P. Sandhya, Harsha Narkhede, M. Gajbhare, Maroti Gaikwad, Kalyani Dandge, A. Munde
Rhino-orbital-cerebral Mucor mycosis is a rare, opportunistic, fatal fungal infection most commonly seen in diabetic and immunocompromised individuals, but an outbreak of cases was seen in post COVID-19 patients during the second wave in India. Our aim is to elaborate the anaesthetic management of post COVID-19 Mucor mycosis patients scheduled for FESS (Functional Endoscopic Sinus Surgery) for debridement of involved areas. Here, we have discussed the anaesthetic challenges faced in a series of eleven patients with COVID-19 and Mucor mycosis such as uncontrolled diabetes mellitus, irrational use of steroids for the treatment of COVID-19, amphotericin B and its interactions with anaesthetic management. Preventive measures in COVID-19 patients, early detection, timely management, perioperative vigilant monitoring, multidisciplinary approach will reduce the morbidity and mortality in these patients. As limited data is available, further studies are necessary to understand aetiology and pathogenesis of Mucor mycosis in post COVID-19 for better management.
{"title":"Post COVID Tsunami of Black Fungus – Anaesthetic Challenges in Management: Case Series","authors":"P. Sandhya, Harsha Narkhede, M. Gajbhare, Maroti Gaikwad, Kalyani Dandge, A. Munde","doi":"10.4038/slja.v30i1.8855","DOIUrl":"https://doi.org/10.4038/slja.v30i1.8855","url":null,"abstract":"Rhino-orbital-cerebral Mucor mycosis is a rare, opportunistic, fatal fungal infection most commonly seen in diabetic and immunocompromised individuals, but an outbreak of cases was seen in post COVID-19 patients during the second wave in India. Our aim is to elaborate the anaesthetic management of post COVID-19 Mucor mycosis patients scheduled for FESS (Functional Endoscopic Sinus Surgery) for debridement of involved areas. Here, we have discussed the anaesthetic challenges faced in a series of eleven patients with COVID-19 and Mucor mycosis such as uncontrolled diabetes mellitus, irrational use of steroids for the treatment of COVID-19, amphotericin B and its interactions with anaesthetic management. Preventive measures in COVID-19 patients, early detection, timely management, perioperative vigilant monitoring, multidisciplinary approach will reduce the morbidity and mortality in these patients. As limited data is available, further studies are necessary to understand aetiology and pathogenesis of Mucor mycosis in post COVID-19 for better management.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43335377","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}
Coins are commonly ingested foreign body (FB) in children, particularly the area just below the cricopharyngeus muscle, being the most common site of lodgement. The aim of the present study was to evaluate the effectiveness of point-of-care ultrasound (POCUS) of the upper airway as an investigation arm to guide and assist the clinical management of foreign body coin in children with expectant management for spontaneous passage. A total of 50 children with coin in upper oesophagus were chosen and POCUS was done in the preoperative area. Those in whom coin was visualised on POCUS were taken for retrieval under general anaesthesia and in whom coin was not visualised were taken for 2 nd X-ray to confirm passage. In 50 children with a coin in upper oesophagus, point-of-care ultrasound (POCUS) showed the presence of coin in 44 children (confirmed on esophagoscopy) and spontaneous passage in 6 children (confirmed on 2 nd X-ray), thus resulting in the reduction of approximately 88% of 2 nd check X-ray to demonstrate the position of coin.
{"title":"Role of Point-of-Care ultrasound as a Bridge Investigation for Management of Upper Oesophageal Coins in Children.","authors":"O. Nazir, Hamid Yatoo, S. Singh, Amit Kumar","doi":"10.4038/slja.v30i1.8803","DOIUrl":"https://doi.org/10.4038/slja.v30i1.8803","url":null,"abstract":"Coins are commonly ingested foreign body (FB) in children, particularly the area just below the cricopharyngeus muscle, being the most common site of lodgement. The aim of the present study was to evaluate the effectiveness of point-of-care ultrasound (POCUS) of the upper airway as an investigation arm to guide and assist the clinical management of foreign body coin in children with expectant management for spontaneous passage. A total of 50 children with coin in upper oesophagus were chosen and POCUS was done in the preoperative area. Those in whom coin was visualised on POCUS were taken for retrieval under general anaesthesia and in whom coin was not visualised were taken for 2 nd X-ray to confirm passage. In 50 children with a coin in upper oesophagus, point-of-care ultrasound (POCUS) showed the presence of coin in 44 children (confirmed on esophagoscopy) and spontaneous passage in 6 children (confirmed on 2 nd X-ray), thus resulting in the reduction of approximately 88% of 2 nd check X-ray to demonstrate the position of coin.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42388233","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}
The novel coronavirus, named SARS-CoV-2 has caused a global pandemic state which affects the respiratory system of patients. Given the current situation, any acute respiratory distress has to be evaluated thoroughly to arrive at a definitive diagnosis for targeted management, which is challenging. We report a patient who presented with respiratory distress with fat embolism syndrome that was suspected as COVID-19 pneumonia.
