Clinical and Experimental Nephrology最新文献

{"title":"Synergistic negative effect of selenium deficiency and thyroid dysfunction on cardiovascular disease in hemodialysis patients.","authors":"Hwa Young Lee, Sung Gyul Lim, Yoojin Shim, Sun Hyung Kim, Yeong Won Choi, Eun-Kyoung Lee, So Mi Kim","doi":"10.1007/s10157-025-02772-y","DOIUrl":"https://doi.org/10.1007/s10157-025-02772-y","url":null,"abstract":"<p><strong>Background: </strong>Selenium is an essential trace element, and its deficiency is associated with thyroid dysfunction, which is known as a cardiovascular risk factor. Hemodialysis (HD) patients are particularly prone to selenium deficiency, and this nutritional factor may increase the risk of thyroid dysfunction and subsequently cardiovascular disease (CVD). Therefore, we investigated selenium deficiency in HD patients and tried to analyze the effect of selenium deficiency on thyroid dysfunction and its correlation with CVD.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 183 chronic HD patients. Selenium deficiency was defined as a serum selenium level below 90 µg/L. Patients were categorized into subgroups based on selenium status and/or thyroid hormone dysfunction. CVD prevalence was assessed.</p><p><strong>Results: </strong>Of the 183 subjects, 79 (43.2%) had selenium deficiency, which was associated with a trend toward higher thyroid dysfunction and increased CVD. In the subgroup analysis, the group with both selenium deficiency and thyroid dysfunction showed a significantly higher CVD prevalence of 68.1% compared to other groups. Additionally, in the logistic regression analysis for CVD risk factors, selenium deficiency/thyroid dysfunction was found to have a significant odds ratio of 3.171.</p><p><strong>Conclusions: </strong>This study demonstrates that selenium deficiency is associated with thyroid dysfunction and an increased CVD risk in chronic HD patients. Moreover, a negative synergistic effect on CVD was observed when both selenium deficiency and thyroid dysfunction were present.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey of exit-site management practices of peritoneal dialysis in Japan.","authors":"Satoshi Kurahashi, Hiroyuki Kadoya, Satoshi Ototake, Takaaki Kosugi, Masahiro Nakagaki, Ai Nagashima, Kenji Harada, Naohiro Toda, Masahiro Eriguchi, Yukinao Sakai, Masashi Mizuno, Satoshi Suzuki, Keisuke Maruyama, Tomoko Inoue, Nanae Matsuo, Yudo Tanno, Yoshitaka Ishibashi, Takefumi Mori, Masaaki Nakayama, Hideki Kawanishi, Jun Minakuchi, Yasuhiko Ito","doi":"10.1007/s10157-025-02776-8","DOIUrl":"https://doi.org/10.1007/s10157-025-02776-8","url":null,"abstract":"<p><strong>Background: </strong>Catheter exit-site infection is a major cause of withdrawal from peritoneal dialysis (PD). However, methods for caring for the peritoneal catheter and exit sites are not established and vary among facilities. No survey has been conducted on exit-site management in Japan. Here, we aimed to identify successful examples that led to best practices.</p><p><strong>Methods: </strong>The Japanese Society for Peritoneal Dialysis-led PD-related infection project was launched in 2023, under which a survey was conducted at 14 facilities nationwide that provide PD therapy. The survey content included questions about the timing of the initiation of exit-site care, the materials used in exit-site protection, and the disinfectants used for exit-site care.</p><p><strong>Results: </strong>Seventy-one percent of the exit-site direction was downward. In all facilities, the exit site was dressed immediately after its creation for several days up to a certain period. Many facilities started exit-site care within 1-2 weeks of PD initiation. Notably, 50% of the facilities did not use disinfectants. Twelve facilities used gauze or film dressings to protect the exit site. The catheter was secured in many facilities; however, the distance of fixation varied. The timing for starting a shower after exit-site creation was commonly 1-4 weeks post-surgery. Nine facilities allowed bathing without a cover, typically after > 1 month. Of these, 7 did not use Spa Clean.</p><p><strong>Conclusions: </strong>These findings provide insights into exit-site care trends across facilities. Further studies and trials are needed to establish the best practice on exit-site care for Japanese patients undergoing PD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PTH variability is associated with increased risk of mortality in Japanese hemodialysis patients.","authors":"Tadashi Kato, Kiryu Yoshida, Maki Abe, Mayu Yamashita, Kazuki Kobayashi, Tomohiro Saito, Toshiaki Takezaki, Noriyuki Kato, Masahide Mizobuchi, Fumihiko Koiwa, Hiroaki Ogata, Hirokazu Honda","doi":"10.1007/s10157-025-02777-7","DOIUrl":"https://doi.org/10.1007/s10157-025-02777-7","url":null,"abstract":"<p><strong>Background: </strong>Elevated parathyroid hormone (PTH) levels are associated with cardiovascular events, bone disease, and mortality in patients undergoing maintenance hemodialysis. Although PTH levels vary widely in patients undergoing hemodialysis, whether this affects mortality is unclear.