CHEST pulmonary最新文献

{"title":"Exercise Capacity Following Pulmonary Embolism in Children and Adolescents","authors":"Mackenzie Parker MD ,&nbsp;Joshua Greer PhD ,&nbsp;Surendranath Veeram Reddy MD ,&nbsp;Maria Bano MD ,&nbsp;Manal Al-Qahtani MD ,&nbsp;Jeannie Dillenbeck MD ,&nbsp;Sean Rinzler MD ,&nbsp;Michael D. Nelson PhD ,&nbsp;Ang Gao PhD ,&nbsp;Song Zhang PhD ,&nbsp;Andrew R. Tomlinson MD ,&nbsp;Tony G. Babb PhD ,&nbsp;Ayesha Zia MD, MSCS","doi":"10.1016/j.chpulm.2024.100073","DOIUrl":"10.1016/j.chpulm.2024.100073","url":null,"abstract":"<div><h3>Background</h3><div>Self-reported physical activity after pediatric pulmonary embolism (PE) is reduced after diagnosis. However, objectively measured exercise capacity and mechanisms of exercise pathophysiology after PE are unknown.</div></div><div><h3>Research Question</h3><div>Does exercise capacity 1 year after acute PE in children differ from control patients?</div></div><div><h3>Study Design and Methods</h3><div>This case-control study compared exercise capacity and responses to maximal exercise in PE survivors with control patients. We also investigated the association of low exercise capacity after PE with prespecified clinical/radiologic features at PE diagnosis and elucidated the cause of functional limitations. The primary study outcome was exercise capacity defined by peak oxygen consumption (<span><math><mrow><mover><mi>V</mi><mo>˙</mo></mover></mrow></math></span><span>o</span>₂peak) as a percent predicted on cardiopulmonary exercise testing (CPET), with &lt; 80% predicted <span><math><mrow><mover><mi>V</mi><mo>˙</mo></mover></mrow></math></span><span>o</span>₂peak considered abnormal/low. Ventilatory inefficiency was defined as ratio of ventilation to CO₂ production on CPET slope &gt; 30 and abnormal stroke volume augmentation as oxygen pulse &lt; 10 mL/beat at peak exercise. Logistic regression was performed to assess the association of prespecified variables with low <span><math><mrow><mover><mi>V</mi><mo>˙</mo></mover></mrow></math></span><span>o</span>₂peak.</div></div><div><h3>Results</h3><div>We compared 25 consecutive pediatric PE survivors who completed CPET 1 year after diagnosis with 25 control patients who underwent CPET within the same period and were otherwise healthy. Exercise capacity was reduced in eight of the 25 PE survivors (32%) at 1 year after diagnosis vs two of the 25 control participants (8%) (<em>P</em> = .034). PE survivors with low exercise capacity demonstrated elevated ratio of ventilation to CO₂ production on CPET slope (<em>P</em> = .01) and a decreased oxygen pulse at peak exercise (<em>P</em> = .001), consistent with cardiovascular limitation. In univariable analysis, PE category, pulmonary vascular obstruction by the Qanadli index, or right ventricular dysfunction at diagnosis was not associated with low exercise capacity.</div></div><div><h3>Interpretation</h3><div>In this study, abnormal exercise capacity of cardiopulmonary origin occurred in one of three pediatric PE survivors despite anticoagulation and irrespective of PE severity, degree of pulmonary vascular obstruction, or right ventricular dysfunction at diagnosis. Cardiorespiratory fitness should be formally considered to develop rehabilitation interventions after pediatric PE.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141398898","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 77-Year-Old Man With Unexplained Hypoxemia","authors":"Patrick Pasqualicchio DO ,&nbsp;Maria Siow MD ,&nbsp;Shanaka Peiris MD ,&nbsp;Imran Arif MD ,&nbsp;Rishi Sukhija MD ,&nbsp;Jean Elwing MD ,&nbsp;Arun Jose MD","doi":"10.1016/j.chpulm.2024.100119","DOIUrl":"10.1016/j.chpulm.2024.100119","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571494","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":"High BMI and COPD Outcomes in Alpha-1 Antitrypsin Deficiency","authors":"Michael A. Campos MD ,&nbsp;Leonard Riley MD ,&nbsp;Jorge Lascano MD ,&nbsp;Brian Garnet MD ,&nbsp;Robert Sandhaus MD, PhD","doi":"10.1016/j.chpulm.2024.100113","DOIUrl":"10.1016/j.chpulm.2024.100113","url":null,"abstract":"<div><h3>Background</h3><div>Elevations in BMI impact morbidity in patients with COPD in general, but little is known about its impact in patients with COPD due to alpha-1 antitrypsin deficiency (AATD-COPD).</div></div><div><h3>Research Question</h3><div>What is the prevalence and clinical impact of high BMI in AATD-COPD?