{"title":"Fat Embolism Syndrome or COVID-19 Pneumonia: A Diagnostic Dilemma","authors":"A. Seneviratna","doi":"10.4038/slja.v29i2.8844","DOIUrl":"https://doi.org/10.4038/slja.v29i2.8844","url":null,"abstract":"The novel coronavirus, named SARS-CoV-2 has caused a global pandemic state which affects the respiratory system of patients. Given the current situation, any acute respiratory distress has to be evaluated thoroughly to arrive at a definitive diagnosis for targeted management, which is challenging. We report a patient who presented with respiratory distress with fat embolism syndrome that was suspected as COVID-19 pneumonia.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70154097","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}
Kavisha P. Dissanayake, Keerthie Dissanayake, Sisira B. Etulgama, Kapila Hettiarachchi
Studies suggest that flexible fibreoptic bronchoscopy, when performed through a laryngeal mask airway (FFB-LMA), have fewer rates of complications and better efficacy. In comparison to rigid bronchoscopy, FFB is safer for the operator, as it prevents direct exposure to respiratory tract infections such as Covid-19. Airway maintenance with LMA is uncommon when performing FFB in Sri Lanka. This study aimed to report the efficacy and peri-procedural complications of FFB performed through LMA at a tertiary care children's hospital in Sri Lanka. Data were retrieved retrospectively from anaesthetic charts and bed head tickets of all the patients who underwent FFBs performed through LMA at the Sirimavo Bandaranayake Specialized Children's Hospital, Peradeniya. Collected data included age, gender, indication, duration of the procedure, bronchoscopy findings, and complications, if any. Of the total of 176 patients, the majority were infants and between 1-5 years (33.52% each). The most common indication was recurrent/persistent respiratory tract infections (57.9%) followed by foreign body aspirations (21.6%). Clinically significant abnormalities were detected in 87% of the cases. The success rate of extraction of positively identified foreign bodies was 100%. Perioperative complications were observed in 4.5% of the patients. Risk factor analysis, based on multivariate logistic regression, identified the duration of the procedure as a risk factor for complications (OR = 15.57, p = 0.0011). FFB performed through LMA has good efficacy and low complication profile in the studied patient sample.
{"title":"Flexible Fibreoptic Bronchoscopy Performed Through a Laryngeal Mask Airway (FFB-LMA) in a Paediatric Population: Experience of a Tertiary Care Children's Hospital in Sri Lanka","authors":"Kavisha P. Dissanayake, Keerthie Dissanayake, Sisira B. Etulgama, Kapila Hettiarachchi","doi":"10.4038/slja.v29i2.8693","DOIUrl":"https://doi.org/10.4038/slja.v29i2.8693","url":null,"abstract":"Studies suggest that flexible fibreoptic bronchoscopy, when performed through a laryngeal mask airway (FFB-LMA), have fewer rates of complications and better efficacy. In comparison to rigid bronchoscopy, FFB is safer for the operator, as it prevents direct exposure to respiratory tract infections such as Covid-19. Airway maintenance with LMA is uncommon when performing FFB in Sri Lanka. This study aimed to report the efficacy and peri-procedural complications of FFB performed through LMA at a tertiary care children's hospital in Sri Lanka. Data were retrieved retrospectively from anaesthetic charts and bed head tickets of all the patients who underwent FFBs performed through LMA at the Sirimavo Bandaranayake Specialized Children's Hospital, Peradeniya. Collected data included age, gender, indication, duration of the procedure, bronchoscopy findings, and complications, if any. Of the total of 176 patients, the majority were infants and between 1-5 years (33.52% each). The most common indication was recurrent/persistent respiratory tract infections (57.9%) followed by foreign body aspirations (21.6%). Clinically significant abnormalities were detected in 87% of the cases. The success rate of extraction of positively identified foreign bodies was 100%. Perioperative complications were observed in 4.5% of the patients. Risk factor analysis, based on multivariate logistic regression, identified the duration of the procedure as a risk factor for complications (OR = 15.57, p = 0.0011). FFB performed through LMA has good efficacy and low complication profile in the studied patient sample.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43067205","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}
Dear Editor, A patient under general anaesthesia is like a passenger on board to a flight for his surgery with an anaesthetist as the pilot. The anaesthetist is responsible for the smooth take-off, stable journey, and hassle-free landing. That is how an anaesthesiologist plays a role in handling a patient when he is anaesthetized. Anaesthesiology was an infamous specialty till this Coronavirus disease (COVID-19) pandemic hit worldwide—the specialist who was always behind the curtains.
