Hintergrund: Das Risiko, an Lungenkrebs zu erkranken, ist bei Rauchern, Patienten mit chronisch-obstruktiver Lungenerkrankung, Personen, die Umweltkarzinogenen ausgesetzt sind, und Personen mit einer Vorgeschichte von Lungenkrebs erhöht. Autoabgase, die Karzinogene enthalten, sind ein Risikofaktor für Lungenkrebs. Wir gehen jedoch durch unser Leben, ohne zu wissen, dass Autoabgase Krebs verursachen. Insbesondere bei Lungenkrebspatienten ist es wichtig, bereits bestehende Risikofaktoren ausfindig zu machen, sie zu vermeiden und sie nach der Behandlung sorgfältig auf ein Wiederauftreten zu überwachen. Falldarstellung: Dies ist der erste Bericht eines Falls mit dreifachem Lungenkrebs mit unterschiedlichen histologischen Typen an verschiedenen Stellen, der bei einem 76-jährigen Parkwächter beobachtet wurde. Das erste Adenokarzinom und das zweite Plattenepithelkarzinom wurden mit stereotaktischer Radiochirurgie behandelt, da der Patient nicht operiert werden wollte. Obwohl der Patient nach der Diagnose mit dem gelegentlichen Rauchen aufhörte, arbeitete er weiterhin als Parkwächter auf dem Parkplatz. 29 Monate nach der ersten Behandlung entwickelte der Patient ein drittes neues kleinzelliges Lungenkarzinom; er wurde mit Chemotherapie behandelt. Schlussfolgerungen: Eine neue Masse nach der Behandlung von Lungenkrebs könnte eher ein multipler primärer Lungenkrebs als eine Metastase sein. Daher ist eine präzise Bewertung wichtig. Dieser Artikel beleuchtet die Risikofaktoren für Lungenkrebs, die leicht übersehen werden, aber nicht außer Acht gelassen werden sollten, und die Notwendigkeit, mit Patienten über die Überwachung nach einer Lungenkrebsbehandlung zu sprechen. Wir sollten die bereits exponierten Umweltkarzinogene sorgfältig prüfen und dazu raten, bei Patienten mit Lungenkrebs bereits bestehende Risikofaktoren am Arbeitsplatz oder Wohnort zu vermeiden.
{"title":"Dreifacher primärer Lungenkrebs: ein Fallbericht","authors":"Hye Sook Choi, Ji-Youn Sung","doi":"10.1159/000526925","DOIUrl":"https://doi.org/10.1159/000526925","url":null,"abstract":"Hintergrund: Das Risiko, an Lungenkrebs zu erkranken, ist bei Rauchern, Patienten mit chronisch-obstruktiver Lungenerkrankung, Personen, die Umweltkarzinogenen ausgesetzt sind, und Personen mit einer Vorgeschichte von Lungenkrebs erhöht. Autoabgase, die Karzinogene enthalten, sind ein Risikofaktor für Lungenkrebs. Wir gehen jedoch durch unser Leben, ohne zu wissen, dass Autoabgase Krebs verursachen. Insbesondere bei Lungenkrebspatienten ist es wichtig, bereits bestehende Risikofaktoren ausfindig zu machen, sie zu vermeiden und sie nach der Behandlung sorgfältig auf ein Wiederauftreten zu überwachen. Falldarstellung: Dies ist der erste Bericht eines Falls mit dreifachem Lungenkrebs mit unterschiedlichen histologischen Typen an verschiedenen Stellen, der bei einem 76-jährigen Parkwächter beobachtet wurde. Das erste Adenokarzinom und das zweite Plattenepithelkarzinom wurden mit stereotaktischer Radiochirurgie behandelt, da der Patient nicht operiert werden wollte. Obwohl der Patient nach der Diagnose mit dem gelegentlichen Rauchen aufhörte, arbeitete er weiterhin als Parkwächter auf dem Parkplatz. 29 Monate nach der ersten Behandlung entwickelte der Patient ein drittes neues kleinzelliges Lungenkarzinom; er wurde mit Chemotherapie behandelt. Schlussfolgerungen: Eine neue Masse nach der Behandlung von Lungenkrebs könnte eher ein multipler primärer Lungenkrebs als eine Metastase sein. Daher ist eine präzise Bewertung wichtig. Dieser Artikel beleuchtet die Risikofaktoren für Lungenkrebs, die leicht übersehen werden, aber nicht außer Acht gelassen werden sollten, und die Notwendigkeit, mit Patienten über die Überwachung nach einer Lungenkrebsbehandlung zu sprechen. Wir sollten die bereits exponierten Umweltkarzinogene sorgfältig prüfen und dazu raten, bei Patienten mit Lungenkrebs bereits bestehende Risikofaktoren am Arbeitsplatz oder Wohnort zu vermeiden.