</div></div><div><h3>Study Design and Methods</h3><div>A total of 646 patients completed clinical and health-related quality of life (HRQoL) questionnaires for 2 years. Patients were grouped by baseline BMI categories (underweight, normal, overweight, obese, and morbidly obese) to compare symptoms, exacerbations, HRQoL, and 5- and 10-year survival. Relation between changes in BMI over time on HRQoL was assessed.</div></div><div><h3>Results</h3><div>The cohort’s mean age ± SD (55 ± 9.2 years), sex distribution (50.1% male), and mean % FEV₁ ± SD (36.6% ± 17.0%) was similar across all BMI categories. One-third (31.6%) had normal BMI, 5.6% were underweight, and 62% had a high BMI (37.3% overweight, 16.1% obese, and 9.4% morbidly obese). Patients with a high BMI had significantly worse St. George’s Respiratory questionnaire (SGRQ) and 36-Item Short Form Survey (SF-36) physical composite scores than patients with normal weight. Patients with morbid obesity had the highest odds of being in the worst SGRQ (OR, 3.8; 95% CI, 1.9-7.8) and SF-36 physical composite (OR, 4.2; 95% CI, 2.1-8.1) quartiles and experienced more emergency department visits and hospitalizations than patients with normal weight (<em>P</em> &lt; .05). Patients who transitioned to a higher BMI category over time reported worsening of SGRQ and SF-36 physical composite scores (<em>P</em> &lt; .05) and vice versa. Despite their higher morbidity, no difference in survival was observed between patients with high BMI and normal BMI after a mean follow-up of 9 years.</div></div><div><h3>Interpretation</h3><div>BMI above normal is prevalent in patients with AATD-COPD and is associated with greater comorbidity and poor HRQoL but does not impact survival. HRQoL is inversely affected by BMI changes over time.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579516","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":"Quantifying Normal Diaphragmatic Motion and Shape and Their Developmental Changes via Dynamic MRI","authors":"You Hao PhD ,&nbsp;Jayaram K. Udupa PhD ,&nbsp;Yubing Tong PhD ,&nbsp;Caiyun Wu PhD ,&nbsp;Joseph M. McDonough MS ,&nbsp;Samantha Gogel BA ,&nbsp;Oscar H. Mayer MD ,&nbsp;Mostafa Alnoury MD ,&nbsp;Patrick J. Cahill MD ,&nbsp;Jason B. Anari MD ,&nbsp;Drew A. Torigian MD","doi":"10.1016/j.chpulm.2024.100115","DOIUrl":"10.1016/j.chpulm.2024.100115","url":null,"abstract":"<div><h3>Background</h3><div>The diaphragm is a critical structure in respiratory function; however, in vivo quantitative description of its motion available in the literature is limited.</div></div><div><h3>Research Question</h3><div>How do we quantitatively describe regional hemidiaphragmatic motion and curvature via free-breathing dynamic MRI (dMRI)?</div></div><div><h3>Study Design and Methods</h3><div>In this prospective cohort study, we gathered dMRI images of 177 healthy children and young adults and segmented hemidiaphragm domes in end-inspiration and end-expiration phases of the constructed 4-dimensional image. We selected 25 points uniformly located on each 3-dimensional (3D) hemidiaphragm surface. Based on the motion and local shape of hemidiaphragm at these points, we computed the velocities and sagittal and coronal curvatures in 13 regions on each hemidiaphragm surface and analyzed the change in these properties with age and sex.</div></div><div><h3>Results</h3><div>This cohort consisted of 94 female patients (range, 6-20 years; mean ± SD, 12.09 ± 3.73 years) and 83 male patients (range, 6-20 years; mean ± SD, 11.88 ± 3.57 years). We observed the following: velocity range: approximately 2 to approximately 13 mm/s; and curvature range: sagittal: approximately 3 to approximately 27 m⁻¹ and coronal: ∼approximately 6 to approximately 20 m⁻¹. There was no significant difference in velocity between sexes; however, the pattern of change in velocity with age was different for the 2 groups. Strong correlations in velocity were observed between homologous regions of right and left hemidiaphragms. There was no significant difference in curvatures between sexes or change in curvatures with age.</div></div><div><h3>Interpretation</h3><div>Regional motion/curvature of the 3D diaphragmatic surface can be estimated using free-breathing dMRI. Our analysis sheds light on heretofore unknown matters such as how the pediatric 3D hemidiaphragm motion/shape varies regionally, between right and left hemidiaphragms, between sexes, and with age.