Pub Date : 2019-05-01DOI: 10.1097/CPM.0000000000000312
R. Imai, R. Tsugitomi, H. Nakaoka, T. Jinta, T. Tamura
Acute exacerbation of interstitial lung disease (AE-ILD) causes severe respiratory failure so that the patients would often require mechanical ventilation. Mechanical ventilation may improve survival in selected patients with AE-ILD; however, in-hospital mortality rate is so high in patients who need mechanical ventilation that the use of mechanical ventilation is weakly recommended. Although there is no fixed strategy with regard to selection of oxygen devices, a palliative approach to how to spend the end-of-life periods is often needed. Although noninvasive ventilation may be used to avoid intubation, high-flow nasal cannula (HFNC) was developed in recent years and has been feasible and useful for acute respiratory failure of various causes. In terms of the quality of life, moreover, HFNC systems are associated with patient comfort and tolerance and more ability for oral intake of nutrition and less occurrence of cognitive dysfunction or coma. HFNC has broad utility, and it is likely that usage will increase more and more in the future. Limited data of its use in AE-ILD are available, and further study will be necessary.
{"title":"Noninvasive Oxygenation Strategies For Acute Exacerbation of Interstitial Lung Disease: A Retrospective Single-center Study and a Review of the Literature","authors":"R. Imai, R. Tsugitomi, H. Nakaoka, T. Jinta, T. Tamura","doi":"10.1097/CPM.0000000000000312","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000312","url":null,"abstract":"Acute exacerbation of interstitial lung disease (AE-ILD) causes severe respiratory failure so that the patients would often require mechanical ventilation. Mechanical ventilation may improve survival in selected patients with AE-ILD; however, in-hospital mortality rate is so high in patients who need mechanical ventilation that the use of mechanical ventilation is weakly recommended. Although there is no fixed strategy with regard to selection of oxygen devices, a palliative approach to how to spend the end-of-life periods is often needed. Although noninvasive ventilation may be used to avoid intubation, high-flow nasal cannula (HFNC) was developed in recent years and has been feasible and useful for acute respiratory failure of various causes. In terms of the quality of life, moreover, HFNC systems are associated with patient comfort and tolerance and more ability for oral intake of nutrition and less occurrence of cognitive dysfunction or coma. HFNC has broad utility, and it is likely that usage will increase more and more in the future. Limited data of its use in AE-ILD are available, and further study will be necessary.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"87 - 91"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43431199","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}
Pub Date : 2019-05-01DOI: 10.1097/CPM.0000000000000304
Kaoru Harada, C. Price
Primary immunodeficiency diseases are becoming more frequently diagnosed in the adult population. Although infections are the most common symptoms, patients can also present with sequelae of autoimmune and noninfectious pulmonary diseases, such as interstitial lung disease and granulomatous disease. Pulmonologists are likely to encounter patients with various and, at times, subtle symptoms suggestive of immunodeficiency. In this review article, we discuss the presentation, evaluation, and management of 4 antibody deficiencies: common variable immunodeficiency, selective immunoglobulin A deficiency, specific antibody deficiency, and immunoglobulin G subclass deficiency.
{"title":"Subtle But Clinically Significant: A Review of Antibody Deficiencies in Adults","authors":"Kaoru Harada, C. Price","doi":"10.1097/CPM.0000000000000304","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000304","url":null,"abstract":"Primary immunodeficiency diseases are becoming more frequently diagnosed in the adult population. Although infections are the most common symptoms, patients can also present with sequelae of autoimmune and noninfectious pulmonary diseases, such as interstitial lung disease and granulomatous disease. Pulmonologists are likely to encounter patients with various and, at times, subtle symptoms suggestive of immunodeficiency. In this review article, we discuss the presentation, evaluation, and management of 4 antibody deficiencies: common variable immunodeficiency, selective immunoglobulin A deficiency, specific antibody deficiency, and immunoglobulin G subclass deficiency.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"71 - 75"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49109973","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}
Pub Date : 2019-05-01DOI: 10.1097/CPM.0000000000000311
S. Mongodi, S. Bonaiti, A. Stella, A. Colombo, Erminio Santangelo, R. Vaschetto, A. Orlando, B. Bouhemad, F. Mojoli
Supplemental Digital Content is available in the text. Lung ultrasound has greatly developed in the last decade, becoming increasingly important both for the diagnosis and for the monitoring of acute respiratory failure; it can be used on a daily basis at the bedside to improve the clinical assessment of the critically ill. This review describes how lung ultrasound can be used to assess patients with acute respiratory distress syndrome (ARDS), from the initial diagnosis to the daily management and monitoring. Quantification of lung aeration can be performed at the bedside with the lung ultrasound score; it is reliable when compared with computed tomography scan, easy to learn, and repeatable. It can be used to guide mechanical ventilation, to identify positive end-expiratory pressure responders, and to assess the efficacy of recruitment maneuvers or pronation. It can be used to monitor recovery from the respiratory disorder and to detect an increase in extravascular lung water during fluid resuscitation. Alone or combined with other ultrasound techniques, lung ultrasound can help in the weaning process. Moreover, frequent ARDS complications such as pneumothorax and ventilator-associated pneumonia can be detected by ultrasound, which also serves as a guide to procedures such as fiberoptic bronchoscopy and pleural drainage. Thanks to its many clinical applications, lung ultrasound may in the future become part of the standard approach to patients with ARDS.
