Hemodialysis international. International Symposium on Home Hemodialysis最新文献

{"title":"Nonlinear Association Between Serum Uric Acid Levels and Mortality in Maintenance Hemodialysis Patients: A Retrospective Study From the Beijing Hemodialysis Quality Control and Improvement Center.","authors":"Huixian Zhang, Zongli Diao, Wang Guo, Wenhu Liu, Jing Liu","doi":"10.1111/hdi.70105","DOIUrl":"https://doi.org/10.1111/hdi.70105","url":null,"abstract":"<p><strong>Background: </strong>To investigate the association between serum uric acid levels and the risks of all-cause and cardiovascular mortality in patients undergoing maintenance hemodialysis.</p><p><strong>Methods: </strong>Patients receiving maintenance hemodialysis registered in 2014 in the Beijing Blood Purification Quality Control and Improvement Center database were included. Patients were stratified into low (≤ 344 μmol/L), intermediate (344-464 μmol/L), and high (> 464 μmol/L) serum uric acid groups. Propensity score matching (1:1:1) was performed using age, sex, diabetes, and dialysis vintage. Survival was analyzed using Kaplan-Meier curves and the log-rank test. Cox proportional hazards models and restricted cubic spline analyses were applied to evaluate the associations between serum uric acid levels and all-cause and cardiovascular death.</p><p><strong>Results: </strong>We enrolled 2070 patients in three matched groups (n = 690 per group). The median follow-up was 64.0 (interquartile range, 31.1-72.0) months. All-cause death occurred in 292/690 (42.3%), 122/690 (17.7%), and 210/690 (30.4%) patients in the low-, intermediate-, and high-serum uric acid groups, respectively. After adjusting for multiple factors, the intermediate serum uric acid group had better survival than the low- (hazard ratio, 1.82; 95% confidence interval [95% CI], 1.41-2.34; p < 0.001) and high-serum uric acid groups (hazard ratio, 2.13; 95% CI, 1.64-2.76; p < 0.001). The pattern of cardiovascular death was consistent with that of all-cause mortality, showing higher risks in both the low- and high-serum uric acid groups compared with the intermediate-serum uric acid group. Further restricted cubic spline analyses suggested a U-shaped association between serum uric acid levels and the risks of all-cause and cardiovascular mortality, with the lowest mortality risk observed at serum uric acid levels of approximately 388-420 μmol/L.</p><p><strong>Conclusion: </strong>Serum uric acid exhibited a U-shaped association with the risks of all-cause and cardiovascular death in patients undergoing maintenance hemodialysis. Both excessively low and high serum uric acid levels were associated with increased mortality risk.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347834","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":"Shared Hemodialysis Care Practice Patterns and Their Association With Shared Decision-Making in the United Kingdom.","authors":"Kevin Breen, Shalini Santhakumaran, Martin Wilkie, Neill Duncan, Tania Barnes, Georgina Hamill, Catherine Stannard, Amanda Busby, Paul Bristow, Udaya Udayaraj","doi":"10.1111/hdi.70104","DOIUrl":"https://doi.org/10.1111/hdi.70104","url":null,"abstract":"<p><strong>Background: </strong>Shared hemodialysis care, or \"shared care,\" empowers in-center hemodialysis patients to undertake some dialysis-related tasks. Although its benefits are increasingly recognized, data on shared care is not routinely reported, and its impact on patient experience is less studied. Shared decision-making-a key component of patient experience-is consistently rated poorly by renal patients. Using data from the UK Kidney Patient Reported Experience Measure survey, we examined the variation in shared care offered across 67 UK kidney centers and assessed its association with shared decision-making scores.</p><p><strong>Methods: </strong>Shared care offer and acceptance was assessed by a single survey question. A measure of shared decision-making was derived from patient responses to three questions (scored between 1 = low and 7 = high). Associations between shared care and shared decision-making scores were analyzed at an individual level using linear mixed models.</p><p><strong>Results: </strong>Analyzes included 6861 patients. 53% of respondents were offered shared care (47% in 2022), with rates from 13% to 93% between centers. Shared care was more likely to be offered to those aged 31-55 years, ethnic minorities and in satellite units. Those offered shared care gave higher scores for each question on shared decision-making, with a mean increase of 0.61 (95% CI 0.51-0.70, p < 0.0001) across all questions.</p><p><strong>Conclusions: </strong>Shared care participation in the UK is increasing but there remains considerable variation between centers with inequitable access to the opportunities it brings according to patient age, ethnicity and dialysis unit location. This study is the first to demonstrate a positive association between shared care and shared decision-making, suggesting that offering shared care can support shared decision-making and improve patient experience of care.