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705747","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 National Survey of Spirometry Interpretation Practices","authors":"Kevin Hachey MD, MPH ,&nbsp;Sande Okelo MD, PhD ,&nbsp;Francesca Duncan MD ,&nbsp;Aaron Baugh MD ,&nbsp;Stephanie Lovinsky-Desir MD ,&nbsp;Joseph P. Smith MD","doi":"10.1016/j.chpulm.2024.100118","DOIUrl":"10.1016/j.chpulm.2024.100118","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571493","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":"Long-Term Efficacy of Dupilumab in Moderate-to-Severe Asthma Phenotyped by Blood Eosinophils and Exhaled Nitric Oxide","authors":"Michael E. Wechsler MD ,&nbsp;Ian D. Pavord MD ,&nbsp;Alberto Papi MD ,&nbsp;Kenneth R. Chapman MD ,&nbsp;Arman Altincatal MS ,&nbsp;Nami Pandit-Abid PharmD ,&nbsp;Juby A. Jacob-Nara MD ,&nbsp;Paul J. Rowe MD ,&nbsp;Yamo Deniz MD ,&nbsp;Elizabeth Laws PhD ,&nbsp;Bolanle Akinlade MD ,&nbsp;Nikhil Amin MD ,&nbsp;Heribert W. Staudinger MD ,&nbsp;David J. Lederer MD ,&nbsp;Megan Hardin MD","doi":"10.1016/j.chpulm.2024.100072","DOIUrl":"10.1016/j.chpulm.2024.100072","url":null,"abstract":"<div><h3>Background</h3><div>Asthma treatment aims to reduce symptom severity and exacerbation risk. Dupilumab, a human monoclonal antibody, blocks the shared receptor for IL-4/IL-13, key drivers of type 2 inflammation. In the Evaluation of Dupilumab in Patients With Persistent Asthma (QUEST) study (NCT02414854), add-on dupilumab every 2 weeks vs placebo was shown to significantly reduce severe asthma exacerbations and improve prebronchodilator (BD) FEV₁ in patients with uncontrolled, moderate-to-severe asthma. Treatment effects were greater in patients with elevated baseline type 2 biomarkers (blood eosinophil count ≥ 150 cells/μL or fractional exhaled nitric oxide ≥ 25 parts per billion).</div></div><div><h3>Research Question</h3><div>What is dupilumab’s long-term efficacy (up to 3 years) in patients with moderate-to-severe type 2 asthma?</div></div><div><h3>Study Design and Methods</h3><div>Patients enrolled in QUEST (receiving placebo or dupilumab), who completed 96 weeks of dupilumab treatment in the open-label extension Long-Term Safety Evaluation of Dupilumab in Patients With Asthma (TRAVERSE) study (NCT02134028), were included. This prespecified analysis evaluated long-term efficacy in patient populations identified by baseline type 2 biomarker level. End points were annualized exacerbation rate (AER) and change from baseline in pre-BD FEV₁ (L), asthma control (5-item Asthma Control Questionnaire), and asthma-related quality of life (Asthma Quality of Life Questionnaire).</div></div><div><h3>Results</h3><div>A total of 663 patients were included. AER was 1.72 to 2.24 at QUEST baseline in dupilumab groups across type 2 populations. AER decreased in populations with elevated type 2 biomarkers to 0.36 to 0.49 during QUEST’s 52-week treatment period, which was sustained over 96 weeks in TRAVERSE. In patients with low type 2 biomarker levels, there was no clinically meaningful AER reduction in QUEST or TRAVERSE, but rates remained below parent study baseline. Similar trends were seen with improvements in pre-BD FEV₁, 5-item Asthma Control Questionnaire, and Asthma Quality of Life Questionnaire; greatest improvements were seen in groups with one or more elevated type 2 biomarker.</div></div><div><h3>Intrepretation</h3><div>This study suggests that long-term dupilumab treatment results in sustained and clinically meaningful efficacy in patients with moderate-to-severe type 2 asthma characterized by elevated blood eosinophil count and/or fractional exhaled nitric oxide.</div></div><div><h3>Clinical Trial Registration</h3><div>ClinicalTrials.gov; No.: NCT02134028; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 1","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691503","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":"Delays in Referral to Multidisciplinary Care for Black Individuals With Sarcoidosis","authors":"Kristen R. Mathias MD ,&nbsp;Ofure Akhiwu MD ,&nbsp;Ali M. Mustafa MD ,&nbsp;Kevin J. Psoter PhD ,&nbsp;Edward S. Chen MD ,&nbsp;Nisha A. Gilotra MD ,&nbsp;Nancy W. Lin MD ,&nbsp;John Odackal MD ,&nbsp;Catherine A. Bonham MD ,&nbsp;Michelle Sharp MD","doi":"10.1016/j.chpulm.2024.100125","DOIUrl":"10.1016/j.chpulm.2024.100125","url":null,"abstract":"<div><h3>Background</h3><div>Sarcoidosis is a complex granulomatous disease that benefits from multidisciplinary subspecialty expertise. Inequitable access to care contributes to racial disparities in many diseases; however, to our knowledge, no studies have examined racial differences in referral times to Sarcoidosis Centers of Excellence.