{"title":"From Behind the Curtain to Physicians with a Nerve of Steel…The Transition of an Anaesthesiologist During the Pandemic","authors":"K. Kaur, Vishal Mangal","doi":"10.4038/slja.v29i2.8724","DOIUrl":"https://doi.org/10.4038/slja.v29i2.8724","url":null,"abstract":"Dear Editor, A patient under general anaesthesia is like a passenger on board to a flight for his surgery with an anaesthetist as the pilot. The anaesthetist is responsible for the smooth take-off, stable journey, and hassle-free landing. That is how an anaesthesiologist plays a role in handling a patient when he is anaesthetized. Anaesthesiology was an infamous specialty till this Coronavirus disease (COVID-19) pandemic hit worldwide—the specialist who was always behind the curtains.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45489817","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}
Cases of anaesthetic management in Rubinstein Taybi Syndrome (RTS) has been confined to a small number since it was first diagnosed in 1963. Anaesthesia for RTS is rare, but consists of few important anaesthetic implications. We present a 3-year-old boy with RTS who underwent general anaesthesia for correction of clinodactyly. He experienced an episode of desaturation with no obvious reason that lead him to have supplemental oxygen and monitoring in the intensive care unit.
{"title":"Anaesthesia for a Patient with Rubinstein Taybi Syndrome","authors":"Harshika Hannadige, Senaka Weerakoon","doi":"10.4038/slja.v29i2.8715","DOIUrl":"https://doi.org/10.4038/slja.v29i2.8715","url":null,"abstract":"Cases of anaesthetic management in Rubinstein Taybi Syndrome (RTS) has been confined to a small number since it was first diagnosed in 1963. Anaesthesia for RTS is rare, but consists of few important anaesthetic implications. We present a 3-year-old boy with RTS who underwent general anaesthesia for correction of clinodactyly. He experienced an episode of desaturation with no obvious reason that lead him to have supplemental oxygen and monitoring in the intensive care unit.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46879250","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}
This case report describes a successfully managed rare variant of Guillain-Barre ́ Syndrome (GBS), the pharyngeal-cervical-brachial (PCB) variant, in a 5-year-old child which is characterized by the involvement of oropharyngeal, neck and upper limb muscles, without disturbed consciousness or ataxia. Since early treatment and supportive care yield successful outcome, it is important for the treating physician to be familiar with other diseases that mimic the disease and variants for prompt and accurate diagnosis.
{"title":"Pharyngeal–Cervical-Brachial Variant: A Rare Form of Guillain–Barre Syndrome in a Paediatric Patient","authors":"T. M. K. Jayasinghearachchi, S.K.J.S. Peiris","doi":"10.4038/slja.v29i2.8881","DOIUrl":"https://doi.org/10.4038/slja.v29i2.8881","url":null,"abstract":"This case report describes a successfully managed rare variant of Guillain-Barre ́ Syndrome (GBS), the pharyngeal-cervical-brachial (PCB) variant, in a 5-year-old child which is characterized by the involvement of oropharyngeal, neck and upper limb muscles, without disturbed consciousness or ataxia. Since early treatment and supportive care yield successful outcome, it is important for the treating physician to be familiar with other diseases that mimic the disease and variants for prompt and accurate diagnosis.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47447836","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}
Alkaptonuria is a rare inherited autosomal recessive metabolic disorder due to the deficiency of homogentisic acid oxidase resulting in accumulation of homogentisic acid in collagen and cartilaginous tissue resulting in stiffening of joints, spine and involving other systems which pose challenges to anaesthesiologist in providing anaesthesia. Here we present a patient with undiagnosed alkaptonuria who was posted for bilateral total knee replacement. Since these patients usually have reduced intervertebral spaces, neuraxial anaesthesia was difficult with classic approach. Taylor’s approach was used for neuraxial anaesthesia and, post-operative analgesia was achieved with continuous femoral nerve block with catheter placement.