{"title":"Lung Ultrasound for Daily Monitoring and Management of ARDS Patients","authors":"S. Mongodi, S. Bonaiti, A. Stella, A. Colombo, Erminio Santangelo, R. Vaschetto, A. Orlando, B. Bouhemad, F. Mojoli","doi":"10.1097/CPM.0000000000000311","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000311","url":null,"abstract":"Supplemental Digital Content is available in the text. Lung ultrasound has greatly developed in the last decade, becoming increasingly important both for the diagnosis and for the monitoring of acute respiratory failure; it can be used on a daily basis at the bedside to improve the clinical assessment of the critically ill. This review describes how lung ultrasound can be used to assess patients with acute respiratory distress syndrome (ARDS), from the initial diagnosis to the daily management and monitoring. Quantification of lung aeration can be performed at the bedside with the lung ultrasound score; it is reliable when compared with computed tomography scan, easy to learn, and repeatable. It can be used to guide mechanical ventilation, to identify positive end-expiratory pressure responders, and to assess the efficacy of recruitment maneuvers or pronation. It can be used to monitor recovery from the respiratory disorder and to detect an increase in extravascular lung water during fluid resuscitation. Alone or combined with other ultrasound techniques, lung ultrasound can help in the weaning process. Moreover, frequent ARDS complications such as pneumothorax and ventilator-associated pneumonia can be detected by ultrasound, which also serves as a guide to procedures such as fiberoptic bronchoscopy and pleural drainage. Thanks to its many clinical applications, lung ultrasound may in the future become part of the standard approach to patients with ARDS.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"92 - 97"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42696383","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}
Pub Date : 2019-05-01DOI: 10.1097/CPM.0000000000000310
Samuel Chung, D. Zappetti
{"title":"Can Quadrupling Inhaled Glucocorticoid Dose During Early Asthma Exacerbation Reduce the Need For Systemic Steroids or Hospital Admission?","authors":"Samuel Chung, D. Zappetti","doi":"10.1097/CPM.0000000000000310","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000310","url":null,"abstract":"","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47779918","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}
Pub Date : 2019-03-01DOI: 10.1097/CPM.0000000000000302
A. Pronko, D. Zappetti
Synopsis: Dupilumab is a novel biologic agent that targets the shared interleukin 4/13 receptor. It is safe and efficacious in patients with moderateto-severe asthma; however, subgroup analysis suggests that patients with elevated markers of type-2 inflammation benefit most from this drug. Source: Castro M, Corren J, Pavord ID, et al. Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma. NEJM 2018;378: 2486–2496.
