Journal of Clinical Anesthesia最新文献

{"title":"Corrigendum to \"Unmasking the silent threat: Navigating the myocardial injury in oncological surgery\" [Journal of Clinical Anesthesia 108 (2026) 112063].","authors":"Zhen-Zhen Xu, Dong-Liang Mu","doi":"10.1016/j.jclinane.2025.112111","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.112111","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"112111"},"PeriodicalIF":5.1,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protection of the nasotracheal tube tip with a red rubber catheter in adults undergoing nasotracheal intubation: A randomized controlled trial","authors":"Neil S. Bailard MD ,&nbsp;David W. Mercier MD ,&nbsp;Christina A. Riccio MD ,&nbsp;Catherine N. Vu MD ,&nbsp;Peter W. Hsu MD ,&nbsp;Rebekka Reinhardt MD ,&nbsp;Paul A. Nakonezny PhD ,&nbsp;Carin A. Hagberg MD","doi":"10.1016/j.jclinane.2025.112109","DOIUrl":"10.1016/j.jclinane.2025.112109","url":null,"abstract":"<div><h3>Background</h3><div>Nasotracheal intubation (NTI) is often required for oropharyngeal surgery to maximize surgical access, but epistaxis is a common complication. NTI using a nasotracheal tube (NTT) telescoped into a red rubber urinary catheter (RRC) to guide the NTT and protect the nasal mucosa has been described for adults and studied in children but has not been systematically evaluated in adults.</div></div><div><h3>Methods</h3><div>This was a two-center, single-blinded, randomized controlled trial. 112 adults (mean age 57.1 ± 16.3 years, 61.6 % male) undergoing surgery requiring NTI were randomized 1: 1 to intubation with a thermosoftened, lubricated NTT, either alone or telescoped into an RRC to shield the beveled NTT tip. The primary outcome was incidence of epistaxis assessed at 5 min post-intubation by a blinded observer. Secondary outcomes included the severity of epistaxis, time to intubation, the rate of complications during nasotracheal intubation, and the degree of postoperative pain in PACU.</div></div><div><h3>Results</h3><div>Use of an RRC significantly reduced the likelihood of epistaxis (39.3 % vs. 62.5 %, Odds Ratio (OR) = 0.380, <em>p</em> = 0.0140; 95 % CI: 0.174 to 0.831, <em>p</em> = 0.0153; FDR = 0.0255) and the severity of epistaxis (OR for lower severity = 4.145; 95 % CI: 1.923 to 8.934, <em>p</em> = 0.0003; FDR = 0.0013), but was associated with a longer time to intubation (Least squares adjusted means 104.2 (SE = 6.87) seconds vs. 74.30 (SE = 6.86) seconds, <em>p</em> = 0.0005; FDR = 0.0015, d = 0.70). No difference was found in postoperative pain or in the rate of procedural complications.</div></div><div><h3>Conclusions</h3><div>Use of the RRC significantly reduced the likelihood and severity of epistaxis following nasal intubation, at the cost of longer time to intubation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112109"},"PeriodicalIF":5.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between infraspinatus-Teres minor (ITM) Interfascial block and superior trunk block in shoulder arthroscopy: A randomized non-inferiority trial","authors":"Yu He M.D ,&nbsp;Wei Zhao M.D. ,&nbsp;Zhenyu Ze M.D. ,&nbsp;Yan Zhao M.D. ,&nbsp;Manyun Bao M.D. ,&nbsp;Ming Yan M.D","doi":"10.1016/j.jclinane.2025.112106","DOIUrl":"10.1016/j.jclinane.2025.112106","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate whether there are differences in postoperative pain scores and the incidence of hemidiaphragmatic paralysis (HDP) between ultrasound-guided superior trunk block (STB) and infraspinatus teres minor fascial plane block (ITM).</div></div><div><h3>Design</h3><div>Prospective, randomized controlled non-inferiority trial.</div></div><div><h3>Setting</h3><div>A tertiary hospital.</div></div><div><h3>Patients</h3><div>A total of 100 patients aged 18 to 65 years scheduled for elective arthroscopic surgery were enrolled.</div></div><div><h3>Interventions</h3><div>Following sterile skin preparation, patients in the STB group received 15 mL of 0.375 % ropivacaine, while those in the ITM group received 25 mL of 0.375 % ropivacaine.</div></div><div><h3>Measurements</h3><div>The primary outcome was the highest resting pain score during the first 24 h postoperatively. Secondary outcomes included resting pain scores at six predefined time points (1, 3, 6, 9, 12,and 24 h), the incidence and severity of hemidiaphragmatic paralysis (HDP), block performance time, sensory block onset time, duration of analgesia, postoperative rescue analgesic consumption, grip strength, patient satisfaction scores, 24-h Quality of Recovery-15 (QoR-15) assessments, and Overall Benefit of Analgesia Scores (OBAS).