Background: Midazolam is a short-acting benzodiazepine frequently used in the perioperative setting. This study aimed to investigate the potential impact of intraoperative midazolam on postoperative delirium (POD) in older patients undergoing non-cardiac surgery.
Methods: This study included patients aged ≥ 65 years who received general anaesthesia between April 2020 and April 2022 in multiple hospitals across China. POD occurring within 7 days was assessed using the 3-minute Diagnostic Interview for Confusion Assessment Method (3D-CAM). Univariable and multivariable logistic regression models based on the random effects were used to determine the association between midazolam administration and the occurrence of POD, presented as risk ratio (RR) and 95% confidence intervals (CI). Kaplan-Meier cumulative incidence curve was plotted to compare the distribution of time to POD onset between patients who received midazolam and those who did not. Subgroup analyses based on specific populations were performed to explore the relationship between midazolam and POD.
Results: In all, 5,663 patients were included, of whom 723 (12.8%) developed POD. Univariate and multivariable logistic regression analyses based on random effects of different hospitals showed no significant association between midazolam medication and POD among older population (unadjusted RR=0.96, 95% CI: 0.90-1.30, P=0.38; adjusted RR=1.09, 95% CI: 0.91-1.33, P=0.35). Kaplan-Meier curve showed no difference in the distribution of time to POD onset (Hazard ratio [HR]=1.02, 95%CI: 0.88-1.18, P=0.82). The results of subgroup analyses found that intraoperative midazolam treatment was not associated with POD in the specific subgroups of patients.
Conclusions: Intraoperative administration of midazolam may not be associated with an increased risk of POD in older patients undergoing non-cardiac surgery.
背景:咪达唑仑是一种短效苯二氮卓类药物,常用于围术期环境。本研究旨在探讨术中使用咪达唑仑对接受非心脏手术的老年患者术后谵妄(POD)的潜在影响:本研究纳入了 2020 年 4 月至 2022 年 4 月期间在中国多家医院接受全身麻醉的年龄≥ 65 岁的患者。采用 3 分钟意识障碍诊断访谈评估法(3D-CAM)对 7 天内发生的 POD 进行评估。基于随机效应的单变量和多变量Logistic回归模型用于确定咪达唑仑用药与POD发生之间的关系,以风险比(RR)和95%置信区间(CI)表示。绘制了 Kaplan-Meier 累计发病率曲线,以比较接受和未接受咪达唑仑治疗的患者之间 POD 发病时间的分布情况。根据特定人群进行了分组分析,以探讨咪达唑仑与 POD 之间的关系:总共纳入了 5,663 名患者,其中 723 人(12.8%)出现了 POD。基于不同医院随机效应的单变量和多变量逻辑回归分析表明,在老年人群中,咪达唑仑用药与 POD 之间无显著关联(未调整 RR=0.96,95% CI:0.90-1.30,P=0.38;调整 RR=1.09,95% CI:0.91-1.33,P=0.35)。卡普兰-梅耶曲线显示,POD发病时间分布无差异(危险比[HR]=1.02,95%CI:0.88-1.18,P=0.82)。亚组分析结果显示,术中咪达唑仑治疗与特定亚组患者的POD无关:结论:在接受非心脏手术的老年患者中,术中使用咪达唑仑可能与 POD 风险增加无关。
{"title":"The effect of intraoperative midazolam on postoperative delirium in older surgical patients: a prospective, multicentre cohort study.","authors":"Hao Li, Chang Liu, Yu Yang, Qing-Ping Wu, Jun-Mei Xu, Di-Fen Wang, Jing-Jia Sun, Meng-Meng Mao, Jing-Sheng Lou, Yan-Hong Liu, Jiang-Bei Cao, Chong-Yang Duan, Wei-Dong Mi","doi":"10.1097/ALN.0000000000005276","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005276","url":null,"abstract":"<p><strong>Background: </strong>Midazolam is a short-acting benzodiazepine frequently used in the perioperative setting. This study aimed to investigate the potential impact of intraoperative midazolam on postoperative delirium (POD) in older patients undergoing non-cardiac surgery.</p><p><strong>Methods: </strong>This study included patients aged ≥ 65 years who received general anaesthesia between April 2020 and April 2022 in multiple hospitals across China. POD occurring within 7 days was assessed using the 3-minute Diagnostic Interview for Confusion Assessment Method (3D-CAM). Univariable and multivariable logistic regression models based on the random effects were used to determine the association between midazolam administration and the occurrence of POD, presented as risk ratio (RR) and 95% confidence intervals (CI). Kaplan-Meier cumulative incidence curve was plotted to compare the distribution of time to POD onset between patients who received midazolam and those who did not. Subgroup analyses based on specific populations were performed to explore the relationship between midazolam and POD.