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304341","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":"Effects of an Interactive Handgrip Game on Vascular Maturation and Grip Strength in Patients Undergoing Arteriovenous Fistula Surgery: A Feasibility Randomized Controlled Trial.","authors":"Yi-Chin Luo, Ping-Hsuan Han, Ying-Ying Chen, Pei-Chen Wu, I-Wen Wu, Yen-Chun Fan, Hsiao-Yean Chiu","doi":"10.1111/hdi.70045","DOIUrl":"10.1111/hdi.70045","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluated the effects of an interactive handgrip game on vascular maturation and grip strength in patients undergoing arteriovenous fistula (AVF) surgery.</p><p><strong>Methods: </strong>This was a preliminary randomized controlled trial. Thirty patients who underwent AVF surgery were randomly assigned to either an interactive handgrip game group or a soft ball group, with 15 participants in each. Both groups began their respective interventions on the first day after returning home; they engaged in either the interactive handgrip game or soft ball exercises for 30 min per session, twice daily (morning and afternoon) for 2 months. Data were obtained using a self-designed structured questionnaire, a Noblus ultrasound machine, and a Jamar hand dynamometer. Assessments were conducted the day before AVF surgery, at the fourth week, and at the eighth week.</p><p><strong>Results: </strong>A total of 30 participants with mean age of 56 years adhered fully to the prescribed training sessions. Compared with the soft ball group, the interactive handgrip game group demonstrated greater improvements in blood flow rate at 8 weeks (1230 vs. 930 mL/min; p < 0.001) and in handgrip strength at both 4 weeks (14 vs. 12 kg; p < 0.001) and 8 weeks (18 vs. 14 kg; p < 0.001). No significant time-by-group interactions were observed for vein diameter or fistula depth. Participants also reported high satisfaction (scores 4.6-5) and strong agreement on the feasibility of the interactive handgrip game (mean = 5).</p><p><strong>Conclusion: </strong>A 2-month regimen of an interactive handgrip game yielded significantly greater vascular maturation and grip strength relative to soft ball exercises. In addition, the game resulted in high patient satisfaction and was feasible to implement, supporting its potential as an effective intervention for AVF maturation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT05493046.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":"343-350"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890738","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 Between Postdialysis Fatigue and Number of Comorbidities and Number and Prevalence of Symptoms.","authors":"Maurizio Bossola, Ilaria Mariani, Carlo Pasquale Piccinni, Enrico Di Stasio","doi":"10.1111/hdi.70059","DOIUrl":"10.1111/hdi.70059","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between postdialysis fatigue (PDF) and physical and emotional symptoms in patients receiving maintenance hemodialysis.</p><p><strong>Methods: </strong>All prevalent patients undergoing maintenance hemodialysis at our Hemodialysis Service between June 2022 and September 2024 were considered eligible. The Dialysis Symptom Index questionnaire was administered during dialysis sessions. PDF was assessed using the approach recommended by Sklar et al. Patients were classified as having PDF if they spontaneously reported feeling fatigued after dialysis in response to the question: \"Do you feel fatigued after dialysis?\"</p><p><strong>Results: </strong>A total of 269 patients were studied: 220 with PDF and 49 without. Patients with PDF were significantly older and had a higher Charlson comorbidity index. The median [95% CI] number of symptoms was 13 [12-14] in patients with PDF versus 7 [6-8.8] in those without (p < 0.0001). In multivariable logistic regression, PDF was independently associated with the Charlson comorbidity index (odds ratio [95% CI]: 1.41 [1.08-1.85], p = 0.010) and the total number of symptoms (1.27 [1.16-1.40], p < 0.0001). The prevalence of 15 out of 29 symptoms was significantly higher in patients with PDF. After adjustment, PDF remained independently associated with swelling in the legs (OR [95% CI]: 12.8 [1.43-113.9], p = 0.022), restless legs (3.41 [0.98-11.8], p = 0.052), difficulty concentrating (8.24 [2.12-32.1], p = 0.002), difficulty becoming sexually aroused (6.00 [2.58-13.9], p < 0.0001), and feeling sad (6.06 [2.31-15.9], p = 0.0003). The severity of itching, bone or joint pain, worrying, feeling nervous, feeling anxious, and decreased interest in sex was also significantly greater in patients with PDF.</p><p><strong>Conclusion: </strong>PDF is independently associated with a higher burden of comorbidities and a greater number of physical and emotional symptoms. It is also specifically linked to the prevalence of leg swelling, restless legs, difficulty concentrating, difficulty becoming sexually aroused, and sadness.