Perspectives in Medicine最新文献

{"title":"Transcranial Doppler sonography in children with sickle cell disease and silent ischemic lesions","authors":"Filippo Maria Farina ,&nbsp;Patrizia Rampazzo ,&nbsp;Laura Sainati ,&nbsp;Renzo Manara ,&nbsp;Angelo Onofri ,&nbsp;Raffaella Colombatti ,&nbsp;Claudio Baracchini ,&nbsp;Giorgio Meneghetti","doi":"10.1016/j.permed.2012.02.046","DOIUrl":"10.1016/j.permed.2012.02.046","url":null,"abstract":"<div><h3>Background</h3><p>Sickle cell disease (SCD) is considered the most frequent cause of stroke in childhood. According to the STOP (stroke prevention trial in sickle cell anemia study) criteria, patients with abnormal values (&gt;200<!--> <!-->cm/s) of time-averaged mean velocities of maximum blood flow (TAMM), detected by transcranial Doppler sonography (TCD), should undergo blood transfusion in order to reduce the risk of ischemic stroke. However, patients with normal TAMM might harbor silent strokes on magnetic resonance imaging (MRI) scan. Our aim was to verify whether SCD patients with normal velocities but with a significant side-to-side asymmetry of TAMM are more prone to develop silent strokes.</p></div><div><h3>Subjects and methods</h3><p>Thirty-one consecutive SCD patients, (15 females; mean age: 9.23<!--> <!-->±<!--> <!-->3.66 years), categorized as “normal” according to the STOP protocol (&lt;170<!--> <!-->cm/s) and without a history of blood transfusions and TIA/stroke, underwent a cerebral MRI scan and complete TCD evaluation in order to detect significant asymmetries in the main intracranial arteries. Then, we subdivided this cohort into two groups according to the detection of TAMM asymmetry: “normal and symmetric” (NS), “normal and asymmetric” (NA).</p></div><div><h3>Results</h3><p>We found 13/31 patients (41.9%) harboring a significant TAMM asymmetry (NA group), while brain MRI detected silent ischemic lesions in 13/31 (41.9%) patients. No significant differences were found between NA and NS regarding silent strokes frequencies (Chi-square test with continuity correction, <em>χ</em>² <!-->=<!--> <!-->0.598), lesion number (<em>t</em>-student test, <em>p</em> <!-->=<!--> <!-->0.09) and lesion burden (<em>t</em>-student test, <em>p</em> <!-->=<!--> <!-->0.227).</p></div><div><h3>Conclusion</h3><p>According to our study, TAMM asymmetry is not a significant predictor of silent cerebral ischemia.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 269-271"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86233002","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}

{"title":"Mechanical recanalization in acute stroke treatment","authors":"Pasquale Mordasini,&nbsp;Gerhard Schroth,&nbsp;Jan Gralla","doi":"10.1016/j.permed.2012.04.004","DOIUrl":"10.1016/j.permed.2012.04.004","url":null,"abstract":"<div><p>Endovascular stroke treatment is a rapidly evolving field in neurointerventions. The article reviews the evolution of the different mechanical thrombolysis and stenting techniques and their working principles for endovascular vessel recanalization and reviews the data on the outcome after acute stroke treatment.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 54-58"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.04.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82202277","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}

{"title":"Advances in neurosonology – Brain perfusion, sonothrombolysis and CNS drug delivery","authors":"Stephen Meairs","doi":"10.1016/j.permed.2012.02.038","DOIUrl":"10.1016/j.permed.2012.02.038","url":null,"abstract":"<div><p>Advances in microbubble pharmacology together with novel ultrasound technologies are leading to new emerging applications for both assessment and treatment of stroke patients. Ultrasound perfusion imaging, for example, has added new perspectives for diagnosis and monitoring of both ischemic and hemorrhagic stroke. Real-time brain perfusion imaging of cerebral infarctions is now possible and quantitative algorithms for evaluation of regional cerebral blood flow are being applied for the first time in humans. There is growing interest in therapeutic applications of ultrasound, particularly in the field of sonothrombolysis. Recent results indicate that ultrasound and microbubbles may be effective in clot lysis of ischemic stroke even without additional thrombolytic drugs. Moreover, this combination may be effective in treating the microcirculation, which will give new dimensions to the application of sonothrombolysis in stroke patients. Further therapeutic avenues include opening of the blood–brain barrier (BBB) with ultrasound and microbubbles to enable novel drug delivery to the brain.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 5-10"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84228199","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}