</p><p><strong>Methods: </strong>A total of 315 maintenance hemodialysis patients who underwent PTH measurements at least twice a year were enrolled. The association between all-cause mortality, cardiovascular events, and fractures was evaluated in patients with PTH concentrations of 60-240 pg/mL (time-in-target range (TTR) 100%) and those with TTR values of 75% ≤ TTR < 100%, 50% ≤ TTR < 75%, and TTR < 50%.</p><p><strong>Results: </strong>There were 122 patients with TTR 100%, 81 patients with 75% ≤ TTR < 100%, 52 patients with 50% ≤ TTR < 75%, and 74 patients with TTR < 50%. Over the 4-year observation period, patients with TTR of 100% had significantly lower all-cause mortality than those with TTR < 50%. (HR 2.26, 95% CI 1.33-3.86) Subgroup analysis by presence or absence of pharmacological intervention showed no statistically significant difference in all-cause mortality in the treatment group (HR 2.08, 95% CI 1.16-3.72), but showed significant differences in the no-treatment group (HR 1.58, 95% CI 0.92-2.70).</p><p><strong>Conclusion: </strong>A prolonged period of deviation from the optimal PTH range was associated with increased all-cause mortality, particularly among patients not receiving SHPT medication. However, this effect was not observed in patients who received pharmacological interventions. These results suggest that early intervention is desirable when PTH levels vary from the optimal range in patients with secondary hyperparathyroidism.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial annual decline in the estimated glomerular filtration rate and adverse kidney outcomes in IgA nephropathy.","authors":"Takaya Sasaki, Nobuo Tsuboi, Hirokazu Marumoto, Yusuke Suzuki, Takashi Yokoo","doi":"10.1007/s10157-025-02778-6","DOIUrl":"https://doi.org/10.1007/s10157-025-02778-6","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of vaccination on the development of acute kidney injury in Japanese COVID-19 patients: a retrospective observational analysis.","authors":"Kenta Taito, Masatoshi Oka, Hikaru Sugimoto, Haruto Fukagawa, Ayano Izawa, Takaaki Tsuchiya, Shiho Matsuno, Noriko Yamanaka, Wako Yumura, Noriyuki Suzuki, Mitsuyo Itabashi, Takashi Takei","doi":"10.1007/s10157-025-02740-6","DOIUrl":"10.1007/s10157-025-02740-6","url":null,"abstract":"<p><strong>Background: </strong>COVID-19-associated AKI has received attention for some time because of its association with mortality, but has not been investigated in Japan. Diabetes mellitus, male sex, aging, etc., have been reported as risk factors for the development of AKI, and recently, it has been reported that unvaccinated status is a risk factor. AKI is thought to be related to inflammation and microthrombi caused by cytokine storms and lung‒kidney connections. The COVID-19 vaccine has the potential to prevent AKI because it lowers cytokine levels and prevents severe disease.</p><p><strong>Methods: </strong>A retrospective cohort study collected clinical and laboratory data from patients admitted to the Tokyo Metropolitan Institute for Geriatrics and Gerontology with a COVID-19 diagnosis between February 2020 and September 2022.</p><p><strong>Results: </strong>Among the 929 patients, 113 (12.2%) had AKI, 33 (3.6%) died, and the mortality rate of patients with AKI was 19.5%, which was significantly higher than that of patients without AKI (1.3%) (p < 0.001). Diabetes mellitus, unvaccinated status, and heart disease were associated with AKI complications (p = 0.001, 0.008, and 0.011, respectively).</p><p><strong>Conclusions: </strong>COVID-19-associated AKI significantly increased mortality in Japanese hospitalized patients. Unvaccinated status emerged as an independent risk factor for AKI, in addition to traditional risk factors such as diabetes mellitus and heart disease. These findings suggest a potential protective role of vaccination against COVID-19-associated AKI.