{"title":"Efficacy of Dupilumab for Treatment of Moderate-to-Severe Asthma","authors":"A. Pronko, D. Zappetti","doi":"10.1097/CPM.0000000000000302","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000302","url":null,"abstract":"Synopsis: Dupilumab is a novel biologic agent that targets the shared interleukin 4/13 receptor. It is safe and efficacious in patients with moderateto-severe asthma; however, subgroup analysis suggests that patients with elevated markers of type-2 inflammation benefit most from this drug. Source: Castro M, Corren J, Pavord ID, et al. Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma. NEJM 2018;378: 2486–2496.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44788908","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}
Pub Date : 2019-03-01DOI: 10.1097/CPM.0000000000000299
A. Tiwari, M. Bowling
The pulmonary vasculitides are an uncommon group of disorders that are characterized by inflammation and necrosis of the blood vessel wall, usually involving the small and medium-sized blood vessels in the lung. Management has traditionally involved the use of immunosuppressive agents and newer adjunctive therapies such as plasmapheresis. Recent trials over the last decade have highlighted the successful use of these agents in treating this life-threatening illness; however, much remains unknown in terms of exact dosing of these agents and duration of treatment. Adverse events from these therapies remain a serious concern requiring close monitoring and a multidisciplinary approach. Other advances in this field include exploration of newer drugs, some of which are currently being used in randomized trials. This review is an update on the advances made in the management of pulmonary vasculitis over recent years, along with a suggested uniform approach to management based on disease severity classification.
{"title":"Management of Pulmonary Vasculitis: A Concise Review","authors":"A. Tiwari, M. Bowling","doi":"10.1097/CPM.0000000000000299","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000299","url":null,"abstract":"The pulmonary vasculitides are an uncommon group of disorders that are characterized by inflammation and necrosis of the blood vessel wall, usually involving the small and medium-sized blood vessels in the lung. Management has traditionally involved the use of immunosuppressive agents and newer adjunctive therapies such as plasmapheresis. Recent trials over the last decade have highlighted the successful use of these agents in treating this life-threatening illness; however, much remains unknown in terms of exact dosing of these agents and duration of treatment. Adverse events from these therapies remain a serious concern requiring close monitoring and a multidisciplinary approach. Other advances in this field include exploration of newer drugs, some of which are currently being used in randomized trials. This review is an update on the advances made in the management of pulmonary vasculitis over recent years, along with a suggested uniform approach to management based on disease severity classification.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"46–52"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000299","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42667732","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}
Pub Date : 2019-03-01DOI: 10.1097/CPM.0000000000000300
Lakshmi Warrior, T. Bleck
Neurological emergencies present a unique challenge in the intensive care unit, requiring rapid evaluation and treatment. There is a complex interplay in critically ill patients, wherein illness affects the brain and the brain can, in turn, affect the illness, making diagnosis and management challenging. In this review, we discuss the diagnosis and management of common neurological issues that may be encountered in the intensive care unit, including elevated intracranial pressure, traumatic brain injury, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, status epilepticus, neurological complications of critical illness, neuromuscular respiratory failure, and neurological complications in the immunocompromised.
{"title":"Neurological Emergencies in the Intensive Care Unit","authors":"Lakshmi Warrior, T. Bleck","doi":"10.1097/CPM.0000000000000300","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000300","url":null,"abstract":"Neurological emergencies present a unique challenge in the intensive care unit, requiring rapid evaluation and treatment. There is a complex interplay in critically ill patients, wherein illness affects the brain and the brain can, in turn, affect the illness, making diagnosis and management challenging. In this review, we discuss the diagnosis and management of common neurological issues that may be encountered in the intensive care unit, including elevated intracranial pressure, traumatic brain injury, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, status epilepticus, neurological complications of critical illness, neuromuscular respiratory failure, and neurological complications in the immunocompromised.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"53–60"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41573935","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}
Pub Date : 2019-03-01DOI: 10.1097/CPM.0000000000000293
E. Jensen, P. Panse, K. Cummings, C. Jokerst, M. Gotway
The pulmonary vasculitides include a wide spectrum of disorders that have in common inflammation and destruction of pulmonary blood vessels. Granulomatosis with polyangiitis (GPA), formerly known as Wegener granulomatosis, is the most common of the antineutrophil cytoplasmic antibody–associated small-vessel vasculitides, and affects a number of organ systems. GPA affects a wide age range, although it typically presents in middle adulthood. The classic triad of GPA—upper airway involvement (sinusitis, otitis media, mucosal ulcerations, airway inflammation), lower respiratory tract disease, and glomerulonephritis—is not always evident at presentation. Furthermore, limited forms of GPA occur, in which the expected upper airway and renal involvement may be lacking. The imaging manifestations of GPA commonly include multiple, bilateral nodules or masses, frequently with cavitation or necrosis. Diffuse lung opacity due to alveolar hemorrhage, or tracheobronchial inflammation that may result in stenosis, may be encountered. Systemic GPA may be diagnosed when cytoplasmic antineutrophil cytoplasmic antibody/anti-proteinase 3 antibodies are detected in the proper clinical context, but, often, the diagnosis of GPA relies on recognition of a combination of common clinical, laboratory, and imaging findings with typical histopathologic changes noted from a biopsy of the affected tissue. A combination of a corticosteroid and immunomodulatory agents is used to induce and maintain remission in patients with GPA. Although potentially fatal if untreated, immunosuppressive therapy has dramatically improved survivorship in patients with GPA.
