Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders最新文献

{"title":"Adult-Onset Still's Disease in an Elderly Patient Presenting as Aseptic Meningitis: A Case Report.","authors":"Ujjwol Risal,&nbsp;Krishna Dhungana,&nbsp;Mrikchhya Ghimire","doi":"10.1177/11795441231195636","DOIUrl":"https://doi.org/10.1177/11795441231195636","url":null,"abstract":"<p><p>Adult-onset Still's disease (AOSD) is a rare auto-inflammatory disease of unknown origin characterized mainly by fever, arthritis, and a rash. Aseptic meningitis is a rare complication of AOSD and is seen most commonly in young adults. Here, we report a case of AOSD in a 78-year female with fever and altered sensorium with lymphocyte predominant pleocytosis in the cerebrospinal fluid who was initially managed as tubercular meningitis. Adult-onset Still's disease was diagnosed as there was no response to antitubercular drugs even after 3 months and based on persistent fever, inflammatory arthritis, rash, and highly raised inflammatory markers.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"16 ","pages":"11795441231195636"},"PeriodicalIF":2.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4f/25/10.1177_11795441231195636.PMC10460291.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10166642","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":"SAPHO Syndrome Presenting With Atlo-Epistrophic Synovitis and Left Vocal Cord Paresis: A Challenging Diagnosis.","authors":"Beatrice Maranini,&nbsp;Giovanni Ciancio,&nbsp;Rosa Rinaldi,&nbsp;Massimo Borrelli,&nbsp;Maura Pugliatti,&nbsp;Marcello Govoni","doi":"10.1177/11795441221118918","DOIUrl":"https://doi.org/10.1177/11795441221118918","url":null,"abstract":"<p><p>SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a rare syndrome mainly characterized by cutaneous and osteoarticular manifestations. The most typical osteoarticular manifestations are localized to the anterior chest wall and include a usually noninfectious osteitis, hyperostosis, and synovitis of the sternoclavicular joints. However, clinical presentation of SAPHO syndrome can be quite heterogeneous. Several clinical and radiological features are shared with other well-defined pathological entities, and clinical signs and symptoms often occur at different timepoints. Mainly due to this complexity and its rarity, there are currently no validated diagnostic criteria for SAPHO syndrome. Inflammation of the soft tissues around the bones and possible nerve compression could contribute to dysphagia, hypophonia, or obstruction of the airways. Neurologic manifestations could therefore be part of this multiorgan involvement. Here, we present a case of SAPHO syndrome with atypical onset symptoms, characterized by left vocal cord paralysis, acute neck pain due to osteolytic atlantoepistrophic lesion, and an unusual cutaneous manifestation, diagnosed as mid-dermal elastolysis. The latest two, to the best of our knowledge, have been here first described in a case of SAPHO syndrome.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":" ","pages":"11795441221118918"},"PeriodicalIF":2.6,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/c7/10.1177_11795441221118918.PMC9459495.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33459664","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":"Radiologically Guided Versus Blinded Intra-articular Injection in Patients With Hip Osteoarthritis: A Retrospective Comparative Study.","authors":"Ahmet Aksoy,&nbsp;Anil Gulcu,&nbsp;Mehmet Mert Tuna,&nbsp;Ahmet Aslan","doi":"10.1177/11795441221118920","DOIUrl":"https://doi.org/10.1177/11795441221118920","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to present the clinical results of patients with Kellgren-Lawrence (KL) stage 2-4 hip osteoarthritis who were administered intra-articular corticosteroid (CS) or hyaluronic acid (HA), with or without fluoroscopy.</p><p><strong>Methods: </strong>This retrospective comparative study was conducted in the clinics where the authors worked between 2010 and 2018. Patients with stage 2-4 hip osteoarthritis according to KL criteria were included in the study. Age, body mass index, American Society of Anesthesiologists stages, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (3rd, 6th, and 12th months) were recorded. Two groups were created as patients who underwent injection with or without fluoroscopy guidance. In group 1, CS (triamnisolone) was administered, and in group 2, sodium hyaluronate 88 mg/4 mL was administered. Obtained parameters were compared.</p><p><strong>Results: </strong>The WOMAC scores at 3 months of both the CS and HA groups were statistically significantly better than before the application, with the improvement in the CS group found to be significantly better than in the HA group (<i>P</i> = .047). At 6 months, the mean WOMAC scores of the CS and HA groups were better than prior to the application, and there was a statistically significant difference (<i>P</i> < .001). No significant difference was found in either the CS or HA group in the comparison of 12-month WOMAC scores with the baseline scores (<i>P</i> = .744 and <i>P</i> = .054).