</div></div><div><h3>Main results</h3><div>Within 24 h postoperation, the highest pain score was 3 [2.0–4.0] in the STB group and 3 [2.8 to 4.3] in the ITM group, with a median difference of 0 (95 % CI, −1 to 0). The upper limit of the 95 % CI was below the prespecified non-inferiority margin of 1″. (non-inferiority <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>For maximal postoperative pain control within 24 h after shoulder arthroscopy, the ITM block was noninferior to STB, with significantly reduced diaphragmatic paralysis rates.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112106"},"PeriodicalIF":5.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a multimodal awareness campaign on preoperative fasting times and postoperative recovery: A prospective before-after study","authors":"Paul Tauzi,&nbsp;Emilie Wargnier,&nbsp;Jeremy Klotz,&nbsp;Marie Dubillot,&nbsp;Sigismond Lasocki,&nbsp;Emmanuel Rineau","doi":"10.1016/j.jclinane.2025.112104","DOIUrl":"10.1016/j.jclinane.2025.112104","url":null,"abstract":"<div><h3>Introduction</h3><div>Application of preoperative fasting rules appears insufficient despite the impact of excessive fasting on patient comfort and morbidity. Primary endpoint of the study was fasting durations before and after a multimodal awareness campaign about fasting rules.</div></div><div><h3>Methods</h3><div>This observational prospective study assessed liquid and solid fasting durations and their impact on recovery before and after a multimodal and multidisciplinary awareness campaign against excessive fasting. Fasting durations and data related to comfort and rehabilitation were collected at the admission to the operating room and on Day 1. Primary endpoint was the comparison of liquid and solid fasting times between the two groups. Secondary endpoints included quality of recovery.</div></div><div><h3>Results</h3><div>365 patients were included in the study in adult surgical departments, 185 during phase 1 from February to April 2023 and 179 during phase 2 from June to July 2023. Liquid fasting time were reduced in phase 2 with 7.5 [4.5–12.8] hours and 6.3 [3.7–11.3] hours in phase 1 and 2 (<em>p</em> &lt; 0.001). Median solid fasting times were not reduced with 14.3 [12.3–17.0] hours in phase 1 versus 14.3 [12.4–16.5] in phase 2 (<em>p</em> = 0.66). Mean FQoR-15 recovery score was better in phase 2 compared to phase 1 (133 [CI 95 %: 129,6–136,1] vs 123 [CI 95 %: 119,3–125,8] respectively, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>After a multimodal awareness campaign, both median preoperative liquid fasting time and quality of recovery score were improved. However, the median solid fasting time was not reduced, calling for additional measures to further improve patient care.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112104"},"PeriodicalIF":5.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between preoperative frailty and major postoperative complications in older surgical patients","authors":"Lu Dong ,&nbsp;Fang Wen ,&nbsp;Lu-Mei Qin ,&nbsp;Xiao-Yan Zhi ,&nbsp;Run Li ,&nbsp;Yi Liang ,&nbsp;Wen Song ,&nbsp;Qun Xia ,&nbsp;Jian Wu ,&nbsp;Li Qiu ,&nbsp;Qiang-Lin Yi ,&nbsp;Yang Zhao ,&nbsp;Li Yan ,&nbsp;Fang-Zhou Yang ,&nbsp;Shang Shi ,&nbsp;Lu Chen ,&nbsp;Jie-Qiong Luo ,&nbsp;Wen-Qi Zhang ,&nbsp;Li Zeng ,&nbsp;Kun Zhou ,&nbsp;Xiao-Hua Zou","doi":"10.1016/j.jclinane.2025.112099","DOIUrl":"10.1016/j.jclinane.2025.112099","url":null,"abstract":"<div><h3>Study objective</h3><div>To assess the relationship between frailty and major postoperative complications (POCs) in elderly patients undergoing elective surgery.</div></div><div><h3>Design</h3><div>A prospective cohort study.</div></div><div><h3>Setting</h3><div>Five hospitals in China.</div></div><div><h3>Patients</h3><div>A total of 1358 elderly patients (≥65 years) were included.</div></div><div><h3>Exposure</h3><div>Preoperative frailty.</div></div><div><h3>Measurements</h3><div>The primary outcome was major POCs. LASSO regression was used for selecting covariates. Multivariate logistic regression modeling were used to evaluate the associations between frailty and major POCs. Net Reclassification Index (NRI) and Integrated Discriminant Improvement Index (IDI) were calculated to further assess the additional predictive value of the frailty for major POCs beyond the identified risk factors. Further subgroup analyses were conducted to determine the robustness of the associations.