{"title":"Medical management of asymptomatic carotid stenosis","authors":"Marek Jauss","doi":"10.1016/j.permed.2012.02.053","DOIUrl":"10.1016/j.permed.2012.02.053","url":null,"abstract":"<div><p>Operative treatment of asymptomatic carotid stenosis is well established since results of Asymptomatic Carotid Atherosclerosis Study (ACAS) trial and Asymptomatic Carotid Surgery Trial (ACST) were published. However, advances in medical treatment and recent trials that revealed success of “best medical treatment” over interventional treatment for stenosis of brain supplying arteries have raised the question, if “best medical treatment” should be considered as first option in case of asymptomatic carotid stenosis.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 116-118"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74504647","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}

{"title":"Symptomatic intracranial stenosis: A university hospital-based ultrasound study","authors":"Federica Viaro,&nbsp;Filippo Maria Farina,&nbsp;Angelo Onofri,&nbsp;Giorgio Meneghetti,&nbsp;Claudio Baracchini","doi":"10.1016/j.permed.2012.02.004","DOIUrl":"10.1016/j.permed.2012.02.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Stenosis of intracranial arteries are responsible for 30–50% of strokes in Orientals, 11% in Hispanics, 6% in Blacks and only 1% in Caucasians. However, the clinical importance of intracranial stenosis in Whites may have been underestimated.</p></div><div><h3>Subjects and methods</h3><p>We examined our database registry of all TIA/ischemic stroke Caucasian patients over a two-year period, from January 1st 2009 to December 31st 2010. All patients underwent a complete cervical and intracranial ultrasound assessment, MRA and/or CTA and/or DSA.</p></div><div><h3>Results</h3><p>Among 292 patients (males 79.7%; mean age, 71.0<!--> <!-->±<!--> <!-->12.8 years), we found 59 (20.2%) subjects harboring at least one intracranial stenosis and 20 (33.9%) patients with 2 stenosis; the total number of intracranial stenosis was 95. Regarding risk factors, hypertension was present in 67.8% of patients, diabetes in 27.1%, smoking in 30.5%, obesity in 10.2%, hypercholesterolemia in 37.3%, previous TIA/stroke in 23.7%, heart disease in 18.6%. Forty-six (77.9%) patients presented with stroke, while 13 (22.1%) with TIA. Concerning the site of stenosis, 50 (52.6%) were located in the anterior circulation [MCA 46 (48.4%), ACA 4 (4.2%)], 45 (47.4%) in the posterior circulation: [PCA 28 (29.5%), BA 11(11.6%), VA 6(6.5%)]; 46 (54.8%) on the right hemisphere, 38 (45.2%) on the left hemisphere.</p></div><div><h3>Conclusions</h3><p>In this university hospital-based study among Caucasian patients with acute cerebral ischemia, ultrasound disclosed a higher prevalence of intracranial stenosis than previously thought, suggesting the clinical importance of this condition in White European TIA/stroke patients.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 211-213"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89853864","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}

{"title":"Threedimensional imaging of carotid arteries: Advantages and pitfalls of ultrasound investigations","authors":"Edoardo Vicenzini,&nbsp;Stefano Pro,&nbsp;Gaia Sirimarco,&nbsp;Patrizia Pulitano,&nbsp;Oriano Mecarelli,&nbsp;Gian Luigi Lenzi,&nbsp;Vittorio Di Piero","doi":"10.1016/j.permed.2012.03.005","DOIUrl":"10.1016/j.permed.2012.03.005","url":null,"abstract":"<div><h3>Objectives</h3><p>To describe normal and pathological findings with three-dimensional (3D) ultrasound of the carotid bifurcation.</p></div><div><h3>Methods</h3><p>Patients admitted to our ultrasound laboratory for vascular screening were submitted to standard carotid duplex and to 3D ultrasound reconstruction of the carotid bifurcation. Volume 3D scans were performed manually, on the axial plane, and the software presented the volume rendering from the inward blood flow signal detected with the Power Color Mode.</p></div><div><h3>Results</h3><p>Forty normal subjects, 7 patients with caliber alterations (4 carotid bulb ectasia and 3 internal carotid lumen narrowing), 45 patients with course variations (tortuosities and kinkings) and 35 patients with internal carotid artery stenosis of various degrees have been investigated.</p></div><div><h3>Conclusions</h3><p>3D ultrasound is a feasible technique. It can improve carotid axis general imaging through a global image presentation “at a glance”, visualizing caliber variations and vessels course. Imaging of stenosis from inward flow can be provided, but complete stenosis characterization requires the assessment of plaque morphology and vessel wall.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 82-85"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.03.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127319872","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}