{"title":"Cough and Nasal Pain: Putting Together an Uncommon Diagnosis","authors":"E. Jensen, P. Panse, K. Cummings, C. Jokerst, M. Gotway","doi":"10.1097/CPM.0000000000000293","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000293","url":null,"abstract":"The pulmonary vasculitides include a wide spectrum of disorders that have in common inflammation and destruction of pulmonary blood vessels. Granulomatosis with polyangiitis (GPA), formerly known as Wegener granulomatosis, is the most common of the antineutrophil cytoplasmic antibody–associated small-vessel vasculitides, and affects a number of organ systems. GPA affects a wide age range, although it typically presents in middle adulthood. The classic triad of GPA—upper airway involvement (sinusitis, otitis media, mucosal ulcerations, airway inflammation), lower respiratory tract disease, and glomerulonephritis—is not always evident at presentation. Furthermore, limited forms of GPA occur, in which the expected upper airway and renal involvement may be lacking. The imaging manifestations of GPA commonly include multiple, bilateral nodules or masses, frequently with cavitation or necrosis. Diffuse lung opacity due to alveolar hemorrhage, or tracheobronchial inflammation that may result in stenosis, may be encountered. Systemic GPA may be diagnosed when cytoplasmic antineutrophil cytoplasmic antibody/anti-proteinase 3 antibodies are detected in the proper clinical context, but, often, the diagnosis of GPA relies on recognition of a combination of common clinical, laboratory, and imaging findings with typical histopathologic changes noted from a biopsy of the affected tissue. A combination of a corticosteroid and immunomodulatory agents is used to induce and maintain remission in patients with GPA. Although potentially fatal if untreated, immunosuppressive therapy has dramatically improved survivorship in patients with GPA.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"63–67"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000293","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48346517","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}
Pub Date : 2019-03-01DOI: 10.1097/cpm.0000000000000307
{"title":"Myth: For Bronchoscopy Training in the 21st Century, there is a Standard Curriculum or Metrics for EBUS-TBNA Bronchoscopy Education With Good Supporting Evidence: Erratum","authors":"","doi":"10.1097/cpm.0000000000000307","DOIUrl":"https://doi.org/10.1097/cpm.0000000000000307","url":null,"abstract":"","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/cpm.0000000000000307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49038114","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}
Pub Date : 2019-03-01DOI: 10.1097/CPM.0000000000000303
Christopher Mcgrath, F. West, D. Zappetti
reach peak benefit by week 12. However, subgroup analysis shows that this drug is primarily effective in patients with increased baseline eosinophil count or increased fraction of exhaled nitric oxide, and performs no differently than matched volume placebo in patients who do not have these proxies of type-2 inflammation; therefore, thoughtful consideration of patient candidacy is still necessary when using dupilumab as a treatment adjunct. Dupilumab is a welcome addition to a growing armamentarium against asthma mediated by type-2 inflammation, with a novel mechanism that targets both IL-4 and IL-13.
{"title":"Zephyr Endobronchial Valves Improve FEV1 and Quality of Life in Heterogenous Emphysema","authors":"Christopher Mcgrath, F. West, D. Zappetti","doi":"10.1097/CPM.0000000000000303","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000303","url":null,"abstract":"reach peak benefit by week 12. However, subgroup analysis shows that this drug is primarily effective in patients with increased baseline eosinophil count or increased fraction of exhaled nitric oxide, and performs no differently than matched volume placebo in patients who do not have these proxies of type-2 inflammation; therefore, thoughtful consideration of patient candidacy is still necessary when using dupilumab as a treatment adjunct. Dupilumab is a welcome addition to a growing armamentarium against asthma mediated by type-2 inflammation, with a novel mechanism that targets both IL-4 and IL-13.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43541853","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}
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