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134313363","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":"7 Fragen an die Trägerin des Dissertationspreises 2022 der Deutschen Lungenstiftung","authors":"Steffi Lenz","doi":"10.1159/000526239","DOIUrl":"https://doi.org/10.1159/000526239","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131340002","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":"Pleuraerkrankungen – nur ein nachrangiges Thema in der pneumologischen Routine?","authors":"F. Stanzel","doi":"10.1159/000526593","DOIUrl":"https://doi.org/10.1159/000526593","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114453788","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}
Background: Dyspnea is one of the common symptoms patients present to the emergency department (ED). The broad spectrum of differentials often requires laboratory and radiological testing in addition to clinical evaluation, causing unnecessary delay. Point of care ultrasound (PoCUS) has shown promising results in accurately diagnosing patients with dyspnea, thus, becoming a popular tool in ED while saving time and maintaining safety standards. Our study aimed to determine the utilization of point of care ultrasound in patients with acute dyspnea as an initial diagnostic tool in our settings. Method: ology: The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Adult patients presenting with acute dyspnea were prospectively enrolled. They were clinically evaluated and necessarily investigated, and a provisional diagnosis was made. Another EP, trained in PoCUS, performed the scan, blinded to the laboratory investigations (not the clinical parameters), and made a PoCUS diagnosis. Our gold standard was the final composite diagnosis made by two Emergency Medicine consultants (who had access to all investigations). Accuracy and concordance of the ultrasound diagnosis to the final composite diagnosis were calculated. The time to formulate a PoCUS diagnosis and final composite diagnosis was compared. Results: Two hundred thirty-seven patients were enrolled. The PoCUS and final composite diagnosis showed good concordance (κ = 0.668). PoCUS showed a high sensitivity for acute pulmonary edema, pleural effusion, pneumothorax, pneumonia, pericardial effusion, and low sensitivity for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute respiratory distress syndrome (ARDS)/acute lung injury (ALI). High overall specificity was seen. A high positive predictive value for all except left ventricular dysfunction, pericardial effusion, non-cardiopulmonary causes of dyspnea, and a low negative predictive value was seen for pneumonia. The median time to make a PoCUS diagnosis was 16 (5–264) min compared to the 170 (8–1346) min taken for the final composite diagnosis. Thus, time was significantly lower for PoCUS diagnosis (p value <0.001). Conclusion: By combining the overall accuracy of PoCUS, the concordance with the final composite diagnosis, and the statistically significant reduction in time taken to formulate the diagnosis, PoCUS shows immense promise as an initial diagnostic tool that may expedite the decision-making in ED for patients’ prompt management and disposition with reliable accuracy.