{"title":"Informativity of pulsatility index and cerebral autoregulation in hydrocephalus","authors":"Vladimir Semenyutin ,&nbsp;Vugar Aliev ,&nbsp;Valery Bersnev ,&nbsp;Andreas Patzak ,&nbsp;Larisa Rozhchenko ,&nbsp;Alexandr Kozlov ,&nbsp;Shakhob Ramazanov","doi":"10.1016/j.permed.2012.03.006","DOIUrl":"10.1016/j.permed.2012.03.006","url":null,"abstract":"<div><h3>Background</h3><p>A high correlation between transcranial Doppler pulsatility index (PI) increase and intracranial hypertension has been recently demonstrated in most neurosurgical patients. But in patients with hydrocephalus PI is sometimes controversial. This may be due to a different degree of cerebral autoregulation (CA) under condition of cerebral perfusion pressure decrease.</p></div><div><h3>Purpose</h3><p>To compare the results of PI and CA assessment in patients with hydrocephalus.</p></div><div><h3>Material and methods</h3><p>Twenty-six patients (aged 16–52; male – 9, female – 17) with various types of hydrocephalus were studied. We monitored blood flow velocity in middle cerebral arteries with Multi Dop X and systemic blood pressure with Finapres-2300. CA was assessed with cuff test (evaluation of ARI) and cross-spectral analysis of spontaneous oscillations of cerebral and systemic hemodynamics within the range of Mayer's waves (evaluation of phase shift in radians – PS).</p></div><div><h3>Results</h3><p>Depending on presence of intracranial hypertension (ICH), all patients have been divided in two groups. Mean values of PI did not differ significantly in both groups. At the same time ARI and PS were considerably (<em>p</em> <!-->&lt;<!--> <!-->0.01) higher in patients without signs of ICH. In group of patients with ICH postoperative clinical improvement was accompanied with considerable (<em>p</em> <!-->&lt;<!--> <!-->0.05) increase of PS. In group of patients without ICH we did not observe any positive changes in neurological state postoperatively.</p></div><div><h3>Conclusion</h3><p>Preoperative CA assessment being more informative than PI evaluation can increase transcranial Doppler valuability in noninvasive diagnostics of cerebral spinal fluid dynamics and may be helpful in clarifying indications for operation in patients with hydrocephalus.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 311-315"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.03.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84766386","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}

{"title":"Cerebral blood flow in the chronic heart failure patients","authors":"Toplica Lepic ,&nbsp;Goran Loncar ,&nbsp;Biljana Bozic ,&nbsp;Dragana Veljancic ,&nbsp;Boban Labovic ,&nbsp;Zeljko Krsmanovic ,&nbsp;Milan Lepic ,&nbsp;Ranko Raicevic","doi":"10.1016/j.permed.2012.02.057","DOIUrl":"10.1016/j.permed.2012.02.057","url":null,"abstract":"<div><h3>Background</h3><p>Global cerebral blood flow (CBF), as a measure of cerebral perfusion, can be non-invasively studied using Doppler sonography. Chronic heart failure (CHF) increases the risk of stroke and dementia. One of the possible causes may be cerebral hypoperfusion in CHF patients. Therefore, we aimed to investigate the relationship between CBF and CHF severity.</p></div><div><h3>Methods</h3><p>The study was performed in 76 ischemic or idiopathic dilatative cardiomyopathy patients, left ventricular ejection fraction (LVEF)<!--> <!-->&lt;<!--> <!-->40%, with no clinical evidence of decompensation and 20 healthy volunteers. Each CHF patient was categorized according to the New NYHA criteria. All patients underwent Doppler echocardiography examination (GE Vivid 7). The LVEF was quantified using the Simpson method. CBF was estimated by a 7.0-MHz linear transducer of a computed sonography system (Toshiba Power vision 6000). CBF volume was determined as the sum of the flow volumes of the ICA and the VA of both sides.</p></div><div><h3>Results</h3><p>Atrial fibrillation was noted in 30%, left bundle branch block in 26%, while pacemaker was implanted in 9% of patients with CHF. History of myocardial infarction was presented in 64% of patients. No differences in age, waist/hip ratio, body mass index and lipid profile were found between CHF patients and healthy subjects. CBF was calculated in 71 of 76 patients. Three patients had occlusion of ICA, while VA was occluded in another two patients. Others did not have a hemodynamically significant ICA and VA stenosis. CBF volume was decreased in CHF patients, (677<!--> <!-->±<!--> <!-->170) according to control (783<!--> <!-->±<!--> <!-->128).</p></div><div><h3>Conclusion</h3><p>Our results of noninvasive sonographic measurement of CBF according to LVEF and NYHA criteria, suggest on significantly reduced CBF in CHF patients.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 304-308"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84767478","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}