</p><p><strong>Conclusion: </strong>In symptomatic hip OA patients, intra-articular administration of CS and HA was seen to be effective at 3 and 6 months after administration. However, the effectiveness was determined to have disappeared within 1 year. Furthermore, in hip OA intra-articular drug applications, it was determined that the blinded technique without radiological guidance performed in the outpatient clinic is as effective and safe as the radiologically guided technique administered in the operating room.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":" ","pages":"11795441221118920"},"PeriodicalIF":2.6,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/cd/10.1177_11795441221118920.PMC9411738.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33442187","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":"Can Complete Blood Count Picture Tell Us More About the Activity of Rheumatological Diseases?","authors":"Sara I. Taha, S. Samaan, R. Ibrahim, Nouran M. Moustafa, E. El-Sehsah, Mariam K. Youssef","doi":"10.1177/11795441221089182","DOIUrl":"https://doi.org/10.1177/11795441221089182","url":null,"abstract":"Background: In clinical practice, distinguishing disease activity in patients with rheumatological illnesses is challenging. Objectives: We aimed to investigate clinical associations of hemogram-derived indices, namely: red cell distribution width (RDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) with disease activity in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS). Methods: In 250 patients with rheumatological disease and 100 healthy age-matched controls, we investigated disease activity scores and indicators and evaluated their association with hemogram-derived indices values. Results: Compared with the control group, RDW, MPV, and PLR significantly increased (P < .001) in the three studied disorders (RA, SLE, and AS), but LMR dramatically decreased. SII was considerably higher in RA and AS patients compared with controls but not in SLE patients. On the other hand, NLR rose dramatically in SLE patients compared with controls (P = .043), but did not change much in RA and AS patients (P > .05). RDW and MPV showed significant changes (P < .001) in the three studied diseases (RA, SLE, and AS) according to disease activity. They significantly increased across worsening activity scores. Only in the SLE group, PLR was significantly increased with disease activity (P < .001), while LMR showed a significant decrease (P = .016). Conclusions: Clinicians must pay close attention to complete blood count (CBC) analysis and its various derived ratios to better characterize the activity of rheumatological disorders and anticipate the disease course and prognosis.","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"2 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78291603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Prophylactic Dose of Trimethoprim-Sulfamethoxazole on Serum Creatinine in Japanese Patients With Connective Tissue Diseases","authors":"R. Kawato, R. Rokutanda, M. Okada, M. Matsushita, K. Yamaji, N. Tamura","doi":"10.1177/11795441221085141","DOIUrl":"https://doi.org/10.1177/11795441221085141","url":null,"abstract":"Objectives: At normal doses of trimethoprim-sulfamethoxazole (TMP/SMX), trimethoprim inhibits tubular creatinine secretion, leading to a rapid but reversible increase in serum creatinine (SCr). Although patients with connective tissue diseases are often in the state of immunosuppression and TMP/SMX is an important prophylactic drug, clinicians often have to stop or reduce the dosage due to concerns regarding its effect on renal function. This study aimed to evaluate the effect of a prophylactic dose of TMP/SMX on SCr in Japanese patients with connective tissue diseases, the extent of SCr level elevation and the independent risk factors for creatinine elevation. Methods: A retrospective cohort study was undertaken. Participants included patients with connective tissue diseases who were treated with a prophylactic dose of TMP/SMX between 2004 and 2018. Using single and multiple regression analyses, the risk factors that affected SCr elevation were evaluated. Results: A total of 262 patients, females, n = 181; age, median (range) = 59 (19-89) years, were included. The median baseline SCr level before treatment was 0.62 (0.16-2.1) mg/dL. The median SCr elevation value was 0.07 (−0.54 to 0.84) mg/dL in 4 weeks after TMP/SMX initiation. Five (2%) participants had ⩾0.3 mg/dL SCr elevation. Multiple regression analyses, including age, baseline SCr, diuretic use, nonsteroidal anti-inflammatory drug use and diabetes mellitus, indicated that baseline SCr and advanced age were independent risk factors of SCr elevation. Conclusions: These results demonstrated that baseline SCr and advanced age were associated with SCr elevation by a prophylactic dose of TMP/SMX. However, a prophylactic dose of TMP/SMX rarely elevated the SCr level significantly. Therefore, other causes can be considered