Revista Espanola de Anestesiologia y Reanimacion最新文献

英文中文

Factores de riesgo para PPC en cirugía abdominal laparoscópica no robótica frente a la laparoscópica robótica (LapRas): Razonamiento y protocolo mediante un análisis a nivel de paciente de LAS VEGAS y AVATaR 非机器人腹腔镜与机器人腹腔镜腹部手术（LapRas）中CLP的风险因素：利用 LAS VEGAS 和 AVATaR 进行的患者层面分析得出的理由和方案

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2024.01.008

Introduction

Postoperative pulmonary complications (PPC) vary in different surgical techniques. We aim to compare the incidence of PPCs after laparoscopic non-robotic versus laparoscopic robotic abdominal surgery.

Methods and analysis

LapRas (Risk Factors for PPCs in Laparoscopic Non-Robotic vs Laparoscopic Robotic Abdominal Surgery) analyses harmonized data from two observational studies on abdominal surgery patients and PPCs: Local ASsessment of VEntilatory management during General Anaesthesia for Surgery (LAS VEGAS), and Assessment of Ventilation during general AnesThesia for Robotic surgery (AVATaR). The primary endpoint is the occurrence of one or more PPC within the first five postoperative days. Secondary endpoints include the occurrence of each individual PPC, hospital length of stay, and in-hospital mortality. Logistic regression models will be used to identify risk factors for PPCs in laparoscopic non-robotic versus laparoscopic robotic abdominal surgery. We will investigate whether differences in the occurrence of PPCs between the groups are driven by differences in duration of anaesthesia and/or the intensity of mechanical ventilation.

Ethics and dissemination

This analysis will address a clinically relevant research question by comparing laparoscopic and robotic surgery. No additional ethical committee approval is required for this meta-analysis. Data will be shared with the scientific community in the form of abstracts and original articles submitted to peer-reviewed journals.

Registration

The registration of this post-hoc analysis is pending; individual studies that were merged into the study database were registered at clinicaltrials.gov: LAS VEGAS with identifier NCT01601223, AVATaR with identifier NCT02989415.

导言术后肺部并发症（PPC）在不同的手术技术中有所不同。我们旨在比较腹腔镜非机器人腹部手术与腹腔镜机器人腹部手术后肺部并发症的发生率。方法和分析LapRas（腹腔镜非机器人腹部手术与腹腔镜机器人腹部手术中肺部并发症的风险因素）分析了两项腹部手术患者和肺部并发症观察性研究的统一数据：LAS VEGAS）和机器人手术全身麻醉期间通气评估（AVATaR）。主要终点是术后前五天内发生一种或多种 PPC。次要终点包括每种 PPC 的发生率、住院时间和院内死亡率。我们将使用逻辑回归模型来确定腹腔镜非机器人腹部手术与腹腔镜机器人腹部手术发生 PPC 的风险因素。我们将研究麻醉持续时间和/或机械通气强度的不同是否会导致两组间PPCs发生率的差异。伦理与传播这项分析将通过比较腹腔镜手术和机器人手术来解决临床相关的研究问题。这项荟萃分析无需获得伦理委员会的额外批准。数据将以摘要和原创文章的形式提交给同行评审期刊，与科学界共享。注册这项事后分析的注册工作尚未完成；合并到研究数据库中的单项研究已在 clinicaltrials.gov 注册：LAS VEGAS的标识符为NCT01601223，AVATaR的标识符为NCT02989415。

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引用次数: 0

Abordaje transcava para inserción de endoprótesis aórtica. Un nuevo reto anestésico 经腔途径植入主动脉内假体。新的麻醉挑战

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.09.006

The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach.

The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence.

We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.

