Journal of medical cases最新文献

{"title":"Combination of 2-Chlorodeoxyadenosine, Cytarabine, and Granulocyte Colony-Stimulating Factor and Venetoclax in a Case of Acute Myelogenous Leukemia.","authors":"Ella Prebel Jackert, Karrune Woan, Preet Chaudhary, George Yaghmour, Abdullah Ladha, Eric Tam","doi":"10.14740/jmc5087","DOIUrl":"10.14740/jmc5087","url":null,"abstract":"<p><p>The high rates of relapse following induction therapy for acute myelogenous leukemia (AML) warrant the investigation of novel chemotherapy regimens to better treat the disease safely. We report a case of refractory AML treated with CLAG (a combination of 2-chlorodeoxyadenosine, cytarabine, and granulocyte colony-stimulating factor (GCSF)), as a replacement for FLAG-IDA (fludarabine, cytarabine, G-CSF and idarubicin), due to a shortage of fludarabine, plus B-cell lymphoma-2 (BCL-2) inhibitor venetoclax (CLAG + VEN). A 38-year-old woman with a past medical history of systemic lupus erythematosus (SLE), managed on hydroxychloroquine, presented to her primary care provider with worsening fatigue and was found to have significant leukocytosis. The patient was diagnosed with AML on bone marrow biopsy (BMBX). The patient delayed care after the initial diagnosis but eventually started on a continuous infusion of cytarabine for therapy day (D) 1 - D7 and daunorubicin 60 mg/m² (D1 - D3) (7 + 3) induction chemotherapy. A BMBX was performed on D18 following induction therapy, revealing residual disease with 46% blasts, indicative of refractory AML. Three weeks after completing induction therapy, the patient underwent CLAG + VEN. After completing CLAG + VEN, she was found to be minimal residual disease (MRD)-negative and was determined to be an appropriate candidate for bone marrow transplant (BMT) following maintenance therapy with Onureg (azacitidine). The patient successfully underwent BMT and remains MRD-negative 1 year post-transplant. Treatment with CLAG + VEN was effective in achieving remission in this case, enabling this patient to successfully undergo BMT. This suggests a potential therapeutic benefit of combining venetoclax with traditional CLAG therapy in complex cases of AML.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 3","pages":"102-106"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757142","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":"An Unusual and Successful Pregnancy With Multiple Large Uterine Fibroids Delivered by Cesarean Myomectomy.","authors":"Dina Marlina, Aditya Utomo, Artha Falentin Putri Susilo, Aditiyono Aditiyono, Putri Nadhira Adinda Adriansyah, Muhammad Alamsyah Aziz","doi":"10.14740/jmc5073","DOIUrl":"10.14740/jmc5073","url":null,"abstract":"<p><p>Uterine fibroids, or myomas, are benign tumors affecting about 68.6% of women, with Indonesia's Hasan Sadikin Hospital reporting a prevalence between 2.4% and 12.46%. In pregnancy, the incidence drops to 0.1% to 10.7%, but fibroids can still lead to complications. This case study highlights the successful management of a complex pregnancy with multiple large uterine fibroids. A 36- to 37-week primigravida presented with a large intramural fibroid (20 × 15 × 10 cm) at the uterine fundus and six smaller fibroids in the anterior corpus. Despite these challenges, the pregnancy progressed without major issues. A cesarean section was performed, delivering a healthy baby weighing 2,815 g and measuring 46 cm. The case demonstrates effective management of a difficult obstetric situation, emphasizing the importance of tailored care and surgical skill in achieving favorable outcomes for both mother and baby.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 3","pages":"95-101"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757140","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":"Medium-Chain Acyl-CoA Dehydrogenase Deficiency Disorder as a Cause of Acute Liver Failure in a 23-Month-Old Baby.","authors":"Inva Gjeta, Ilirjana Bakalli, Durim Sala, Ermela Celaj, Marsela Biqiku, Vladimir Hoxha, Virtut Velmishi, Elmira Kola","doi":"10.14740/jmc5093","DOIUrl":"10.14740/jmc5093","url":null,"abstract":"<p><p>Fatty acid oxidation disorders are inborn metabolic defects caused by impaired beta-oxidation of fats within the mitochondria. This occurs due to a deficiency in the pathway of fatty acids into the mitochondria via carnitine. Although their incidence is not frequent, the clinical presence of this disorder often leads to morbidity and high mortality. Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is part of the large group of fatty acid oxidation disorders which has a high variability in clinical manifestations and in daily medical practice can be challenging to early and correctly diagnose. In this article, we present a 23-month-old boy with drowsiness, mild hypoglycemia, and rapid progression to acute liver failure as a consequence of this metabolic disorder. Once the diagnosis was confirmed, treatment was conducted following the guideline of hypoglycemia of the metabolic disorder of MCAD deficiency and its complications. The child was discharged in good condition and the follow-up after 6 months was successful. Further, we review the literature on this genetic condition and check on how they connect to our case. The article aims to focus on the early evaluation of the clinical signs that present from the underlying of this rare metabolic disorder and the importance of aggressive treatment to prevent complications that can be fatal for the patient.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 3","pages":"114-119"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757147","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":"Successful Sentinel Lymph Node Biopsy in Accessory Breast Cancer.","authors":"Young Duck Shin, Young Jin Choi","doi":"10.14740/jmc5094","DOIUrl":"10.14740/jmc5094","url":null,"abstract":"<p><p>Primary breast cancer occurring in accessory breast tissue is exceptionally rare, with an incidence of 0.2-0.6%. It can aggressively progress, often leading to early metastasis. Treatment is typically delayed due to the rarity, variety of differentials, and lack of clinical awareness of the disease. In axillary surgery, sentinel lymph node mapping in patients with axillary breast cancer is technically challenging and has been poorly described. Here, we present a case of a 53-year-old woman with a 0.5 × 1 cm hard lump in the right axillary region for 2 years, progressive growth for 6 months, and no concomitant breast lesion or axillary lymphadenopathy. Core needle biopsy revealed invasive ductal carcinoma with estrogen receptor and progesterone receptor expression and human epidermal growth factor receptor 2 negativity, whereas mammography and breast magnetic resonance imaging revealed no primary breast lesions. She was diagnosed with invasive cancer arising from an accessory breast and underwent wide total excision of the right accessory breast and sentinel lymph node biopsy. Sentinel lymph node biopsy can be successfully performed using intratumoral dye and subareolar radiocolloid mapping in accessory breast cancer surgery. Axillary accessory breast tissue is outside the scope of the screening breast examination; therefore, oncologists must be aware of this entity and associated pathologies.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 3","pages":"107-113"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757149","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":"Lipomatous Hypertrophy of the Interatrial Septum.","authors":"Adam Golda, Beata Bialkowska-Niepon, Tadeusz Zebik","doi":"10.14740/jmc5108","DOIUrl":"10.14740/jmc5108","url":null,"abstract":"<p><p>The abnormal accumulation of lipid-rich adipose tissue within the interatrial septum (IAS) is the hallmark of lipomatous hypertrophy of the interatrial septum (LHIS), a relatively rare medical condition. To accurately distinguish LHIS, it is essential to recognize the characteristic \"dumbbell\" shape of IAS. Here, we present a case of a 59-year-old woman who was suspected of having cardiac myxoma and was subsequently admitted to our hospital. Transthoracic echocardiography of the patient showed that the IAS had a lack of thickening in the region of the foramen ovale and a hyperechogenic structure in the basal and vault portions of IAS. An abnormal mass located in the IAS anterior to the foramen ovale and not infiltrating the foramen ovale was discovered by computed tomography (CT) scan of the heart. The cardiac magnetic resonance imaging (MRI) confirmed the presence of significant fat deposition within the IAS with sparing of the fossa ovalis, which was consistent with the initial findings. The patient was discharged home with the recommendation of regular visits to the cardiology outpatient clinic for LHIS monitoring. The article presents the visualization of LHIS in consecutive diagnostic modalities, summarizes the actual knowledge of LHIS, and enables proper LHIS diagnosis in patients based on available imaging methods.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 3","pages":"120-126"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757144","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":"Hemophagocytic Lymphohistiocytosis After Treatment With Checkpoint Inhibitor Therapy.","authors":"Cameron Peres, Christopher Willner","doi":"10.14740/jmc4318","DOIUrl":"10.14740/jmc4318","url":null,"abstract":"<p><p>Hemophagocytic lymphohistiocytosis (HLH) is a rare hematological syndrome presenting with massive, dysregulated cytokine release that can result in multiple organ failure and is associated with a high risk of mortality. Based on the recent North American consortium recommendations, it has been suggested to categorize HLH into two entities, HLH syndrome and HLH disease. HLH disease encompasses multiple subgroups, including familial HLH (F-HLH), HLH-associated immune compromise (IC-HLH) and HLH observed after immune activating therapies. The diagnosis can be quite challenging, and the pathophysiology leading to HLH disease has yet to be fully elucidated. Much less is known about HLH that occurs due to treatment with immunotherapy such as immune checkpoint inhibitors (ICIs). Herein, the authors report a case of a 71-year-old man who was treated with a combination of nivolumab and ipilimumab for bladder cancer. He later presented with mental status changes and pancytopenia, ultimately meeting the diagnostic criteria for HLH syndrome.