</p><p><strong>Results: </strong>In all, 5,663 patients were included, of whom 723 (12.8%) developed POD. Univariate and multivariable logistic regression analyses based on random effects of different hospitals showed no significant association between midazolam medication and POD among older population (unadjusted RR=0.96, 95% CI: 0.90-1.30, P=0.38; adjusted RR=1.09, 95% CI: 0.91-1.33, P=0.35). Kaplan-Meier curve showed no difference in the distribution of time to POD onset (Hazard ratio [HR]=1.02, 95%CI: 0.88-1.18, P=0.82). The results of subgroup analyses found that intraoperative midazolam treatment was not associated with POD in the specific subgroups of patients.</p><p><strong>Conclusions: </strong>Intraoperative administration of midazolam may not be associated with an increased risk of POD in older patients undergoing non-cardiac surgery.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/ALN.0000000000005229
Alexandre Mansour, Thomas Lecompte, Nicolas Nesseler, Isabelle Gouin-Thibault
{"title":"Antithrombin Levels during Venoarterial ECMO: Reply.","authors":"Alexandre Mansour, Thomas Lecompte, Nicolas Nesseler, Isabelle Gouin-Thibault","doi":"10.1097/ALN.0000000000005229","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005229","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/ALN.0000000000005236
Justin C Cordova
{"title":"A Poem for Henry.","authors":"Justin C Cordova","doi":"10.1097/ALN.0000000000005236","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005236","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/ALN.0000000000005228
Gennaro Martucci, Shu Y Lu, Yuko Mishima, Kenichi A Tanaka
{"title":"Antithrombin Levels during Venoarterial ECMO: Comment.","authors":"Gennaro Martucci, Shu Y Lu, Yuko Mishima, Kenichi A Tanaka","doi":"10.1097/ALN.0000000000005228","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005228","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/ALN.0000000000005196
Adriana L Grossman
{"title":"Life and Death in the Land of Women.","authors":"Adriana L Grossman","doi":"10.1097/ALN.0000000000005196","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005196","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Recent evidence indicates that general anesthesia and sleep-wake behavior share some overlapping neural substrates. GABAergic neurons in the central amygdala (CeA) have a high firing rate during wakefulness and play a role in regulating arousal-related behaviors. The objective of this study is to investigate whether CeA GABAergic neurons participate in the regulation of isoflurane general anesthesia and uncover the underlying neural circuitry.
Methods: Fiber photometry recording was used to determine the changes in calcium signals of CeA GABAergic neurons during isoflurane anesthesia in Vgat-Cre mice. Chemogenetic and optogenetic approaches were used to manipulate the activity of CeA GABAergic neurons, and a righting reflex test was used to determine the induction and emergence from isoflurane anesthesia. Cortical electroencephalogram (EEG) recording was used to assess the changes in EEG spectral power and burst-suppression ratio during 0.8% and 1.4% isoflurane anesthesia, respectively. Both male and female mice were used in this study.
Results: The calcium signals of CeA GABAergic neurons decreased during the induction of isoflurane anesthesia and was restored during the emergence. Chemogenetic activation of CeA GABAergic neurons delayed induction time (mean ± SD, vehicle vs. clozapine-N-oxide: 58.75±5.42 s vs. 67.63±5.01 s; n=8, P=0.0017) and shortened emergence time (385.50±66.26 s vs. 214.60±40.21 s; n=8, P=0.0017) from isoflurane anesthesia. Optogenetic activation of CeA GABAergic neurons produced a similar effect. Furthermore, optogenetic activation decreased EEG delta power (Pre-stim vs. Stim: 46.63%±4.40% vs. 34.16%±6.47%; n=8, P=0.0195) and burst-suppression ratio (83.39%±5.15% vs. 52.60%±12.98%; n=8, P=0.0002). Moreover, optogenetic stimulation of terminals of CeA GABAergic neurons in the basal forebrain (BF) also promoted cortical activation and accelerated behavioral emergence from isoflurane anesthesia.
Conclusions: Our results suggest that CeA GABAergic neurons play a role in general anesthesia regulation, which facilitates behavioral and cortical emergence from isoflurane anesthesia through the GABAergic CeA-BF pathway.