与传统的开腹手术治疗相比，近年来血管内治疗技术的巨大进步使急性主动脉综合征的治疗受益匪浅。然而，血管内治疗要取得成功，患者必须有足够的血管通路。那些血管解剖结构不佳的病例必须考虑进行开腹手术，而开腹手术的发病率很高，甚至需要拒绝手术。最近，腹主动脉的一种新方法被描述为这些不可能有其他血管通路且绝对或相对不适合经胸方法的患者的一种适应症。主动脉综合征的麻醉处理方法众所周知，尽管有多种选择，但所有这些方法的安全性和有效性都已得到证实。我们介绍了西班牙首例经腔主动脉内假体植入术、其麻醉影响以及文献综述。

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引用次数: 0

Uso de cannabinoides en el dolor agudo posoperatorio 使用大麻素治疗急性术后疼痛

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.11.004

Doubts about the efficacy of medicinal cannabis in the treatment of acute postoperative pain are well justified, at least in light of the information gathered from Google Scholar, Clinical Trials, PubMed, and Cochrane databases. The conflation of cannabis and cannabinoids engenders not only normative but also medical implications. Despite cannabinoids having evinced their efficacy in the treatment of various pathologies, they have yet to demonstrate such in the context of acute postoperative pain.

The burgeoning corpus of research on this subject does instill a modicum of hope in this regard; nevertheless, the manifold methodological approaches employed obfuscate the prospect of reaching unequivocal conclusions. Given the current status of this matter, this article abstains from making a definitive pronouncement either in favor of or against the role of pharmaceuticals incorporating cannabinoid compounds in the management of acute postoperative pain.

至少从 Google Scholar、Clinical Trials、PubMed 和 Cochrane 数据库中收集的信息来看，对药用大麻治疗急性术后疼痛疗效的怀疑是有道理的。将大麻和大麻素混为一谈不仅会产生规范性影响，还会产生医学影响。尽管大麻素在治疗各种病症方面已显示出其疗效，但在急性术后疼痛方面尚未显示出这种疗效。有关这一主题的研究成果不断涌现，确实在这方面带来了一点希望；然而，所采用的多种方法学方法模糊了得出明确结论的前景。考虑到这一问题的现状，本文不会对含有大麻素化合物的药物在急性术后疼痛治疗中的作用发表明确的赞成或反对意见。

引用次数: 0

Fracaso de la extubación: obstrucción de la vía aérea superior por chicle. Informe de un caso 拔管失败：口香糖导致上气道阻塞。病例报告

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.11.001

Extubation failure can result from different complications, mostly well described in the literature such as laryngeal edema. Airway obstruction by foreign bodies is a less frequent and unexpected complication and its detection remains a challenge to healthcare professionals. In this case-report, we describe a patient admitted in an intensive care unit following a motor vehicle accident and who underwent an extubation failure and tracheostomy placement due to a misdiagnosed obstruction of a foreign body in the upper airway. Thus, screening of foreign bodies should be considered with a careful interpretation of medical imagery and clinical evaluation in these patients. Finally, cuff leak test, ultrasonography and videolaryngoscopy can be important adjuvants to the identification of suspected foreign bodies.

拔管失败可能由不同的并发症导致，其中大部分在文献中都有详细描述，如喉水肿。异物阻塞气道是一种不太常见的意外并发症，其检测对医护人员来说仍是一项挑战。在本病例报告中，我们描述了一名因机动车事故被送入重症监护室的患者，由于误诊为上气道异物阻塞，导致拔管失败并进行了气管造口术。因此，在对这些患者进行医学影像和临床评估时，应考虑对异物进行筛查。最后，充气罩囊漏气试验、超声波检查和视频喉镜检查可作为识别可疑异物的重要辅助手段。

引用次数: 0

Aneurisma del seno de Valsalva causante de cierre espontáneo de defecto del tabique ventricular congénito 瓦尔萨尔瓦窦动脉瘤导致先天性室间隔缺损自发闭合

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.03.009

引用次数: 0

Encuesta nacional sobre la monitorización perioperatoria de anticoagulantes orales directos: encuesta MonACOD 直接口服抗凝剂围手术期监测全国调查：MonACOD 调查