{"title":"Intra- and post-operative monitoring of deep brain implants using transcranial ultrasound","authors":"Uwe Walter","doi":"10.1016/j.permed.2012.02.012","DOIUrl":"10.1016/j.permed.2012.02.012","url":null,"abstract":"<div><p>Transcranial sonography (TCS) of the brain parenchyma meanwhile allows a high-resolution imaging of deep brain structures in the majority of adults. A new application of TCS is the intra- and post-operative visualization with TCS and the TCS-assisted insertion of deep brain stimulation (DBS) electrodes. In pilot studies it has been shown that the TCS-assisted insertion of DBS electrodes into the subthalamic nucleus and the globus pallidus interna is feasible and safe provided the exact knowledge on the extent of electrode TCS imaging artifacts. Even more, TCS can be recommended for the post-operative monitoring of DBS electrode position. Dislocation of a DBS electrode can be easily detected. In a recent longitudinal study we could demonstrate that TCS measures of lead coordinates agreed with MRI measures in anterior–posterior and medial–lateral axis, and that the TCS-based grading of optimal vs suboptimal lead location predicts the clinical 12 months outcome of patients with movement disorders. Currently, an international multi-center study is being planned to further prove the value of TCS in the post-operative monitoring of DBS electrode position. This trial is intended to start in 2012, and is still open for joining. The obvious advantages of TCS will promote its increasing use for the intra- and post-operative monitoring of deep brain implants.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 344-348"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88860999","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}

{"title":"The role of color duplex sonography in the brain death diagnostics","authors":"Igor D. Stulin ,&nbsp;Denis S. Solonskiy ,&nbsp;Mikhail V. Sinkin ,&nbsp;Rashid S. Musin ,&nbsp;Alexandr O. Mnushkin ,&nbsp;Alexey V. Kascheev ,&nbsp;Leonid A. Savin ,&nbsp;Mikhail A. Bolotnov","doi":"10.1016/j.permed.2012.03.002","DOIUrl":"10.1016/j.permed.2012.03.002","url":null,"abstract":"<div><p>In Russia brain death diagnostic is still under great public attention. In such environment confirmatory tests are absolutely necessary. Aim of our study is to investigate the cerebral blood flow in brain death using color-coded duplex sonography. The sonographic study of 20 patients with brain death was performed and included transcranial and extracranial color duplex sonography. All patients were untrepanized. The following parameters were measured – presence of reverberating flow, Vmax ranges.</p><p><em>Results</em>: At baseline TCDS revealed both MCA in all patients, and the BA in 18 patients. Oscillating flow with Vmax −32<!--> <!-->±<!--> <!-->12<!--> <!-->sm/s in MCA was found. Reverberating flow in the proximal segment of ICA and in the V2 segment of VA was found in all patients. Vmax ranges were 96<!--> <!-->±<!--> <!-->27<!--> <!-->sm/s in ICA and 58<!--> <!-->±<!--> <!-->17<!--> <!-->sm/s in VA. After 6<!--> <!-->h TCDS was successful in 16 patients. In all of 16 cases blood flow in the MCA as a systolic peak or reverberating flow was detected. Basilar system study was successful in 12 cases. In all vessels blood flow was as systolic peaks.</p><p>Extracranial ICA and VA were visualized in all cases. In the ICA and V2, V3 segments of the VA reverberating flow were detected. Vmax was 47<!--> <!-->±<!--> <!-->25<!--> <!-->sm/s in ICA and 35<!--> <!-->±<!--> <!-->17<!--> <!-->sm/s in VA. In BD color duplex scanning reveals oscillating flow or systolic spikes in distal ICA, VA, intracranial vessels. In TCDS, the most common finding is MCA with reverberating flow. The optimum combination is extracranial and intracranial scanning in the early stages of BD.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 362-365"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86878698","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}