{"title":"Dyspnoe-Symptomatik in der Notaufnahme: PoC-Sonographie als Investition in Diagnosestellung und Patientenversorgung","authors":"G. Sofianos","doi":"10.1159/000526675","DOIUrl":"https://doi.org/10.1159/000526675","url":null,"abstract":"Background: Dyspnea is one of the common symptoms patients present to the emergency department (ED). The broad spectrum of differentials often requires laboratory and radiological testing in addition to clinical evaluation, causing unnecessary delay. Point of care ultrasound (PoCUS) has shown promising results in accurately diagnosing patients with dyspnea, thus, becoming a popular tool in ED while saving time and maintaining safety standards. Our study aimed to determine the utilization of point of care ultrasound in patients with acute dyspnea as an initial diagnostic tool in our settings. Method: ology: The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Adult patients presenting with acute dyspnea were prospectively enrolled. They were clinically evaluated and necessarily investigated, and a provisional diagnosis was made. Another EP, trained in PoCUS, performed the scan, blinded to the laboratory investigations (not the clinical parameters), and made a PoCUS diagnosis. Our gold standard was the final composite diagnosis made by two Emergency Medicine consultants (who had access to all investigations). Accuracy and concordance of the ultrasound diagnosis to the final composite diagnosis were calculated. The time to formulate a PoCUS diagnosis and final composite diagnosis was compared. Results: Two hundred thirty-seven patients were enrolled. The PoCUS and final composite diagnosis showed good concordance (κ = 0.668). PoCUS showed a high sensitivity for acute pulmonary edema, pleural effusion, pneumothorax, pneumonia, pericardial effusion, and low sensitivity for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute respiratory distress syndrome (ARDS)/acute lung injury (ALI). High overall specificity was seen. A high positive predictive value for all except left ventricular dysfunction, pericardial effusion, non-cardiopulmonary causes of dyspnea, and a low negative predictive value was seen for pneumonia. The median time to make a PoCUS diagnosis was 16 (5–264) min compared to the 170 (8–1346) min taken for the final composite diagnosis. Thus, time was significantly lower for PoCUS diagnosis (p value <0.001). Conclusion: By combining the overall accuracy of PoCUS, the concordance with the final composite diagnosis, and the statistically significant reduction in time taken to formulate the diagnosis, PoCUS shows immense promise as an initial diagnostic tool that may expedite the decision-making in ED for patients’ prompt management and disposition with reliable accuracy.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122509516","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}
Background: Current management of poorly draining complex effusions favours less invasive image-guided placement of smaller tubes and adjunctive intrapleural fibrinolysis therapy (IPFT). In MIST-2 trial, intrapleural 10 mg alteplase (t-PA) with 5 mg of pulmozyme (DNase) twice daily for 72 h were used. We aimed to assess the effectiveness and safety of a modified regimen 16 mg t-PA with 5 mg of DNase administered over 24 h in the management of complex pleural infection. Methods: This was a single centre, prospective study involving patients with poorly drained pleural infection. Primary outcome was the change of pleural opacity on chest radiograph at day 7 compared to baseline. Secondary outcomes include volume of fluid drained, inflammatory markers improvement, surgical referral, length of hospitalisation, and adverse events. Results: Thirty patients were recruited. Majority, 27 (90%) patients were successfully treated. Improvement of pleural opacity on chest radiograph was observed from 36.9% [Interquartile range (IQR 21.8–54.9%)] to 18.1% (IQR 8.8–32.7%) of hemithorax (P < 0.05). T-PA/DNase increased fluid drainage from median of 45 mls (IQR 0–100) 24 h prior to intrapleural treatment to 1442 mls (IQR 905–2360) after 72 h; (P < 0.05) and reduction of C-reactive protein (P < 0.05). Pain requiring escalation of analgesia affected 20% patients and 9.9% experienced major adverse events. None required surgical intervention. Conclusion: This study suggests that a modified regimen 16 mg t-PA with 5 mg DNase can be safe and effective for patients with poorly drained complex pleural infection. Trial registration: The study was registered retrospectively on 07/06/2021 with ClinicalTrials number NCT04915586 (https://clinicaltrials.gov/ct2/show/NCT04915586).
