors: median SMI, 28.8 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt; (IQR, 22-34 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;) vs 33.5 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt; (IQR, 25.7-44.1 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;; &lt;em&gt;P&lt;/em&gt; = .03); median PMI, 3.3 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt; (IQR, 2.5-4.5 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;) vs 4 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt; (IQR, 3.2-5.6 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;; &lt;em&gt;P&lt;/em&gt; = .02); and median BD, 131 Hounsfield units (HU; IQR, 100-196 HU) vs 175 HU (IQR, 131-220 HU; &lt;em&gt;P&lt;/em&gt; &lt; .01). Lower SMI (OR per 10-unit decrease, 2.00; 95% CI, 1.21-3.33; &lt;em&gt;P&lt;/em&gt; &lt; .01), PMI (OR per 1-unit decrease, 1.54; 95% CI, 1.06-2.23; &lt;em&gt;P&lt;/em&gt; = .02), and BD (OR per 10-unit decrease, 1.10; 95% CI, 1.01-1.20; &lt;em&gt;P&lt;/em&gt; = .05) were associated significantly with 1-year mortality. No significant association was found between musculoskeletal indexes and FIM 7 days after ICU stay. Significant differences in SMI were found across discharge groups (χ&lt;sup&gt;2&lt;/sup&gt; (3) = 7.882; &lt;em&gt;P&lt;/em&gt; = .048).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The results of this study suggest that decreased musculoskeletal indexes are associated with 1-year mortality in chronically critically ill patients. These findings may help to inform clinical decision-making.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trial Registration&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;; No.: &lt;span&gt;&lt;span&gt;NC","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100176"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852955","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":"Protocol and Statistical Analysis Plan for a Multicenter Randomized Trial of Ketamine vs Etomidate for Emergency Tracheal Intubation","authors":"Stephanie C. DeMasi MD ,&nbsp;Brant Imhoff MS ,&nbsp;Ariel A. Lewis BSN, RN, MPH ,&nbsp;Kevin P. Seitz MD ,&nbsp;Brian E. Driver MD ,&nbsp;Kevin W. Gibbs MD ,&nbsp;Adit A. Ginde MD, MPH ,&nbsp;Stacy A. Trent MD, MPH ,&nbsp;Derek W. Russell MD ,&nbsp;Amelia L. Muhs MD ,&nbsp;Matthew E. Prekker MD, MPH ,&nbsp;John P. Gaillard MD ,&nbsp;Daniel Resnick-Ault MD ,&nbsp;L. Jane Stewart MD, JD, MPH ,&nbsp;Micah R. Whitson MD ,&nbsp;Graham W.W. Van Schaik MD, MBA ,&nbsp;Aaron E. Robinson MD, MPH ,&nbsp;Jessica A. Palakshappa MD ,&nbsp;Neil R. Aggarwal MD, MHSc ,&nbsp;Jason C. Brainard MD ,&nbsp;Matthew W. Semler MD","doi":"10.1016/j.chstcc.2025.100177","DOIUrl":"10.1016/j.chstcc.2025.100177","url":null,"abstract":"<div><h3>Background</h3><div>Emergency tracheal intubation is a common and high-risk procedure. Ketamine and etomidate are medicines commonly used to induce anesthesia for emergency tracheal intubation, but whether the induction medication used affects patient outcomes is uncertain.</div></div><div><h3>Research Question</h3><div>Does the use of ketamine for induction of anesthesia decrease the incidence of death among adults undergoing emergency tracheal intubation compared with the use of etomidate?</div></div><div><h3>Study Design and Methods</h3><div>The Randomized Trial of Sedative Choice for Intubation (RSI) is a pragmatic, multicenter, unmasked, parallel-group randomized trial being conducted at 14 sites (6 emergency departments and 8 ICUs) in the United States. The trial compares ketamine vs etomidate for induction of anesthesia among 2,364 critically ill adults undergoing emergency tracheal intubation. The primary outcome is all-cause 28-day in-hospital mortality. The secondary outcome is the incidence of cardiovascular collapse during intubation, a composite of hypotension, receipt of vasopressors, and cardiac arrest.</div></div><div><h3>Results</h3><div>Enrollment began on April 6, 2022, and is expected to conclude in 2025.</div></div><div><h3>Interpretation</h3><div>The RSI will provide important data on the effects of ketamine vs etomidate on death and other outcomes for critically ill adults undergoing emergency tracheal intubation. Specifying the protocol and statistical analysis plan before the conclusion of enrollment increases the rigor, reproducibility, and transparency of the trial.