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2024.02.002

引用次数: 0

Eficacia del bloqueo retrolaminar ecoguiado frente al bloqueo paravertebral clásico en pacientes sometidos a hernioplastia inguinal unilateral: estudio controlado aleatorizado 在接受单侧腹股沟疝成形术的患者中，超声引导下椎后区阻滞与传统椎旁阻滞的疗效：随机对照研究。

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2024.01.005

Background

In daily surgical practice, inguinal hernioplasty is a frequent procedure that is frequently accompanied by severe postoperative pain. Multiple regional blocks have been described for analgesia after such operations. Retrolaminar block (RLB) is a paravertebral block (PVB) variant that provides excellent analgesia and reduces the risk of complications. This prospective trial compared the analgesic efficacy of PVB and RLB in the inguinal hernioplasty.

Methods

The 56 patients included were randomly assigned into two equal groups according to the block performed under ultrasound guidance at the T12 level: PVB group (28 patients) and RLB (28 patients). Time until the first rescue analgesia was our primary outcome. Other outcomes included the time to perform the block, changes in intraoperative hemodynamic parameters, postoperative VAS, 24-hour morphine consumption, the level of patient satisfaction, and the incidence of block-related complications.

Results

Demographic data were comparable in the two groups. However, the time needed for the block was significantly shortened with the RLB (p < 0.001). Patients in the PVB groups expressed better pain scores and lower opioid consumption. Additionally, the time to the first call for opioid analgesia showed a significant prolongation in association with the PVB. There was no discernible difference in the frequency of adverse events and recorded MAP and HR.

Conclusion

The PVB has a superior perioperative analgesic profile compared to the RLB, which manifested in the prolonged duration to the first rescue analgesics, better pain scores, and less opioid consumption, with no significant increase in block-related complications.

背景在日常手术实践中，腹股沟疝成形术是一种常见的手术，术后经常伴有剧烈疼痛。已有多种区域阻滞用于此类手术后的镇痛。视网膜阻滞（RLB）是椎旁阻滞（PVB）的一种变体，可提供出色的镇痛效果并降低并发症风险。这项前瞻性试验比较了 PVB 和 RLB 在腹股沟疝成形术中的镇痛效果：PVB组（28例）和RLB组（28例）。首次镇痛前的时间是我们的主要结果。其他结果包括阻滞时间、术中血流动力学参数变化、术后 VAS、24 小时吗啡消耗量、患者满意度以及阻滞相关并发症的发生率。但使用 RLB 时阻滞所需时间明显缩短（p < 0.001）。PVB 组患者的疼痛评分更佳，阿片类药物用量更少。此外，首次呼叫阿片类镇痛的时间也因使用 PVB 而明显延长。结论与 RLB 相比，PVB 的围术期镇痛效果更佳，表现在首次抢救镇痛药的时间更长、疼痛评分更好、阿片类药物用量更少，而阻滞相关并发症没有明显增加。

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引用次数: 0

La prolongación del intervalo QT en los pacientes con COVID-19 severa es multicausal y no se limita a los fármacos anti-SARS-CoV-2 严重 COVID-19 患者的 QT 延长有多种原因，并不局限于抗 SARS-CoV-2 药物。

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.11.011

引用次数: 0

Ácido úrico y daño renal agudo en pacientes con alto riesgo de desarrollar daño renal agudo sometidos a cirugía cardiaca: cohorte prospectiva multicéntrica 接受心脏手术的急性肾损伤高危患者的尿酸和急性肾损伤：前瞻性多中心队列。

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-08-01 DOI: 10.1016/j.redar.2023.09.005

Purpose

It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI.

Design

Multicenter prospective international cohort study.

Setting

Fourteen university hospitals in Spain and the United Kingdom.

Participants

We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥4 points, from July to December 2017.

Interventions

None.

Measurements and Main Results

AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (> = 7 mg/dL) and AKI. Elevated preoperative AUS (> = 7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; p = 0.17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95% CI 0.93-1.19, p = 0.37).