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":"366-373"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151578","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":"Characteristics and Management of Dissection in Early Cannulation Arteriovenous Grafts.","authors":"Huan Luo, Zhiqiang Duan, Xuyang Luo, Yi Fan, Xudong Wang, Jiaojiao Du, Fei Deng","doi":"10.1111/hdi.70058","DOIUrl":"10.1111/hdi.70058","url":null,"abstract":"<p><strong>Introduction: </strong>Vascular access is critical for hemodialysis in patients with end-stage renal disease. Autogenous arteriovenous fistula is the first-line option, while arteriovenous grafts are an alternative for patients with poor native vascular conditions. Over the past decade, early cannulation arteriovenous grafts with a multi-layered structure have emerged, allowing cannulation within 24-72 h after implantation to meet urgent dialysis needs. However, this specific structure renders them susceptible to dissection, a unique complication. To date, no systematic review has summarized the characteristics and management of this complication, and this paper aims to address this gap.</p><p><strong>Methods: </strong>The search was conducted in the PubMed database. Finally, seven case reports and one cohort study were included.</p><p><strong>Findings: </strong>The diagnosis of dissection in early cannulation arteriovenous grafts mainly relies on Doppler ultrasound examination. Most reported cases involve Acuseal grafts, with dissections predominantly located between the middle and outer layers, and mostly on the anterior wall. It may be associated with balloon dilation, vascular sheath insertion, inappropriate puncture angle, and repeated joint movement. There is no standard treatment protocol. Available options include PTA, stent implantation, graft replacement, and conservative observation. Graft replacement yields the best primary patency rate. Stent implantation or graft replacement is recommended as the first-line treatment.</p><p><strong>Discussion: </strong>Reports on dissection in early cannulation arteriovenous grafts remain scarce. The true incidence across different graft types, optimal treatment strategies, and long-term outcomes following various interventions have not been fully clarified, and further research should be conducted in the future.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":"313-317"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127609","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":"Petting Zoo Perils: Escherichia coli O157:h7 Associated Hemolytic Uremic Syndrome Secondary to Animal Exposure.","authors":"Bailey Mims, Eric Stickles, Mihail M Subtirelu, Sai Sudha Mannemuddhu","doi":"10.1111/hdi.70043","DOIUrl":"10.1111/hdi.70043","url":null,"abstract":"<p><p>Animal exhibits can be a source of E. coli O157:h7 transmission and may lead to hemolytic uremic syndrome. The E. coli O157:h7 outbreak in Tennessee affected over 64 children. Five children, 15 months to 7 years of age, developed acute renal failure due to HUS, requiring renal replacement therapy. They were admitted to the hospital with acute renal failure between 7 and 12 days after exposure to animals. All children presented with vomiting, diarrhea, abdominal pain, and oligo-anuria and had laboratory confirmation of E. coli O157:h7 in the stool sample. They all required renal replacement therapy, and one child required therapeutic plasma exchange due to thrombotic microangiopathy vasculitis-associated encephalopathy. These children experienced dialysis catheter malfunction (n = 1), encephalopathy (n = 1), and thrombosis of the right jugular vein (n = 1). All children developed hypertension, and three out of five required anti-hypertensives at discharge. At the 1-year follow-up, the GFR ranged from 54 to 92 mL/min. Hypertension was noted in two. Hemolytic uremic syndrome can cause long-term sequelae like cerebral atrophy, hypertension, and chronic kidney disease. Hygiene measures can potentially prevent hemolytic uremic syndrome.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":"425-430"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919450","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 Serum Calcium Levels With Coronary Artery Calcification in Patients at the Initiation of Hemodialysis.","authors":"Hidetoshi Ito, Kiryu Yoshida, Hirohito Sugawara, Yuri Fukuzaki, Hiroki Mizuyama, Hiroya Shigematsu, Takafumi Fujita, Dai Kitahara, Yoshinori Saito, Masanori Kato, Akiko Takeshima, Masahiro Yamamoto","doi":"10.1111/hdi.70064","DOIUrl":"10.1111/hdi.70064","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between serum calcium levels at the initiation of hemodialysis and coronary artery calcium score (CACS) remains unclear. This study examined whether albumin-corrected calcium (correctedCa; Payne's formula) and ionized calcium (ionizedCa) measured at dialysis initiation are associated with CACS assessed by screening coronary computed tomography.