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1425-1434"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical insights on the prognostic value of serum hepcidin-25 for cardiovascular events in maintenance hemodialysis patients from INFINITY cohort.","authors":"Nimrah Bhatti, Ali Karim, Mohammad Sarim Sharaf, Mohammad Tufail, Muhammad Ahmed Khan, Sajid Ali","doi":"10.1007/s10157-025-02717-5","DOIUrl":"10.1007/s10157-025-02717-5","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1496-1497"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of kidney function and leisure activities on disability risk among community-dwelling older adults.","authors":"Takahiro Shimoda, Kouki Tomida, Chika Nakajima, Ayuka Kawakami, Hiroyuki Shimada","doi":"10.1007/s10157-025-02754-0","DOIUrl":"10.1007/s10157-025-02754-0","url":null,"abstract":"<p><strong>Background: </strong>Impaired kidney function has been shown to be associated with both leisure activity participation and disability incidence. However, whether kidney function could influence the association between leisure activity and disability incidence in older adults remains unclear. Therefore, in the present study, we aimed to examine the influence of kidney function on the association between leisure activities and incident disability among community-dwelling older adults.</p><p><strong>Methods: </strong>We enrolled 16,354 community-dwelling older adults from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. The estimated glomerular filtration rate (eGFR) was determined based on creatinine levels; the participants were classified into two categories: eGFR ≥ 60 mL/min/1.73 m² and eGFR < 60 mL/min/1.73 m². Participants' engagement in 15 leisure activities was assessed through interviews. Disability incidence was determined using data from Japan's long-term care insurance system.</p><p><strong>Results: </strong>Overall, 786 (5.0%) patients developed a disability within 24 (interquartile range 24-24) months. Using Cox proportional hazards regression models adjusted for potential confounders, low leisure activity participation was identified as a significant factor for increased risk of disability (hazard ratio 1.25; 95% confidence interval 1.04-1.50) independent of eGFR. No significant interaction was observed between eGFR and leisure activity participation (P = 0.66).</p><p><strong>Conclusions: </strong>In this study, leisure activity was associated with the risk of disability incidence independent of kidney function among community-dwelling older adults. These findings suggest that assessing leisure activity might be important for identifying the risk of disability in this population.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1448-1455"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of renal effects between sacubitril/valsartan and thiazide diuretics among patients with uncontrolled hypertension and chronic kidney disease in Japan.","authors":"Mari Sotozawa, Kyoji Chiba, Kazuo Kobayashi, Keiichi Chin, Hideo Shimura, Toshinao Tsuge, Shun Ito, Hiroyuki Sakai, Takayuki Furuki, Atsushi Matsuzaki, Shinichi Nakajima, Nobukazu Takada, Hareaki Yamamoto, Hiroshi Takeda, Takamasa Iwasawa, Togo Aoyama, Masao Toyoda, Akira Kanamori, Hiromichi Wakui, Kouichi Tamura","doi":"10.1007/s10157-025-02743-3","DOIUrl":"10.1007/s10157-025-02743-3","url":null,"abstract":"<p><strong>Background: </strong>Sacubitril/valsartan is typically prescribed for patients with heart failure and hypertension. We previously reported that sacubitril/valsartan provides comparable blood pressure (BP) reduction and superior tolerability compared to thiazide diuretics. This post hoc study aimed to compare the effects of sacubitril/valsartan and thiazide diuretics in patients with chronic kidney disease (CKD).</p><p><strong>Methods: </strong>Among patients with poorly controlled BP in the office or at home despite combination therapy with renin-angiotensin system (RAS) inhibitors and calcium channel blockers, 611 patients were included: those treated with thiazide diuretics (THZ group) and those who were switched from RAS inhibitors to sacubitril/valsartan for the next 12 months. After implementing multiple methods, 505 patients with CKD (n = 211 in the THZ group and n = 294 in the SacVal group) were analyzed using propensity score analysis with inverse probability weighting.</p><p><strong>Result: </strong>Compared to the THZ group, the SacVal group demonstrated significantly reduced systolic office BP, uric acid, and glycated hemoglobin A_1c (HbA_1c) with mean difference (95% confidence interval [CI]) of -3.9 mmHg (-6.9, -0.9) (p = 0.01), -0.7 mg/dl (-1.1, -0.4) (p < 0.001), and -2.9 mmol/mol (-5.7, -0.7) (p = 0.01), respectively. The annual decline in the estimated glomerular filtration rate (eGFR) was less in the SacVal group than in the THZ group, with a mean difference (95%CI) of 3.2 (1.3, 5.0) (p < 0.001).