{"title":"Management der pleuralen Infektion: Modifiziertes Therapie-Regime mit intrapleuraler Alteplase und Pulmozyme","authors":"F. Stanzel","doi":"10.1159/000526429","DOIUrl":"https://doi.org/10.1159/000526429","url":null,"abstract":"Background: Current management of poorly draining complex effusions favours less invasive image-guided placement of smaller tubes and adjunctive intrapleural fibrinolysis therapy (IPFT). In MIST-2 trial, intrapleural 10 mg alteplase (t-PA) with 5 mg of pulmozyme (DNase) twice daily for 72 h were used. We aimed to assess the effectiveness and safety of a modified regimen 16 mg t-PA with 5 mg of DNase administered over 24 h in the management of complex pleural infection. Methods: This was a single centre, prospective study involving patients with poorly drained pleural infection. Primary outcome was the change of pleural opacity on chest radiograph at day 7 compared to baseline. Secondary outcomes include volume of fluid drained, inflammatory markers improvement, surgical referral, length of hospitalisation, and adverse events. Results: Thirty patients were recruited. Majority, 27 (90%) patients were successfully treated. Improvement of pleural opacity on chest radiograph was observed from 36.9% [Interquartile range (IQR 21.8–54.9%)] to 18.1% (IQR 8.8–32.7%) of hemithorax (P < 0.05). T-PA/DNase increased fluid drainage from median of 45 mls (IQR 0–100) 24 h prior to intrapleural treatment to 1442 mls (IQR 905–2360) after 72 h; (P < 0.05) and reduction of C-reactive protein (P < 0.05). Pain requiring escalation of analgesia affected 20% patients and 9.9% experienced major adverse events. None required surgical intervention. Conclusion: This study suggests that a modified regimen 16 mg t-PA with 5 mg DNase can be safe and effective for patients with poorly drained complex pleural infection. Trial registration: The study was registered retrospectively on 07/06/2021 with ClinicalTrials number NCT04915586 (https://clinicaltrials.gov/ct2/show/NCT04915586).","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115201255","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}
Background: Pleural effusions can occur due to acute pericarditis and can necessitate intervention. We sought to add to the evidence base by performing a retrospective review of patients presenting to the advanced cardiac imaging unit with pericarditis and pleural effusion to determine laterality, trends in pleural fluid analyses, and the need for pleural intervention. Local ethical (Caldicott) approval was obtained for this study. Methodology: Descriptive statistical methodology was applied with continuous data presented as mean (standard deviation, SD; range) and categorical variables as frequencies or percentages. Results: In 60 patients with pericarditis, 24 (39%) had pleural effusions on contemporaneous imaging. The mean age of the study population was 63.3 years (range: 20–83), and 17 patients were males. Diagnoses were viral (five), rheumatological (one), amyloidosis (one), listeria (one), and the rest idiopathic (17). Four effusions were only left-sided, one right-sided, and 20 bilateral. Ten pleural taps were performed, one for a unilateral effusion and nine for one side being bigger than the other. The mean pH was 7.46 (7.33–7.6), mean lactate dehydrogenase was 210 (74–393 U/L), mean fluid protein was 36.1 (19–56 g/L) (four effusions exudative/three transudative), mean glucose was 5.8 (4.8–6.8 mmol/L), and all cytologies were negative. Five patients underwent large volume aspirations for symptom control. Three indwelling pleural catheters (IPC) were placed for treatment refractory effusions. There was one pleural space infection in six months related to an IPC. There were three deaths at 12 months, with none related to pericarditis. Conclusions: Pleural effusions associated with pericarditis are usually small, bilateral, and exudative. Treatment refractory cases require pleural intervention, with aspirations, drains, and IPCs being viable options. Further prospective studies are warranted.