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT05277896; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100177"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830197","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":"Gastroesophageal Reflux Symptoms and Health-Related Quality of Life Among ICU Survivors","authors":"Sachin Wali MD, DNB, DM ,&nbsp;Mohan Gurjar MD ,&nbsp;Samir Mohindra MD, DM ,&nbsp;Prabhaker Mishra PhD ,&nbsp;Shreyas H. Gutte MD, DM ,&nbsp;Afzal Azim MD ,&nbsp;Jitendra S. Chahar MD ,&nbsp;Banani Poddar MD","doi":"10.1016/j.chstcc.2025.100169","DOIUrl":"10.1016/j.chstcc.2025.100169","url":null,"abstract":"<div><h3>Background</h3><div>Gastroesophageal reflux disease (GERD) is a common clinical condition in the general population. However, no prospective study is available to estimate the burden of gastroesophageal reflux symptoms (GERSs) among survivors of the ICU.</div></div><div><h3>Research Question</h3><div>What are the incidence and severity of GERSs among survivors of the ICU?</div></div><div><h3>Study Design and Methods</h3><div>This prospective observational study was conducted in a 20-bed ICU at a university hospital in India. All adult survivors of the ICU were screened for the presence of GERSs, defined as presence of heartburn, regurgitation symptoms, or both ≥ 2 times/wk. Exclusions were: Glasgow Coma Scale score of &lt; 15, presence of tracheostomy or feeding tube, open abdomen, and pregnancy. The severity of symptoms was assessed through the Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) score (range, 0-50, where 50 is worst) at 2 time points 6 weeks apart.</div></div><div><h3>Results</h3><div>During the study period, 116 patients were included, with a median age of 44 years (interquartile range [IQR], 26-59 years). Sixty-five patients (56%) were male, and the median admission Sequential Organ Failure Assessment score was 7 (IQR, 4-10). During the ICU stay, 59 patients (50.8%) required mechanical ventilation, 42 patients (36.2%) required vasopressors, and 11 patients (9.4%) received dialysis. Among them, 43 patients (37%) had history of GERSs before the illness. In the remaining 73 patients, 23 patients (31.5%) had new-onset GERSs. The use of medications known to increase the risk of GERD (eg, prednisolone, acetylsalicylic acid, and amlodipine) and the prolonged presence of a feeding tube were associated significantly with new-onset GERSs (OR, 4.49 [95% CI, 1.06-18.9; <em>P</em> = .04] and OR, 1.04 [95% CI, 1.00-1.09; <em>P</em> = .03]), respectively, even after adjusting for age and presence of preexisting known risk factors (diabetes, hypertension, and smoking and alcohol intake). The median GERD-HRQL score among patients with new-onset GERSs at follow-up decreased from 10 (IQR, 2-20) to 4 (IQR, 0-15; <em>P</em> = .01).</div></div><div><h3>Interpretation</h3><div>In this study, one-third of survivors of the ICU experienced new-onset GERSs. However, symptoms improved significantly at the 6-week follow-up.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: <span><span>NCT05193266</span><svg><path></path></svg></span>; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890539","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":"Response","authors":"Yonatan Y. Greenstein MD, FCCP,&nbsp;Keith Guevarra DO, FCCP","doi":"10.1016/j.chstcc.2025.100174","DOIUrl":"10.1016/j.chstcc.2025.100174","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100174"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779453","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":"Ascorbate for Organ Dysfunction in Critically Ill Patients With Sepsis","authors":"D. Clark Files MD ,&nbsp;Michael A. Matthay MD ,&nbsp;Lorraine B. Ware MD ,&nbsp;Roy G. Brower MD ,&nbsp;Neil R. Aggarwal MD ,&nbsp;Samuel M. Brown MD ,&nbsp;Steven Y. Chang MD ,&nbsp;Ivor S. Douglas MD ,&nbsp;Abhijit Duggal MD ,&nbsp;Kevin W. Gibbs MD ,&nbsp;Scott Fields PharmD ,&nbsp;Andrea S. Foulkes ScD ,&nbsp;Adit Ginde MD ,&nbsp;Andrew Goodwin MD ,&nbsp;Estelle S. Harris MD ,&nbsp;Gregory W. Hendey MD ,&nbsp;Kathryn Hibbert MD ,&nbsp;R.Duncan Hite MD ,&nbsp;Catherine L. Hough MD ,&nbsp;Weixing Huang MSPH ,&nbsp;Alpha A. Fowler MD","doi":"10.1016/j.chstcc.2025.100168","DOIUrl":"10.1016/j.chstcc.2025.100168","url":null,"abstract":"<div><h3>Background</h3><div>A phase 2 trial of high-dose IV ascorbate suggested reduced mortality in patients with ARDS, although trials in sepsis have failed to show clinical benefit.