背景:最近的证据表明,全身麻醉和睡眠-觉醒行为有一些重叠的神经基底。中央杏仁核(CeA)中的GABA能神经元在清醒时具有较高的发射率,并在调节唤醒相关行为中发挥作用。本研究旨在探讨杏仁核中央 GABA 能神经元是否参与异氟醚全身麻醉的调控,并揭示其潜在的神经回路:方法:采用纤维光度记录法测定Vgat-Cre小鼠在异氟烷麻醉过程中CeA GABA能神经元钙信号的变化。化学遗传学和光遗传学方法被用来操纵CeA GABA能神经元的活动,右反射试验被用来确定异氟烷麻醉的诱导和唤醒。皮层脑电图(EEG)记录分别用于评估0.8%和1.4%异氟醚麻醉期间EEG频谱功率和猝发抑制比的变化。本研究使用了雄性和雌性小鼠:结果:CeA GABA能神经元的钙信号在异氟醚麻醉诱导过程中减少,并在苏醒过程中恢复。对CeA GABA能神经元的化学激活延迟了异氟烷麻醉的诱导时间(平均值±标度,载体 vs. 氯氮平-氧化物:58.75±5.42 s vs. 67.63±5.01 s;n=8,P=0.0017),缩短了异氟烷麻醉的苏醒时间(385.50±66.26 s vs. 214.60±40.21 s;n=8,P=0.0017)。光遗传激活 CeA GABA 能神经元也产生了类似的效果。此外,光遗传激活降低了脑电图的δ功率(刺激前 vs. 刺激:46.63%±4.40% vs. 34.16%±6.47%;n=8,P=0.0195)和猝发抑制比(83.39%±5.15% vs. 52.60%±12.98%;n=8,P=0.0002)。此外,对基底前脑(BF)中的CeA GABA能神经元末端进行光遗传刺激也促进了大脑皮层的激活,并加速了异氟烷麻醉后的行为唤醒:我们的研究结果表明,CeA GABA能神经元在全身麻醉调节中发挥作用,通过GABA能CeA-BF通路促进行为和大脑皮层从异氟醚麻醉中苏醒。
{"title":"GABAergic neurons in the central amygdala promote emergence from isoflurane anesthesia in mice.","authors":"Jin-Sheng Zhang, Wei Yao, Lei Zhang, Zhang-Shu Li, Xia-Ting Gong, Li-Li Duan, Zhi-Xian Huang, Tong Chen, Jin-Chuang Huang, Shu-Xiang Yang, Changxi Yu, Ping Cai, Li Chen","doi":"10.1097/ALN.0000000000005279","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005279","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence indicates that general anesthesia and sleep-wake behavior share some overlapping neural substrates. GABAergic neurons in the central amygdala (CeA) have a high firing rate during wakefulness and play a role in regulating arousal-related behaviors. The objective of this study is to investigate whether CeA GABAergic neurons participate in the regulation of isoflurane general anesthesia and uncover the underlying neural circuitry.</p><p><strong>Methods: </strong>Fiber photometry recording was used to determine the changes in calcium signals of CeA GABAergic neurons during isoflurane anesthesia in Vgat-Cre mice. Chemogenetic and optogenetic approaches were used to manipulate the activity of CeA GABAergic neurons, and a righting reflex test was used to determine the induction and emergence from isoflurane anesthesia. Cortical electroencephalogram (EEG) recording was used to assess the changes in EEG spectral power and burst-suppression ratio during 0.8% and 1.4% isoflurane anesthesia, respectively. Both male and female mice were used in this study.</p><p><strong>Results: </strong>The calcium signals of CeA GABAergic neurons decreased during the induction of isoflurane anesthesia and was restored during the emergence. Chemogenetic activation of CeA GABAergic neurons delayed induction time (mean ± SD, vehicle vs. clozapine-N-oxide: 58.75±5.42 s vs. 67.63±5.01 s; n=8, P=0.0017) and shortened emergence time (385.50±66.26 s vs. 214.60±40.21 s; n=8, P=0.0017) from isoflurane anesthesia. Optogenetic activation of CeA GABAergic neurons produced a similar effect. Furthermore, optogenetic activation decreased EEG delta power (Pre-stim vs. Stim: 46.63%±4.40% vs. 34.16%±6.47%; n=8, P=0.0195) and burst-suppression ratio (83.39%±5.15% vs. 52.60%±12.98%; n=8, P=0.0002). Moreover, optogenetic stimulation of terminals of CeA GABAergic neurons in the basal forebrain (BF) also promoted cortical activation and accelerated behavioral emergence from isoflurane anesthesia.</p><p><strong>Conclusions: </strong>Our results suggest that CeA GABAergic neurons play a role in general anesthesia regulation, which facilitates behavioral and cortical emergence from isoflurane anesthesia through the GABAergic CeA-BF pathway.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1097/ALN.0000000000005267
Mathieu Capdevila, Audrey De Jong, Fouad Belafia, Aurelie Vonarb, Julie Carr, Nicolas Molinari, Olivier Choquet, Xavier Capdevila, Samir Jaber
Background: Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. Diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. We aimed to evaluate ultrasound guided transcutaneous phrenic nerve stimulation for daily bedside assessment of diaphragm function by targeted electrical phrenic nerve stimulation.