if patients show an SCr elevation ⩾0.3 mg/dL.","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"9 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84224208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colchicine May Interfere With the Efficacy of the Adenoviral Vector–Based Vaccine for COVID-19","authors":"Cheng-Wei Lin","doi":"10.1177/11795441221081061","DOIUrl":"https://doi.org/10.1177/11795441221081061","url":null,"abstract":"Under the ongoing COVID-19 pandemic, vaccines have become the crucial players to reduce the spread of the infection. Among them, the ChAdOx1 nCoV-19 vaccine is an adenoviral vector vaccine with an overall efficacy of 70.4% in protection. The engineered adenovirus contains the SARS-CoV-2 spike protein gene and pushes its DNA into the vaccinated cell’s nucleus and subsequently, the spike protein can be made. During vaccination, the genome transition of adenovirus is influenced by the architecture and dynamics of the microtubule. Colchicine can alter microtubule dynamics by suppressing microtubule dynamics at lower concentrations and inducing depolymerization of microtubules at higher concentrations. Accordingly, the delivery of the genome to the vaccinated cell’s nucleus by the adenoviral vector could be hindered under the presence of colchicine. Nevertheless, colchicine is a common medication for gout therapy worldwide, and though not recommended by guidelines, colchicine has even been taken into consideration as a possible therapeutic option for COVID-19 infection. Given the above reasons and the worldwide use of colchicine, the impact of colchicine on the efficacy of the COVID-19 vaccine via adenoviral vector should be viewed cautiously.","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"8 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75530366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musculoskeletal Manifestations of Sarcoidosis.","authors":"Georges El Hasbani,&nbsp;Imad Uthman,&nbsp;Ali Sm Jawad","doi":"10.1177/11795441211072475","DOIUrl":"https://doi.org/10.1177/11795441211072475","url":null,"abstract":"<p><p>Since its initial description in the late 19th century, sarcoidosis has been extensively studied. Although the general mechanism of immune activation is known, many details especially in the context of disease associations are still missing. One of such associations is the musculoskeletal complications that are widely variable in terms of presentation and response to treatment. Sarcoidosis can involve the joints leading to acute and, less commonly chronic, arthritis. While acute arthritis is mostly self-resolving in nature, chronic arthritis may lead to deformity and destruction of the joint. Sarcoidosis can also involve the muscles, leading to different pathologies primarily categorized according to the clinical presentation, despite the efforts to find a new classification based on imaging, histological, and clinical findings. The bones can be directly and indirectly affected. Different types of bone lesions have been described, although around half of these patients remain asymptomatic. Osteoporosis, increased risk of fractures, hypercalcemia, and hypercalciuria are examples of the indirect effect of sarcoidosis on the bones, possibly contributed to elevated levels of calcitriol. Nevertheless, sarcoidosis can be associated with small-vessel, medium-vessel, and large vessel vasculitis, although it is frequently difficult to differentiate between the co-existence of a pure vasculitis and sarcoidosis and sarcoid vasculitis.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":" ","pages":"11795441211072475"},"PeriodicalIF":2.6,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/5e/10.1177_11795441211072475.PMC8854226.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39648009","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":"Ingredients of a Natural Oral Nutritional Supplement and Their Role in the Treatment of Osteoarthritis","authors":"K. Bharat, N. Manhas, James Gutcho, Joshua Lin, S. Bhattacharyya, Robertus Kounang","doi":"10.1177/11795441211063365","DOIUrl":"https://doi.org/10.1177/11795441211063365","url":null,"abstract":"Osteoarthritis is a prevalent degenerative disease affecting a large portion of the world’s aging population. Currently, nonsteroidal anti-inflammatory drugs and acetaminophen are first-line medications for treating osteoarthritis patients’ pain. However, several studies have noted that while these medications control pain they do not halt progressive degeneration and tend to have an unfavorable side-effect profile with prolonged use. Recently, due to their more favorable side-effect profiles, herbal alternatives for controlling osteoarthritis symptoms and for alleviating the progression of the disease are being increasingly studied. Synogesic is a newly developed herbal supplement blend by renowned orthopedic surgeons and physiatrists consisting of turmeric, rutin, ginger root, vitamin C, vitamin D, and boswellia extracts. A study by Sharkey et al. has commented on the efficacy of the