Conclusions

Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

目的目前尚不清楚术前血清尿酸（SUA）升高是否会在心脏手术相关急性肾损伤（AKI）（CSA-AKI）的发生中发挥作用。我们开展了一项队列研究，评估术前高尿酸血症对罹患 SC-AKI 高风险患者 AKI 的影响。设计多中心前瞻性国际队列研究。设置西班牙和英国的 14 家大学医院。参与者我们对 2017 年 7 月至 12 月期间连续 261 名罹患 CSA-AKI 高风险患者进行了研究，根据克利夫兰评分≥4 分。采用多变量逻辑回归模型和倾向得分匹配配对分析来确定术前高尿酸血症（> = 7 mg/dL）与 AKI 之间的调整关联。190例患者（72.8%）术前出现高尿酸血症（> = 7 mg/dL），145例患者（55.5%）出现CSA-AKI。在多变量逻辑回归模型中，高尿酸血症与 AKI 风险的显著增加无关（调整后的比值比 [OR]：1.58; 95% 置信区间 [CI]：0.81-3; p = 0.17).在对 140 例患者进行倾向评分匹配分析时，高尿酸血症组发生 AKI 的调整后几率相似（OR 1.05，95% CI 0.93-1.19，P = 0.37）。

{"title":"Ácido úrico y daño renal agudo en pacientes con alto riesgo de desarrollar daño renal agudo sometidos a cirugía cardiaca: cohorte prospectiva multicéntrica","authors":"","doi":"10.1016/j.redar.2023.09.005","DOIUrl":"10.1016/j.redar.2023.09.005","url":null,"abstract":"<div><h3>Purpose</h3><p>It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI.</p></div><div><h3>Design</h3><p>Multicenter prospective international cohort study.</p></div><div><h3>Setting</h3><p>Fourteen university hospitals in Spain and the United Kingdom.</p></div><div><h3>Participants</h3><p>We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥4 points, from July to December 2017.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Measurements and Main Results</h3><p>AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (> = 7 mg/dL) and AKI. Elevated preoperative AUS (> = 7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; p = 0.17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95% CI 0.93-1.19, p = 0.37).</p></div><div><h3>Conclusions</h3><p>Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.</p></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 7","pages":"Pages 514-521"},"PeriodicalIF":0.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S003493562400015X/pdfft?md5=166e065b850d42f573a927e270fa6e1b&pid=1-s2.0-S003493562400015X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hiperlactacidemia en pacientes con estatus asmático. Análisis mediante el modelo de Stewart 哮喘状态患者的高乳酸血症。使用斯图尔特模型进行分析

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-08-01 DOI: 10.1016/j.redar.2023.10.004

Background

Patients with status asthmaticus (SA) frequently present with lactic acidosis (LA). Our goal is to identify the nature of LA using the Stewart physicochemical model and to identify the independent factors associated with LA in children with SA.

Methods

Analytical study of a retrospective cohort using a nested case-control design. Twenty-eight episodes of SA in 24 children were included. Patients admitted to a paediatric intensive care unit (PICU) for SA over a 9-year period were recruited consecutively. LA was analysed using the Stewart model and the Strong Ion Calculator. Data and were analysed using descriptive statistics and regression models were fitted in the general linear model.

Results

Hyperlacticaemia (Lact[mM/L] = 3.905 [95% CI = 3.018-4.792]) and acidosis (pH = 7.294 [95% CI = 7.241-7.339]) were observed in 18 episodes (15 patients; 62.5%). According to the Stewart model, acidosis was caused by a decrease in strong ion difference. Initially, pCO2 was high (pCO2[mmHg] = 45.806 [95% CI = 37.314-54.298]) but the net unmeasured ion (NUI) component was normal (NUI = -4,461 [95% CI = -3.51 - -5.412]), and neither changed significantly over the clinical course. There was no need to determine pyruvate, as the NUI was normal and the LA was type B (non-hypoxic, lactate / pyruvate < 25). We observed a correlation (p = 0.023) between LA and intramuscular epinephrine administered on arrival at hospital, but not between LA and the cumulative dose of nebulized salbutamol.

