Current rheumatology reviews最新文献

{"title":"Infection Screening and Vaccination of Adult and Pediatric Patients with Autoimmune Inflammatory Rheumatic Diseases: An Emirati Delphi Consensus.","authors":"Ahlam Almarzooqi, Jehad Abdalla, Mohamed Sharif Elsadeg, Noura Zamani, Amel Abdel Gadir Ginawi, Zaid Alrawi, Rajaie Namas, Afra Aldhaheri, Ahmed Zayat, Faisal Elbadawi, Layla ALDabal, Najla Aljaberi, Shazia Abdullah, Suad Hannawi, Khalid A Alnaqbi, Fatima Al Dhaheri, Beena Hameed, Jamal Al-Saleh","doi":"10.2174/0115733971368196250117105119","DOIUrl":"https://doi.org/10.2174/0115733971368196250117105119","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with autoimmune and inflammatory rheumatic diseases (AIIRD) have an increased susceptibility to infections due to their compromised immune systems and the use of immunosuppressive therapies. Infections are a leading cause of morbidity and mortality in these patients, emphasizing the need for strategies such as infection control and vaccination to prevent avoidable harm to both patients and healthcare workers. This study aims to provide expert consensus on infection screening and vaccination guidelines for AIIRD patients.</p><p><strong>Methods: </strong>A task force of experts from the United Arab Emirates developed a set of statements based on available evidence and expert opinion. The consensus was structured into two main categories: infection screening (9 statements with 23 sub-statements) and vaccination (7 statements).</p><p><strong>Results: </strong>The infection screening consensus covered nine key areas: tuberculosis (TB) screening (I.1), methods and periodicity of TB screening (I.2), strategies for managing positive IGRA test results (I.3), and infection control for hepatitis B (I.4), hepatitis C (I.5), HIV (I.6), varicella-zoster virus (I.7), and Pneumocystis jirovecii (I.8). The vaccination consensus included recommendations on general vaccination principles (V.0) and specific vaccinations for influenza (V.1), pneumococcal disease (V.2), human papillomavirus (HPV) (V.3), varicella-zoster virus (V.4), tetanus (V.5), and COVID-19 (V.6). Delphi voting showed strong consensus among the task force experts, validating their relevance and applicability for clinicians managing AIIRD patients.</p><p><strong>Conclusion: </strong>This Emirati consensus provides up-to-date guidance and recommendations for clinicians to enhance the care and safety of AIIRD patients.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022556","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":"The Causal Effects of Lifestyle Factors on Osteoarthritis: A Two-sample Mendelian Randomisation Study.","authors":"Justin Ho, Christopher Chi Hang Mak, Lawrence Chun Man Lau, Kendrick To, Wasim Khan","doi":"10.2174/0115733971335445241203054553","DOIUrl":"https://doi.org/10.2174/0115733971335445241203054553","url":null,"abstract":"<p><strong>Background: </strong>Modern sedentary lifestyles are prevalent among individuals with osteoarthritis. However, direct evidence linking such behaviours as causative factors of osteoarthritis remain limited due to the presence of confounding variables.</p><p><strong>Objective: </strong>This study aims to determine the extent to which lifestyle factors have causal effects on osteoarthritis through a two-sample Mendelian randomisation (MR) study.</p><p><strong>Methods: </strong>Exposure-outcome relationships were evaluated using inverse variance weighted twosample MR and summary statistics of genome-wide association studies of lifestyle factors and osteoarthritis. Weighted median, MR-PRESSO, and MR-Egger regression were used as sensitivity analyses. We obtained causality estimates, 95% confidence intervals (CI), and P-values from each MR method. Steiger filtering and radial filtering were used to exclude SNPs demonstrating reverse causality and significant heterogeneity, respectively.</p><p><strong>Results: </strong>MR analyses demonstrated that certain lifestyle factors had causal effects on osteoarthritis, particularly insomnia (OR 1.09 (0.387-1.79), P = 0.0024), BMI (OR 6.45 (4.48-8.42), P = 1.38e-10) and protein intake (OR 2.94 (0.361-5.52), P = 0.026). Effects were consistent across sensitivity analyses using median-based MR methods. ZNF131 & SEMA3F, and potentially RWDD2B & USP8 are genetic loci identified to mediate these causal effects.</p><p><strong>Conclusion: </strong>Our results illustrate that lifetime exposure to certain lifestyle factors has causal effects on osteoarthritis. Further studies are required to determine the efficacy of lifestyle-based interventions in reducing the population-wide disease burden of osteoarthritis.