</div></div><div><h3>Research Question</h3><div>Is there an association between race and time from sarcoidosis diagnosis to referral to an independently certified, peer-reviewed World Association of Sarcoidosis and Other Granulomatous Disorders Center of Excellence? Does a referral result in a change in sarcoidosis management?</div></div><div><h3>Study Design and Methods</h3><div>We retrospectively reviewed all 2021 referrals to the Johns Hopkins Sarcoidosis Center of Excellence. Multivariable Cox regression evaluated the association between race and time to referral, adjusting for covariates of sex, ethnicity, referral type, referral provider, insurance provider, employment status, organ involvement, and sarcoidosis medications. Changes in sarcoidosis management including treatment changes, additional organ evaluation, and/or additional subspecialty expertise were ascertained 1 year after establishing care.</div></div><div><h3>Results</h3><div>At total of 207 individuals were analyzed (40% Black, 55% White, and 5% Asian and other race). Black individuals experienced longer referral delay than White individuals, with a median of 9 vs 5 years, respectively (<em>P</em> &lt; .05). In multivariable analysis, the hazard of referral for White individuals was higher than for Black individuals (hazard ratio, 2.04; 95% CI, 1.48-2.82; <em>P</em> &lt; .001), independent of the covariates. Sarcoidosis management changed in 78% of individuals after referral.</div></div><div><h3>Interpretation</h3><div>Black patients experienced significant delays in referral to a multidisciplinary subspecialty Sarcoidosis Center of Excellence compared with other racial groups. Recognition of referral delay may offer insight and opportunity to address disparities in clinical outcomes observed in Black individuals with sarcoidosis. Future multicenter studies must quantify the impact of care received through World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Centers of Excellence, define patient phenotypes in need of urgent referral, and develop targeted patient and provider outreach.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 53-Year-Old Woman With Stage IV Non-Small Cell Lung Cancer and Progressive Paratracheal Lymphadenopathy","authors":"Alberto Goizueta MD ,&nbsp;Aileen Anglin APRN, ACNP-BC, AOCNP ,&nbsp;Bruce F. Sabath MD","doi":"10.1016/j.chpulm.2024.100081","DOIUrl":"10.1016/j.chpulm.2024.100081","url":null,"abstract":"<div><h3>Case Presentation</h3><div>A 53-year-old woman with a history of <em>EGFR</em> mutation-positive stage IV lung adenocarcinoma underwent scheduled surveillance imaging. The disease was stable with osimertinib treatment for the preceding 24 months. Surveillance imaging noted new paratracheal adenopathy concerning for cancer progression. She was referred to interventional pulmonology for bronchoscopic evaluation. She provided written informed consent.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716748","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 Dramatic Decline in Lung Transplantation for Cystic Fibrosis in the United States","authors":"Tijana Milinic MD ,&nbsp;Kathleen J. Ramos MD, MSc ,&nbsp;Eliana R. Gill PhD ,&nbsp;Nora Burdis MD ,&nbsp;Christopher H. Goss MD, MSc ,&nbsp;Siddhartha G. Kapnadak MD","doi":"10.1016/j.chpulm.2024.100077","DOIUrl":"10.1016/j.chpulm.2024.100077","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140060","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":"Is Rapid On-Site Cytology Evaluation Cost-Effective in Navigational Bronchoscopy? The Challenge of Modeling Benefit in the Rapidly Evolving Landscape of Advanced Diagnostic Bronchoscopy","authors":"Kim Styrvoky MD ,&nbsp;Dominique J. Pepper MD","doi":"10.1016/j.chpulm.2024.100078","DOIUrl":"10.1016/j.chpulm.2024.100078","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 4","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140063","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}