</div></div><div><h3>Research Question</h3><div>Does IV high-dose ascorbate improve outcomes in patients with sepsis at risk of or with ARDS?</div></div><div><h3>Study Design and Methods</h3><div>In this phase 2b multicenter randomized placebo-controlled trial, patients with known or suspected infection and either shock or acute hypoxemic respiratory failure were randomized to ascorbate (50 mg/kg IV every 6 hours for 5 days) or a matching placebo. The primary outcome was days alive and free of respiratory, renal, and circulatory organ support to day 28. Secondary outcomes included clinical and biological end points.</div></div><div><h3>Results</h3><div>After enrolling 79 participants, the trial was terminated because of the publication of a separate study of septic shock reporting increased mortality with ascorbate. In the current study, days free of organ support were not different for patients receiving ascorbate compared with those receiving placebo: mean (SD), 20.5 (9.5) days vs 19.0 (10.8) days, respectively (<em>P</em> = .528). The 90-day all-cause mortality was 15% in the ascorbate group vs 33% in the placebo group (<em>P</em> = .057). This was 1 of 19 secondary end points. Soluble tumor necrosis factor receptor 1 levels were reduced in the ascorbate group vs placebo from baseline to both day 2 (median, –861 pg/mL [interquartile range (IQR), –3,043 to 128.9 pg/mL] vs 241.4 pg/mL [–820 to 1,671 pg/mL]; <em>P</em> = .005) and day 3 (median, –1,511 pg/mL [IQR, –2,636 to –36.3 pg/mL] vs –131 pg/mL [–986 to 2,202 pg/mL]; <em>P</em> = .008).</div></div><div><h3>Interpretation</h3><div>Ascorbate did not improve days free of organ failure, although no safety concerns were identified in this small study. Ascorbate was shown to reduce a biological marker of inflammation associated with adverse outcomes in sepsis and lung injury.</div></div><div><h3>Clinical Trial Registration</h3><div>ClinicalTrials.gov; No.: NCT04291508; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904077","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":"Predictive Markers of Neurological Complications in Patients Treated With Extracorporeal Membrane Oxygenation","authors":"Adeel Abbasi MD, ScM ,&nbsp;Linn Ayers ,&nbsp;Ron Balczon PhD ,&nbsp;Amy R. Nelson PhD ,&nbsp;Allison J. Bauman ,&nbsp;Maya Cohen MD, ScM ,&nbsp;Neelia Abadi ,&nbsp;John R. Priest BSRT ,&nbsp;Saraschandra Vallabhajosyula MD, FAHA, FACC ,&nbsp;Grayson L. Baird PhD ,&nbsp;Troy Stevens PhD ,&nbsp;Corey E. Ventetuolo MD, FAHA","doi":"10.1016/j.chstcc.2025.100170","DOIUrl":"10.1016/j.chstcc.2025.100170","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830355","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":"Sepsis in Previously Healthy Adults","authors":"Fizza Manzoor MD,&nbsp;Michael Klompas MD, MPH,&nbsp;Chanu Rhee MD, MPH","doi":"10.1016/j.chstcc.2025.100172","DOIUrl":"10.1016/j.chstcc.2025.100172","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749344","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":"Response","authors":"Tessa A. Mulder MD ,&nbsp;Linda Becude MD ,&nbsp;Jorge E. Lopez Matta MD ,&nbsp;Wilbert B. van den Hout PhD ,&nbsp;David J. van Westerloo MD, PhD ,&nbsp;Martijn P. Bauer MD, PhD","doi":"10.1016/j.chstcc.2025.100173","DOIUrl":"10.1016/j.chstcc.2025.100173","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100173"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830199","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":"Parsing Prone Positioning Practices","authors":"Chad H. Hochberg MD, MHS,&nbsp;David N. Hager MD, PhD","doi":"10.1016/j.chstcc.2025.100171","DOIUrl":"10.1016/j.chstcc.2025.100171","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842353","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}