Methods: In this randomized cross-over study we compared a new method of ultrasound guided transcutaneous electrical phrenic nerve stimulation (SONOTEPS method) using a peripheral nerve stimulator, with the magnetic phrenic nerve stimulation. Intensive care unit adult patients under mechanical ventilation with a Richmond-Agitation-Sedation-Scale score of -4 or -5 were included. Each patient received the two methods of stimulation, in a randomized order. The primary outcome was the tracheal pressure (Ptrach) induced by stimulation.
Results: We analyzed 232 measures of Ptrach from 116 patients of whom 77 presented a diaphragm dysfunction (Ptrach < 11 cmH2O) and 50 a severe diaphragm dysfunction (Ptrach < 8 cmH2O). The Passing-Bablok regression showed no significant differences (intercept A of -0.03 [CI95:-0.83-0.52] and slope B of 0.98 [CI95:0.90-1.05]) between SONOTEPS method and magnetic stimulation which were positively correlated (R²=0.639). The mean bias was -1.08 (CI95 5.02, -7.18) cmH2O. The receiver operating curves showed an excellent performance for the diagnosis of diaphragm dysfunction and severe diaphragm dysfunction with respectively an area under curve of 0.90 (CI95 0.83-0.97) and 0.88 (CI95 0.82-0.95). This performance was not significantly affected by the body mass index or the presence of a neck catheter.
Conclusions: The SONOTEPS method is a simple and accurate tool for bedside assessment of diaphragm function with ultrasound guided transcutaneous phrenic nerve stimulation in sedated patients with no or minimal spontaneous respiratory activity.
{"title":"Ultrasound guided transcutaneous phrenic nerve stimulation in critically ill patients: a new method to evaluate diaphragmatic function.","authors":"Mathieu Capdevila, Audrey De Jong, Fouad Belafia, Aurelie Vonarb, Julie Carr, Nicolas Molinari, Olivier Choquet, Xavier Capdevila, Samir Jaber","doi":"10.1097/ALN.0000000000005267","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005267","url":null,"abstract":"<p><strong>Background: </strong>Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. Diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. We aimed to evaluate ultrasound guided transcutaneous phrenic nerve stimulation for daily bedside assessment of diaphragm function by targeted electrical phrenic nerve stimulation.</p><p><strong>Methods: </strong>In this randomized cross-over study we compared a new method of ultrasound guided transcutaneous electrical phrenic nerve stimulation (SONOTEPS method) using a peripheral nerve stimulator, with the magnetic phrenic nerve stimulation. Intensive care unit adult patients under mechanical ventilation with a Richmond-Agitation-Sedation-Scale score of -4 or -5 were included. Each patient received the two methods of stimulation, in a randomized order. The primary outcome was the tracheal pressure (Ptrach) induced by stimulation.</p><p><strong>Results: </strong>We analyzed 232 measures of Ptrach from 116 patients of whom 77 presented a diaphragm dysfunction (Ptrach < 11 cmH2O) and 50 a severe diaphragm dysfunction (Ptrach < 8 cmH2O). The Passing-Bablok regression showed no significant differences (intercept A of -0.03 [CI95:-0.83-0.52] and slope B of 0.98 [CI95:0.90-1.05]) between SONOTEPS method and magnetic stimulation which were positively correlated (R²=0.639). The mean bias was -1.08 (CI95 5.02, -7.18) cmH2O. The receiver operating curves showed an excellent performance for the diagnosis of diaphragm dysfunction and severe diaphragm dysfunction with respectively an area under curve of 0.90 (CI95 0.83-0.97) and 0.88 (CI95 0.82-0.95). This performance was not significantly affected by the body mass index or the presence of a neck catheter.</p><p><strong>Conclusions: </strong>The SONOTEPS method is a simple and accurate tool for bedside assessment of diaphragm function with ultrasound guided transcutaneous phrenic nerve stimulation in sedated patients with no or minimal spontaneous respiratory activity.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1097/aln.0000000000005178
Maxwell B Baker,Jamel Ortoleva,Yan Wang,Ala Nozari,William E Baker
{"title":"Damage Control Resuscitation in Traumatic Hemorrhage: Comment.","authors":"Maxwell B Baker,Jamel Ortoleva,Yan Wang,Ala Nozari,William E Baker","doi":"10.1097/aln.0000000000005178","DOIUrl":"https://doi.org/10.1097/aln.0000000000005178","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"95 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}