</div></div><div><h3>Main results</h3><div>Logistic regression modeling revealed that frailty was associated with major POCs (adjusted odds ratio [aOR], 95 % confidence interval [CI]: 2.61, 1.47–4.62). Each 1-point increase in frailty was associated with a 35 % increase in the risk of major POCs (aOR, 95 % CI: 1.35, 1.10–1.66). Slow walking speed, low physical activity and frequent exhaustion were independently associated with major POCs. Their ORs (95 % CI): 2.34 (1.33–4.13), 1.98 (1.09–3.57), 2.26 (1.28–3.99). Adding frailty to baseline risk model improved the predictive value of major POCs (NRI: 0.5551, 0.3095–0.8006; IDI: 0.0144, 0.0003–0.0286). Subgroup analyses revealed the same trend between frailty and major POCs.</div></div><div><h3>Conclusions</h3><div>Frail elderly patients scheduled for elective surgery were at an increased risk of major POCs, especially those with slow walking speed, low levels of physical activity, and frequent feelings of exhaustion.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112099"},"PeriodicalIF":5.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The neurocardiac axis in acute intracranial stress","authors":"Wesley L. Allen ,&nbsp;Kiran S. Merchant ,&nbsp;Archer K. Martin,&nbsp;Shaun E. Gruenbaum,&nbsp;Benjamin F. Gruenbaum","doi":"10.1016/j.jclinane.2025.112105","DOIUrl":"10.1016/j.jclinane.2025.112105","url":null,"abstract":"<div><div>Acute intracranial injuries including subarachnoid hemorrhage, traumatic brain injury, stroke, and seizures often trigger cardiovascular and pulmonary complications through the neurocardiac axis. This bidirectional connection between the brain and the heart is mediated by sympathetic overactivity, catecholamine excess, autonomic imbalance, and systemic inflammation. This narrative review synthesizes current evidence published between 1968 and 2025, identified through a comprehensive literature search. Representative studies were selected to provide an integrative overview of neurocardiac complications in acute neurologic injury, focusing on underlying mechanisms, clinical manifestations, diagnostic challenges, and management strategies. We describe the mechanisms underlying neurogenic stunned myocardium and Takotsubo syndrome, highlighting regional vulnerability based on autonomic innervation. Electrocardiographic features, cardiac biomarkers, and echocardiographic findings are discussed in the context of early recognition and risk stratification. We further examine diagnostic challenges, the importance of distinguishing neurologic from primary cardiac pathology, and therapeutic approaches including autonomic modulation and cardiopulmonary protective strategies. Understanding the unique pathogenesis of these syndromes can help guide individualized treatment strategies and anesthetic management to improve outcomes in patients with acute neurologic injury. By consolidating multidisciplinary insights, this review aims to enhance recognition and management of neurocardiac complications in this population.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112105"},"PeriodicalIF":5.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative cannabinoid exposure and postoperative pain: A narrative review","authors":"Daniel D. King ,&nbsp;Rhea Temmermand ,&nbsp;Jennifer E. Greenwood","doi":"10.1016/j.jclinane.2025.112097","DOIUrl":"10.1016/j.jclinane.2025.112097","url":null,"abstract":"<div><h3>Background</h3><div>Cannabis use is increasingly common, yet its effects on postoperative pain and opioid requirements remain unclear. While cannabinoids are used in chronic pain, their role in acute perioperative recovery is less defined.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, CINAHL, and Embase identified studies published within the past ten years that examined preoperative cannabis use and its relationship with postoperative pain and opioid consumption. Forty-two studies met the inclusion criteria. Data were extracted and summarized using a narrative synthesis methodology.</div></div><div><h3>Results</h3><div>Exposure definitions, surgical specialties, and outcome metrics were heterogeneous, limiting cross-study comparability; therefore, effects were reported in their native form without pooling. Of the 42 included studies, 14 (33.3 %) found that cannabis users reported higher postoperative pain, 10 (23.8 %) reported no difference, 2 (4.8 %) suggested reduced pain, and 16 (38.1 %) did not report pain outcomes. Regarding opioids, 18 studies (42.9 %) indicated greater postoperative requirements, 17 (40.5 %) found no difference, 3 (7.1 %) suggested reduced use, and 4 (9.5 %) did not report opioid outcomes. Specialty-specific patterns emerged: mixed cohorts (90 %) and spine populations (55 %) more frequently reported increased opioid use, whereas arthroplasty studies more often reported no difference (62 %). Limited, low-certainty evidence suggested that resuming cannabis after discharge was associated with lower persistent opioid use.