</p><p><strong>Methods: </strong>This single-center cross-sectional study included 176 adults who initiated hemodialysis between 2015 and 2023 and underwent coronary computed tomography with CACS measurement within ±30 days. Restricted cubic spline (RCS) logistic regression was used to evaluate the associations of correctedCa and ionizedCa with CACS ≥ 400, adjusting for clinical covariates. Subgroup analyses were performed according to the median serum albumin level. For models in which nonlinearity was not significant, logistic models treating the variable as a linear term were fitted to calculate odds ratios (OR) per 1-standard deviation (SD) increase.</p><p><strong>Findings: </strong>The mean age was 70.9 years, 32.9% were women, 54.3% had diabetes, and the mean eGFR was 5.45 mL/min/1.73 m². Higher calcium levels were associated with higher CACS. ionizedCa showed a linear association with CACS ≥ 400 (OR per 1-SD, 1.51; 95% CI, 1.08-2.11). correctedCa also showed a statistically linear association (OR per 1-SD, 1.53; 95% CI, 1.09-2.13), although the RCS curve visually plateaued at higher correctedCa levels. Subgroup analyses revealed that this convex pattern was driven by the low-albumin group.</p><p><strong>Discussion: </strong>Higher calcium at hemodialysis initiation was associated with increased coronary calcification. ionizedCa tended to show a more stable linear relationship with CACS than correctedCa, as correctedCa may overestimate ionizedCa in patients with low albumin. Measurement of ionizedCa at dialysis initiation may help refine vascular calcification risk stratification as patients enter the dialysis period.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":"351-358"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367492","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":"Blood Volume Cannot Be Calculated From Extracellular Volume.","authors":"Joachim Kron, John Volkenandt, Stefanie Broszeit, Til Leimbach, Susanne Kron","doi":"10.1111/hdi.70042","DOIUrl":"10.1111/hdi.70042","url":null,"abstract":"","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":"414-415"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822476","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":"Effect of Progressive Muscle Relaxation Exercises on Hemodialysis-Related Symptoms and Quality of Life: A Randomized Controlled Trial.","authors":"Sabri Toğluk, Uğur Öner","doi":"10.1111/hdi.70060","DOIUrl":"10.1111/hdi.70060","url":null,"abstract":"<p><strong>Introduction: </strong>Hemodialysis, the primary treatment for chronic kidney disease, prolongs life but is frequently accompanied by physical and psychological symptoms that impair quality of life. Progressive muscle relaxation exercises offer a novel non-pharmacological approach to symptom management. This study aimed to evaluate progressive muscle relaxation exercises on dialysis-related symptoms (primary outcome) and quality of life (secondary outcome) in patients undergoing hemodialysis.</p><p><strong>Methods: </strong>A randomized controlled pre-test-post-test study was conducted between May and September 2025 in two dialysis units in eastern Türkiye. Ninety-two hemodialysis patients were randomly assigned to either an intervention group (n = 46) or a control group (n = 46). The intervention group received 24 sessions of progressive muscle relaxation exercises over 8 weeks, while the control group received routine care. Data were collected at baseline and after the intervention using the dialysis symptom index and the Short Form-36 quality-of-life scale.</p><p><strong>Findings: </strong>The groups were similar in baseline. After the intervention, the progressive muscle relaxation exercises group demonstrated a significant reduction in symptom burden, with mean dialysis symptom index scores decreasing from 29.4 ± 13.3 to 16.3 ± 6.77 (t = 7.21, p < 0.001). Short-Form-36 quality-of-life scores increased from 51.4 ± 9.83 to 65.8 ± 10.1 (t = 4.67, p < 0.001), with significant improvements in physical functioning, vitality, pain, general health, and mental well-being (p < 0.05).</p><p><strong>Discussion: </strong>Progressive muscle relaxation exercises reduced dialysis-related symptoms and improved quality of life in hemodialysis patients. Given its simplicity, non-invasive nature, and low cost, it may be used as a complementary intervention in routine hemodialysis care. Further research should examine long-term effects and broader clinical applicability.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":"394-406"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145078","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":"Comment on the Effect of Nursing Care Based on Kolcaba's Comfort Theory on Symptom Severity and Comfort of Hemodialysis Patients.","authors":"Dexia Kong, Huachun Zhang","doi":"10.1111/hdi.70053","DOIUrl":"10.1111/hdi.70053","url":null,"abstract":"","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":"418-419"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000221","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}