blend on the patients with knee osteoarthritis. So far, a review on the ingredients of the blend has not yet carried outbeen. By exploring prominent literature databases including PubMed and ScienceDirect, our aim is to write a narrative review to explore the individual ingredients of this blend and delve into their characteristics, as well as the most recent literature on their mechanism and efficacy in patients with osteoarthritis. Through this, we hope to inform clinicians and patients alike on relevant up-to-date research on the supplement and provide insight on the potential for this supplement for alleviating the disease course of patients with osteoarthritis.","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"29 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91371726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Representation Rate and Management of Gout for Patients Discharged From Emergency Departments in Illawarra Shoalhaven Local Health District.","authors":"Aravinthan Loganathan,&nbsp;Arupam Raman,&nbsp;Natalia Berlinski,&nbsp;John Riordan","doi":"10.1177/11795441221097351","DOIUrl":"https://doi.org/10.1177/11795441221097351","url":null,"abstract":"<p><strong>Introduction: </strong>The estimated prevalence of gout in Western societies is 2.7% to 6.7%. In Australia, there have been increasing rates of hospitalisations for gout flares. Urate-lowering therapy (ULT) is effective in reducing urate burden, which can prevent gout flares and destructive arthropathy. This study assessed the representation rate of patients presenting to the Emergency Department (ED) with crystal arthropathy and the utilisation of ULT in the community for patients with a pre-existing history of gout.</p><p><strong>Methods: </strong>A retrospective review of electronic records of patients presenting to the ED from the Illawarra Shoalhaven Local Health District was performed. Patients included were coded as per the 10th revision of the International Classification of Diseases coding for crystal arthropathy.</p><p><strong>Results: </strong>In all, 18.8% of all crystal arthropathy encounters to the ED were repeat presentations. Of the 70% of patients with a history of gout, only 30.8% were on ULT.</p><p><strong>Discussion: </strong>Despite evidence-based recommendations for a 'treat-to-target' approach, most patients with a previous history of gout were not on ULT. One in five encounters were re-presentations for crystal arthropathy. Effective adherence to treatment guidelines may reduce the number of repeat encounters for gout flare in the ED.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"15 ","pages":"11795441221097351"},"PeriodicalIF":2.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/a3/10.1177_11795441221097351.PMC9134409.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10244883","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":"Prevalence of Osteoporosis Among Iranian Postmenopausal Women: A Systematic Review and Meta-analysis","authors":"Tayebeh Eghbali, K. Abdi, Mahboubeh Nazari, E. Mohammadnejad, Reza Ghanei Gheshlagh","doi":"10.1177/11795441211072471","DOIUrl":"https://doi.org/10.1177/11795441211072471","url":null,"abstract":"Objectives: Osteoporosis is the most common metabolic bone disease. It is considered the silent epidemic, with high prevalence after menopause, in the current time. Different studies conducted in Iran have reported different prevalence. The present systematic review and meta-analysis aims to estimate the overall prevalence of osteoporosis in Iranian postmenopausal women. Methods: The national scientific databases Scientific Information Database and MagIran and the international scientific databases PubMed, Web of Science, and Scopus were searched for related articles without any time limitation. The keywords osteopenia, osteoporosis, post menopause, OP, bone mineral density, and Iran along with their combinations were used in the search. The inconsistency in the data was examined using I2 test. The data were analyzed using the meta-analysis method and the random-effects model in Stata software, version 14. Results: The analysis of 26 articles with a sample size of 6735 showed that the prevalence of osteoporosis and osteopenia in Iranian postmenopausal women is, respectively, 33.70% (95% CI [confidence interval]: 22.68-44.73) and 47.60% (95% CI: 32.88-62.32). The pooled prevalence of osteoporosis in the spine and in the femur bone was 31.99% and 15.93%, respectively. Also, the prevalence of osteopenia in the spine and in the femur bone was 22.48% and 39.88%, respectively. Conclusion: Osteoporosis and osteopenia are highly prevalent in Iranian postmenopausal women to the extent that one-third of women suffer from osteoporosis and nearly half of them suffer from osteopenia. It seems essential to teach a healthy lifestyle to these women to reduce the prevalence of these issues.","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"112 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78667975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}