Conclusions

Most patients with SA presented LA. The Stewart model confirmed that LA is not hypoxic, probably due to sympathomimetic-related glycolysis.

背景哮喘（SA）患者经常出现乳酸酸中毒（LA）。我们的目标是利用斯图尔特理化模型来确定乳酸性酸中毒的性质，并找出与哮喘患儿乳酸性酸中毒相关的独立因素。研究纳入了 24 名儿童的 28 例 SA。连续招募了9年期间因SA入住儿科重症监护室（PICU）的患者。采用斯图尔特模型和强离子计算器对LA进行分析。结果在 18 次病例（15 名患者；62.5%）中观察到高乳酸血症（Lact[mM/L] = 3.905 [95% CI = 3.018-4.792]）和酸中毒（pH = 7.294 [95% CI = 7.241-7.339]）。根据斯图尔特模型，酸中毒是由强离子差减少引起的。最初，pCO2 偏高（pCO2[mmHg] = 45.806 [95% CI = 37.314-54.298]），但未测量的净离子（NUI）成分正常（NUI = -4,461 [95% CI = -3.51 --5.412]），两者在临床过程中均无明显变化。由于 NUI 正常且 LA 为 B 型（非缺氧，乳酸/丙酮酸 <25），因此无需测定丙酮酸。我们观察到 LA 与到达医院时肌肉注射的肾上腺素之间存在相关性（p = 0.023），但 LA 与雾化沙丁胺醇的累积剂量之间不存在相关性。Stewart 模型证实，LA 并非缺氧，可能是由于拟交感神经相关的糖酵解所致。

{"title":"Hiperlactacidemia en pacientes con estatus asmático. Análisis mediante el modelo de Stewart","authors":"","doi":"10.1016/j.redar.2023.10.004","DOIUrl":"10.1016/j.redar.2023.10.004","url":null,"abstract":"<div><h3>Background</h3><p>Patients with status asthmaticus (SA) frequently present with lactic acidosis (LA). Our goal is to identify the nature of LA using the Stewart physicochemical model and to identify the independent factors associated with LA in children with SA.</p></div><div><h3>Methods</h3><p>Analytical study of a retrospective cohort using a nested case-control design. Twenty-eight episodes of SA in 24 children were included. Patients admitted to a paediatric intensive care unit (PICU) for SA over a 9-year period were recruited consecutively. LA was analysed using the Stewart model and the Strong Ion Calculator. Data and were analysed using descriptive statistics and regression models were fitted in the general linear model.</p></div><div><h3>Results</h3><p>Hyperlacticaemia (Lact[mM/L]=3.905 [95% <span>C</span>I=3.018-4.792]) and acidosis (pH=7.294 [95% CI=7.241-7.339]) were observed in 18 episodes (15 patients; 62.5%). According to the Stewart model, acidosis was caused by a decrease in strong ion difference. Initially, pCO2 was high (pCO2[mmHg]=45.806 [95% CI=37.314-54.298]) but the net unmeasured ion (NUI) component was normal (NUI=-4,461 [95% CI=-3.51 - -5.412]), and neither changed significantly over the clinical course. There was no need to determine pyruvate, as the NUI was normal and the LA was type B (non-hypoxic, lactate / pyruvate <25). We observed a correlation (p=0.023) between LA and intramuscular epinephrine administered on arrival at hospital, but not between LA and the cumulative dose of nebulized salbutamol.</p></div><div><h3>Conclusions</h3><p>Most patients with SA presented LA. The Stewart model confirmed that LA is not hypoxic, probably due to sympathomimetic-related glycolysis.</p></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 7","pages":"Pages 501-505"},"PeriodicalIF":0.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278824","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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