{"title":"Antiinflammatorische Therapie bei Perikarditis mit Pleuraergüssen: Denkanstoß für die Behandlung einer nicht spezifischen Pleuritis","authors":"S. Keymel","doi":"10.1159/000526437","DOIUrl":"https://doi.org/10.1159/000526437","url":null,"abstract":"Background: Pleural effusions can occur due to acute pericarditis and can necessitate intervention. We sought to add to the evidence base by performing a retrospective review of patients presenting to the advanced cardiac imaging unit with pericarditis and pleural effusion to determine laterality, trends in pleural fluid analyses, and the need for pleural intervention. Local ethical (Caldicott) approval was obtained for this study. Methodology: Descriptive statistical methodology was applied with continuous data presented as mean (standard deviation, SD; range) and categorical variables as frequencies or percentages. Results: In 60 patients with pericarditis, 24 (39%) had pleural effusions on contemporaneous imaging. The mean age of the study population was 63.3 years (range: 20–83), and 17 patients were males. Diagnoses were viral (five), rheumatological (one), amyloidosis (one), listeria (one), and the rest idiopathic (17). Four effusions were only left-sided, one right-sided, and 20 bilateral. Ten pleural taps were performed, one for a unilateral effusion and nine for one side being bigger than the other. The mean pH was 7.46 (7.33–7.6), mean lactate dehydrogenase was 210 (74–393 U/L), mean fluid protein was 36.1 (19–56 g/L) (four effusions exudative/three transudative), mean glucose was 5.8 (4.8–6.8 mmol/L), and all cytologies were negative. Five patients underwent large volume aspirations for symptom control. Three indwelling pleural catheters (IPC) were placed for treatment refractory effusions. There was one pleural space infection in six months related to an IPC. There were three deaths at 12 months, with none related to pericarditis. Conclusions: Pleural effusions associated with pericarditis are usually small, bilateral, and exudative. Treatment refractory cases require pleural intervention, with aspirations, drains, and IPCs being viable options. Further prospective studies are warranted.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130663937","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}
Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive and irreversible airflow limitation. Different factors that modify pulmonary function include age, sex, muscular strength, and a history of exposure to toxic agents. However, the impact of body composition compartments and sarcopenia on pulmonary function is not well-established. This study aimed to evaluate how body composition compartments and sarcopenia affect pulmonary function in COPD patients. Methods: In a cross-sectional study, patients with a confirmed diagnosis of COPD, > 40 years old, and forced expiratory volume in the first second/forced vital capacity ratio (FEV1/FVC) < 0.70 post-bronchodilator were included. Patients with cancer, HIV, and asthma were excluded. Body composition was measured with bioelectrical impedance. Sarcopenia was defined according to EWGSOP2, and pulmonary function was assessed by spirometry. Results: 185 patients were studied. The mean age was 72.20 ± 8.39 years; 55.14% were men. A linear regression adjusted model showed associations between body mass index, fat-free mass, skeletal muscle mass index, appendicular skeletal muscle mass index, and phase angle (PhA), and sarcopenia with FEV1 (%). As regards FVC (%), PhA and exercise tolerance had positive associations. Conclusion: Body composition, especially PhA, SMMI, ASMMI, and sarcopenia, has a significant impact on pulmonary function. Early detection of disturbances of these indexes enables the early application of such therapeutic strategies in COPD patients.
{"title":"COPD: Bei älteren Patienten an Sarkopenie denken und diese in ein therapeutisches Gesamtkonzept integrieren","authors":"H. Frohnhofen","doi":"10.1159/000526183","DOIUrl":"https://doi.org/10.1159/000526183","url":null,"abstract":"Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive and irreversible airflow limitation. Different factors that modify pulmonary function include age, sex, muscular strength, and a history of exposure to toxic agents. However, the impact of body composition compartments and sarcopenia on pulmonary function is not well-established. This study aimed to evaluate how body composition compartments and sarcopenia affect pulmonary function in COPD patients. Methods: In a cross-sectional study, patients with a confirmed diagnosis of COPD, > 40 years old, and forced expiratory volume in the first second/forced vital capacity ratio (FEV1/FVC) < 0.70 post-bronchodilator were included. Patients with cancer, HIV, and asthma were excluded. Body composition was measured with bioelectrical impedance. Sarcopenia was defined according to EWGSOP2, and pulmonary function was assessed by spirometry. Results: 185 patients were studied. The mean age was 72.20 ± 8.39 years; 55.14% were men. A linear regression adjusted model showed associations between body mass index, fat-free mass, skeletal muscle mass index, appendicular skeletal muscle mass index, and phase angle (PhA), and sarcopenia with FEV1 (%). As regards FVC (%), PhA and exercise tolerance had positive associations. Conclusion: Body composition, especially PhA, SMMI, ASMMI, and sarcopenia, has a significant impact on pulmonary function. Early detection of disturbances of these indexes enables the early application of such therapeutic strategies in COPD patients.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125858986","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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