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 7","pages":"267-270"},"PeriodicalIF":0.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12292014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736489","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":"An Adverse Double-Hit by Pembrolizumab: A Case Report of Bullous Pemphigoid and Pneumonitis.","authors":"Christodoulos Chatzigrigoriadis, Prodromos Avramidis, Christos Davoulos, Foteinos-Ioannis Dimitrakopoulos, George Eleftherakis, Christina Petropoulou, Despoina Sperdouli, Georgios Marios Stergiopoulos, Panagis Galiatsatos, Stelios Assimakopoulos","doi":"10.14740/jmc5089","DOIUrl":"10.14740/jmc5089","url":null,"abstract":"<p><p>Immune checkpoint inhibitors like pembrolizumab represent a modern approach to the management of various malignancies, including non-small cell lung cancer. The therapeutic activity of immunotherapy is exerted by the activation of immune cells against the tumor cells. However, systemic activation of the immune system can lead to the development of autoimmune complications known as immune-related adverse events. A combination of rare immune-related adverse events is occasionally observed simultaneously in the same patient. We present the case of a 66-year-old male with squamous non-small cell lung carcinoma who presented to the emergency department with dyspnea and respiratory failure. Imaging findings were consistent with pulmonary embolism and nonspecific interstitial pneumonitis. One month before this event, he was diagnosed with bullous pemphigoid following 21 cycles of treatment with pembrolizumab. The radiological findings, the lack of response to antibiotics, the negative microbiological workup, and the excellent response to corticosteroids established the diagnosis of pembrolizumab-induced pneumonitis. The combination of bullous pemphigoid and pneumonitis secondary to pembrolizumab is rare; only a few case reports exist in the literature. Hence, this case highlights the possibility of multiple immune-related adverse events in the same patient. The exclusion of infectious diseases and other immunologic disorders with a similar clinical presentation is necessary to make the final diagnosis of immune-related adverse events and start the appropriate treatment. Serology, histopathology, and direct immunofluorescence aid to the diagnosis of immune-related bullous pemphigoid; the differential diagnosis includes other pemphigoid or lichenoid diseases, Stevens-Johnson syndrome/toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. Imaging, microbiological testing, and bronchoscopy (if possible) confirm the diagnosis of immune-related pneumonitis, which should be differentiated from acute coronary syndrome, cardiogenic pulmonary edema, pulmonary embolism, tumor progression, and lower respiratory tract infections (especially <i>Pneumocystis jirovecii</i> pneumonia in immunocompromised patients). An interdisciplinary approach is necessary for the management of these cases.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 2","pages":"69-76"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401143","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":"A Peculiar Case of Fetal Distress Leading to the Diagnosis of Diabetic Ketoacidosis in Pregnancy.","authors":"Wen Yu Quak, Zhi Wen Loh, Poh Ting Lim, Wai Kheong Ryan Lee","doi":"10.14740/jmc5088","DOIUrl":"10.14740/jmc5088","url":null,"abstract":"<p><p>Diabetes ketoacidosis (DKA) in pregnancy is associated with significant maternal and neonatal morbidity. It is rare for women without a prior history of diabetes mellitus (DM) to develop DKA. This case report describes an atypical presentation of DKA in a 38-year-old primigravida, with no history of DM, presenting with \"unexplained\" fetal distress. She presented at 25 weeks to our labor ward triage with an unrelated complaint of prolapsed piles. There were no complaints of reduced fetal movement, abdominal or contraction pains or per vaginal bleeding. Ultrasonography showed an appropriately grown fetus with normal liquor volume. Incidental fetal distress was picked up on a cardiotocography (CTG) which showed a fetal heart rate of 150 beats per minute with reduced variability and shallow decelerations. The unlikely diagnosis of DKA was suspected when a random capillary blood glucose (CBG) level returned as \"HI\". Investigations revealed the triad of elevated venous