</div></div><div><h3>Conclusions</h3><div>Preoperative cannabis exposure is associated with increased postoperative pain and opioid requirements in some, but not all, surgical contexts. Outcomes vary by specialty, and residual confounding and nonstandardized exposure measurement constrain inference, underscoring the need for standardized exposure definitions, prospective designs, and individualized perioperative pain strategies.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112097"},"PeriodicalIF":5.1,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracting intraoperative blood loss from unstructured clinical narratives","authors":"Anne B. Alnor ,&nbsp;Rasmus B. Lynggaard ,&nbsp;Lina E. Pedersen ,&nbsp;Jonas Storgaard ,&nbsp;Martin S. Laursen ,&nbsp;Pernille J. Vinholt","doi":"10.1016/j.jclinane.2025.112101","DOIUrl":"10.1016/j.jclinane.2025.112101","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112101"},"PeriodicalIF":5.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative SGLT2i therapy and acute kidney injury in patients undergoing emergency and urgent coronary artery bypass grafting - A causal inference framework","authors":"Michael Kolland ,&nbsp;Selina Sartori ,&nbsp;Christoph Klivinyi ,&nbsp;Michael Schörghuber ,&nbsp;Jakob Pannold ,&nbsp;Igor Knez ,&nbsp;Alexander H. Kirsch ,&nbsp;Nikolaus Schreiber","doi":"10.1016/j.jclinane.2025.112103","DOIUrl":"10.1016/j.jclinane.2025.112103","url":null,"abstract":"<div><h3>Background</h3><div>Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG), associated with adverse short- and long-term outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce occurrence of AKI in several populations, yet their perioperative effects in patients undergoing CABG are unknown.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study at the Department of Cardiac Surgery, Medical University of Graz (2020–2024) to evaluate the impact of preoperative SGLT2i use on cardiac surgery–associated AKI in adults undergoing urgent or emergent isolated coronary artery bypass grafting in patients with an indication for SGLT2i therapy (type 2 diabetes mellitus, heart failure with reduced ejection fraction, or chronic kidney disease). Patients with preoperative dialysis, sepsis, reoperation, mechanical circulatory support or missing laboratory data were excluded. Exposure was defined as SGLT2i use within two weeks before surgery, and the primary outcome was cardiac surgery-associated AKI (CSA-AKI) according to KDIGO criteria. Secondary outcomes included kidney replacement therapy, ICU length of stay, 30-day mortality and postoperative diabetic ketoacidosis. Causal effects were estimated using entropy balancing. Results were reported as weighted risk differences, risk ratios, and adjusted mean differences, with time-to-event outcomes analyzed via weighted Cox models and Kaplan–Meier estimates.</div></div><div><h3>Results</h3><div>Among 484 patients, 135 were on SGLT2i. CSA-AKI occurred in 23.0 % of SGLT2i users vs. 28.1 % of non-users (risk ratio of 0.63 [95 % CI 0.44–0.91; <em>p</em> = 0.014]). The association was pronounced in patients with heart failure with reduced ejection fraction and those with high EuroSCORE II. No differences were observed in other secondary endpoints and no cases of postoperative diabetic ketoacidosis occurred.</div></div><div><h3>Conclusion</h3><div>Preoperative SGLT2i use was associated with a significantly lower risk of CSA-AKI in patients undergoing urgent or emergent CABG. These findings need to be confirmed in prospective multicenter trials but underline the favorable safety profile of this medication.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112103"},"PeriodicalIF":5.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the operating room: Holistic support for frail surgical patients.","authors":"Aubrey Samost-Williams, Alparslan Turan, Victoria Tang","doi":"10.1016/j.jclinane.2025.112095","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.112095","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"112095"},"PeriodicalIF":5.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}