{"title":"Taylor’s Approach to Rescue: A Case of Undiagnosed Alkaptonuria Undergoing Bilateral Total Knee Replacement","authors":"Bhimala Ramya, Sujil Sudhersan, S. Segaran","doi":"10.4038/slja.v29i2.8743","DOIUrl":"https://doi.org/10.4038/slja.v29i2.8743","url":null,"abstract":"Alkaptonuria is a rare inherited autosomal recessive metabolic disorder due to the deficiency of homogentisic acid oxidase resulting in accumulation of homogentisic acid in collagen and cartilaginous tissue resulting in stiffening of joints, spine and involving other systems which pose challenges to anaesthesiologist in providing anaesthesia. Here we present a patient with undiagnosed alkaptonuria who was posted for bilateral total knee replacement. Since these patients usually have reduced intervertebral spaces, neuraxial anaesthesia was difficult with classic approach. Taylor’s approach was used for neuraxial anaesthesia and, post-operative analgesia was achieved with continuous femoral nerve block with catheter placement.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45968421","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}
A prospective cross-sectional single centre clinical study was performed to determine the incidence of anaemia and blood transfusion practice in neurosurgical and neurotrauma intensive care units (ICU). All the adult patients who met the criteria and were admitted to the neurosurgical and neurotrauma ICUs of National Hospital of Sri Lanka from 15April to 14 June 2013 were included in the study. Out of the 100 patients in the study, 82% were anaemic on admission and 95% had anaemia at some point during ICU stay. The mean haemoglobin (Hb) level was less than10g/dl in 30% of patients. 47% of patients received blood transfusion in the ICU. Only 23.6% of the transfusion events met the standards for the transfusion trigger.
{"title":"Incidence of Anaemia and Blood Transfusion Practice in Neurosurgical and Neurotrauma Intensive Care Units at National Hospital of Sri Lanka","authors":"Jane Sangeetha Benedict, S. Sabaretnam","doi":"10.4038/slja.v29i2.8662","DOIUrl":"https://doi.org/10.4038/slja.v29i2.8662","url":null,"abstract":"A prospective cross-sectional single centre clinical study was performed to determine the incidence of anaemia and blood transfusion practice in neurosurgical and neurotrauma intensive care units (ICU). All the adult patients who met the criteria and were admitted to the neurosurgical and neurotrauma ICUs of National Hospital of Sri Lanka from 15April to 14 June 2013 were included in the study. Out of the 100 patients in the study, 82% were anaemic on admission and 95% had anaemia at some point during ICU stay. The mean haemoglobin (Hb) level was less than10g/dl in 30% of patients. 47% of patients received blood transfusion in the ICU. Only 23.6% of the transfusion events met the standards for the transfusion trigger.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49116937","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}
Azizul Akram Salim, Dayang Shariza Abang Abdillah, H. C. Lim, J. Johari, M. Yusof
Paraspinal abscess or clinically significant soft tissue infection following epidural analgesia is a rare but serious complication if left untreated. We report a 54-year-old gentleman with underlying chronic diabetes mellitus who had a motor vehicle accident and had undergone several surgeries. A course of steroid was provided for delayed left lower motor neuron facial nerve palsy (House-Brackmann stage 4). The epidural catheter was inserted with a single attempt at the L3/L4 level. One month later, he complained of crippling lower back pain and growing swelling with a punctum. MRI showed a paraspinal abscess with bilateral involvement of the spinae erector. This report is intended to highlight the excellent outcome of surgical treatment for paraspinal abscess despite the late presentation. A high level of suspicion should be taken into account when the patient is immunocompromised, particularly with steroid use and chronic diabetes mellitus. Early detection via MRI, high suspicion index and immediate surgery have extraordinary benefits in managing paraspinal abscesses.
{"title":"A Good Outcome Following Delayed Debridement of Lumbar Paraspinal Abscess after Postoperative Epidural Catheterization: Case Report","authors":"Azizul Akram Salim, Dayang Shariza Abang Abdillah, H. C. Lim, J. Johari, M. Yusof","doi":"10.4038/slja.v29i2.8701","DOIUrl":"https://doi.org/10.4038/slja.v29i2.8701","url":null,"abstract":"Paraspinal abscess or clinically significant soft tissue infection following epidural analgesia is a rare but serious complication if left untreated. We report a 54-year-old gentleman with underlying chronic diabetes mellitus who had a motor vehicle accident and had undergone several surgeries. A course of steroid was provided for delayed left lower motor neuron facial nerve palsy (House-Brackmann stage 4). The epidural catheter was inserted with a single attempt at the L3/L4 level. One month later, he complained of crippling lower back pain and growing swelling with a punctum. MRI showed a paraspinal abscess with bilateral involvement of the spinae erector. This report is intended to highlight the excellent outcome of surgical treatment for paraspinal abscess despite the late presentation. A high level of suspicion should be taken into account when the patient is immunocompromised, particularly with steroid use and chronic diabetes mellitus. Early detection via MRI, high suspicion index and immediate surgery have extraordinary benefits in managing paraspinal abscesses.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41911152","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：