glucose, raised serum ketones and high anion gap metabolic acidosis (with a maternal pH of 7.14), consistent with the diagnosis of DKA. She was aggressively treated with intravenous insulin and hydration therapy. Fetal distress resolved with resolution of the DKA. She eventually delivered a healthy baby at 37-week gestation. This case raises awareness of a rare occurrence of DKA in late pregnancy as the first presentation of DM and highlights the importance of considering a hyperglycemic crisis as a potential cause of a suspicious CTG in an asymptomatic woman without any clear reason for fetal distress. Timely diagnosis and prompt treatment of the underlying condition is lifesaving, and avoids urgent delivery and risks associated with prematurity.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 2","pages":"87-93"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401142","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":"Long-Term Outcomes and Management of Atypical Carotid Web in Nonagenarian.","authors":"Daniel L Burke, Aldin Malkoc, Iden Andacheh","doi":"10.14740/jmc4339","DOIUrl":"10.14740/jmc4339","url":null,"abstract":"<p><p>Internal carotid artery webs (ICAWs) have been described as noninflammatory, nonatherosclerotic shelf-like projections of intimal fibrous tissue which may be the culprit for embolic stroke of unknown origin. Carotid webs are an atypical form of intimal fibromuscular dysplasia (FMD) and internal carotid webs create areas of stagnation and recirculation distal to the web that favor thrombus formation and embolism. Symptomatic carotid webs are conventionally associated with young women presenting with few vascular risk factors and < 50% stenosis in the affected ICA. ICAWs are being described more and more in the vascular literature, but the management of this pathology remains unclear. We describe a rare case of a 90-year-old male who presented with a significantly sclerosed symptomatic right ICAW without evidence of comorbid atherosclerotic disease. The clinical management, intraoperative findings, and postoperative course are described herein. At the age of 90, this patient is the oldest case of symptomatic carotid web recorded in the literature. Successful management with a carotid endarterectomy is an appropriate strategy for treatment even in a nonagenarian. We would favor carotid endarterectomy over carotid artery stenting given the circumferential, fibrotic nature of these lesions.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 2","pages":"82-86"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401090","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":"An Unusual Case of Extracavitary/Solid Variant Primary Effusion Lymphoma With Associated Hemophagocytic Lymphohistiocytosis.","authors":"Chika Iguh, Julie Kim, Akudo Akaraonye, Amani Minja, Xin Qing","doi":"10.14740/jmc5084","DOIUrl":"10.14740/jmc5084","url":null,"abstract":"<p><p>Primary effusion lymphoma (PEL) is a rare, aggressive large B-cell lymphoma variant that is invariably associated with human herpesvirus 8 (HHV8), predominantly in human immunodeficiency virus (HIV)-infected patients, and its oncogenicity is often augmented by coinfection with Epstein-Barr virus. It typically presents as a serous effusion in body cavities without detectable solid tumors. The extracavitary variant of PEL may represent a diagnostic challenge. A 37-year-old man with HIV/acquired immunodeficiency syndrome (AIDS) was transferred to our hospital for evaluation of a mediastinal mass with associated clinically diagnosed hemophagocytic lymphohistiocytosis (HLH), fever, pancytopenia, hepatosplenomegaly, retroperitoneal lymphadenopathy, and wasting syndrome. Contrast-enhanced computed tomography showed a large soft tissue mass extending along the middle/posterior mediastinum into the left hilum and a large left pleural effusion. Endoscopic fine-needle biopsy of the lesion showed sheets of large pleomorphic lymphoma cells with prominent nucleoli and abundant cytoplasm. These cells were also seen on the cytospin smear of pleural fluid. Immunohistochemical stains showed lymphoma cells positive for CD3 (small subset), CD45, CD138, MUM-1, and HHV8 and negative for CD5, CD20, CD30, ALK1, AE1/3, and PAX-5. The lymphoma cells were also positive for Epstein-Barr virus-encoded RNA (EBER) (<i>in situ</i> hybridization). Solid masses in extracavitary PEL have been shown to involve lymph nodes and/or solid organs such as the gastrointestinal tract, lung, liver, spleen, and skin, with a similar phenotype as classic PEL except that they may express B-cell markers with lower expression of CD45 and/or aberrant coexpression of T-cell antigens. This case illustrates the unusual manifestation of PEL as a mediastinal mass with associated HLH.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 2","pages":"48-54"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401086","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}