</p><p><strong>Conclusion: </strong>Compared to the addition of thiazide diuretics, the transition to sacubitril/valsartan resulted in greater BP reduction and more favorable changes in uric acid, HbA_1c, and eGFR in patients with CKD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1465-1475"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between elevated serum soluble B7-H6 and infection in hemodialysis patients.","authors":"Yansheng Jin, Xiaojun Wang, Weixin Kong, Xiaozhong Li","doi":"10.1007/s10157-025-02705-9","DOIUrl":"10.1007/s10157-025-02705-9","url":null,"abstract":"<p><strong>Background: </strong>Infection represents the second most common factor causing death in uremia, partly owing to immune dysfunction. Soluble B7-H6, a soluble form of cell-surface immunoreceptor B7-H6, is induced under infectious conditions. So far, the levels of circulating soluble B7-H6 in uremia cases have not been examined.</p><p><strong>Methods: </strong>In this prospective cohort study, 55 patients undergoing maintenance hemodialysis were recruited from October 2021 to February 2022; 20 healthy volunteers were enrolled.</p><p><strong>Intervention(s): </strong>None. All hemodialysis cases were followed up until death, switched to peritoneal dialysis, transplantation, or confirmed infection.</p><p><strong>Results: </strong>Patients were followed up for a mean duration of 331 days. Sixteen hemodialysis cases were diagnosed with infectious diseases, including pneumonia in seven cases, urinary tract infection in four, shingles in two, cutaneous infection in two, and sepsis in one. Compared with healthy controls, serum soluble B7-H6 amounts were markedly elevated in hemodialysis cases with or without infection (P < 0.001). Soluble B7-H6 levels were markedly increased in hemodialysis cases with infection compared to counterparts without infection (P < 0.001). Multivariable Cox proportional hazards model showed that soluble B7-H6 was the significant predictor of infection in hemodialysis patients (hazard ratio 3.308; 95% confidence interval 1.118-9.794; P = 0.031). Patients with high-serum soluble B7-H6 levels had a markedly higher cumulative hazard rate of infection in comparison with the low-serum soluble B7-H6 group (P < 0.05). Finally, soluble B7-H6 levels were positively correlated with neutrophil count (P < 0.05).</p><p><strong>Conclusions: </strong>This study first showed that serum soluble B7-H6 is elevated in hemodialysis patients and could be considered a potential predictive factor of infection under such conditions.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1476-1483"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"cnm-positive Streptococcus mutans, a major pathogen in dental caries, may exacerbate IgA nephropathy via the tonsils.","authors":"Seigo Ito, Taro Misaki, Shuhei Naka, Daiki Matsuoka, Kana Suehara, Yuto Suehiro, Yasuyuki Nagasawa, Ryota Nomura, Michiyo Matsumoto-Nakano, Kazuhiko Nakano","doi":"10.1007/s10157-025-02708-6","DOIUrl":"10.1007/s10157-025-02708-6","url":null,"abstract":"<p><strong>Background: </strong>Streptococcus mutans is a major pathogen in dental caries. This organism, which expresses Cnm protein encoded by the cnm gene, has been associated with the pathogenesis of IgA nephropathy (IgAN). Although tonsillectomy is used to treat IgAN, its efficacy is presently unclear in patients with IgAN who harbor cnm-positive S. mutans.</p><p><strong>Methods: </strong>The presence of cnm-positive S. mutans in saliva specimens from 158 patients with IgAN was determined by polymerase chain reaction assay. The patients were divided according to the results of cnm-positive S. mutans detection and history of tonsillectomy into those who were cnm-positive S. mutans (-), tonsillectomy (-) (group A, n = 57); cnm-positive S. mutans (-), tonsillectomy ( +) (group B, n = 62); cnm-positive S. mutans ( +), tonsillectomy (-) (group C, n = 19); and cnm-positive S. mutans ( +), tonsillectomy ( +) (group D, n = 20). The patients' clinical data were compared between the four groups.</p><p><strong>Results: </strong>The proportions of patients with proteinuria > 2 + and an estimated glomerular filtration rate < 60 mL/min/1.73 m² were significantly greater in group C than in the other groups (p < 0.0083). Moreover, the proportion of patients with a serum IgA concentration of > 347 mg/dL was significantly higher in group C than in the other groups (p < 0.05).</p><p><strong>Conclusions: </strong>These findings suggest that exacerbation of IgAN by cnm-positive S. mutans is possibly mediated by the tonsils and that tonsillectomy may be particularly effective in patients with IgAN and cnm-positive S. mutans in the oral cavity.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1400-1408"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}