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001893","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":"Using Multi-Omics Methods to Understand Gouty Arthritis.","authors":"Siming Gao, Hui Song","doi":"10.2174/0115733971329652241119060025","DOIUrl":"https://doi.org/10.2174/0115733971329652241119060025","url":null,"abstract":"<p><p>Gouty arthritis is a common arthritic disease caused by the deposition of monosodium urate crystals in the joints and the tissues around it. The main pathogenesis of gout is the inflammation caused by the deposition of monosodium urate crystals. Omics studies help us evaluate global changes in gout during recent years, but most studies used only a single omics approach to illustrate the mechanisms of gout. In this review, we review the genomics, transcriptomics, epigenetics, proteomics, and metabolomics of gout, observing that different genes, DNA methylation, miRNAs, LncRNAs, circRNAs, proteins, and metabolites are found between hyperuricemia, acute gout arthritis, and chronic gout arthritis, and some of them are associated with disease activity, prognosis or treatment, which help us broaden our understanding of the pathogenesis and provide important clues for valuable biomarkers. To our knowledge, this is the first study that combines all omics studies from genomics to metabolomics and may serve as a reference for future studies to identify the key underlying pathways in gout.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983024","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":"Influence of Multidrug Resistance 1 Gene Variants on Response to Intravenous Methylprednisolone Pulse in Systemic Lupus Erythematosus Patients: Preliminary Results.","authors":"Doaa H S Attia, Dalia Ahmed Hamza Dorgham, Ahmed Amin Al Maghraby, Manal B Abdelrazik, Dina Aly Ezzat","doi":"10.2174/0115733971345970241107114732","DOIUrl":"https://doi.org/10.2174/0115733971345970241107114732","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Genetic variations could explain individual responses to drugs. This case-control study aimed to investigate the association between the multidrug resistance 1 (MDR1) gene exonic single nucleotide variants (SNVs), rs1128503/C1236T and rs1045642/C3435T, and the response to intravenous methylprednisolone in Egyptian patients with active systemic lupus erythematosus (SLE).</p><p><strong>Method: </strong>Real-time polymerase chain reaction was used. Patients were divided into responders and resistant based on the SLE Disease Activity Index (SLEDAI). The degree of improvement was determined according to a 7-point Likert scale.</p><p><strong>Results: </strong>The study included 80 patients: 40 patients with renal flares and 40 patients with extrarenal flares. In patients with extrarenal flares, 71.4% of responders had the CT+TT model of the C1236T variant versus 36.8% of resistant patients (p = 0.028); the T allele was detected in 47.6% of responders versus 23.7% of resistant patients (p = 0.026). Patients with the TT and CT genotypes, TT+CT model, and T allele of the C1236T variant had significant improvement based on the Likert scale compared with the CC genotype, CC model and C allele (p = 0.049, 0.038, 0.010 and <0.001, respectively). In the renal subgroup, patients with the CC genotype and C allele of the C3435T variant had significant improvement based on the Likert scale compared with the CT genotype and T allele (p = 0.028 and 0.046, respectively). Patients with the CC model had significantly lower post-treatment proteinuria compared with the TT+CT model (p = 0.024).</p><p><strong>Conclusion: </strong>MDR1 C1236T variant allele and C3435T wild allele seem to enhance the response to glucocorticoids in Egyptian patients with active SLE.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946221","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":"Clodronate: The Influence on ATP Purinergic Signaling.","authors":"Sergio Rosini, Stefano Rosini, Gianantonio Saviola, Luigi Molfetta","doi":"10.2174/0115733971358895241216112008","DOIUrl":"https://doi.org/10.2174/0115733971358895241216112008","url":null,"abstract":"<p><p>ATP is involved in numerous physiological functions, such as neurotransmission, modulation, and secretion, as well as in cell proliferation, differentiation, and death. While ATP serves an essential intracellular role as a source of energy, it behaves differently in the extracellular environment, where it acts as a signaling molecule capable of activating specific purinergic receptors (P2YRs and P2XRs) that modulate the response to ATP. Extracellular ATP signaling is a dynamic area of research, with particular interest in ATP's effects on inflammatory conditions and pain modulation. Clodronate differs from other bisphosphonates that contain an amino group in their structure (N-BPs), and it is metabolized within osteoclasts into a toxic ATP analog, AppCCl2p, which causes mitochondrial dysfunction and osteoclast apoptosis. This characteristic differentiates Clodronate from N-BPs, as the latter act by interfering with the mevalonate pathway. Clodronate has demonstrated anti-inflammatory and analgesic activity in various bone and musculoskeletal diseases through mechanisms involving macrophages, neutrophils, peripheral nociceptors, and the central nervous system. ATP produced inside cells is accumulated within transport vesicles, where it penetrates via a VNUT channel and is then released extracellularly, playing an active role in acute and chronic inflammatory processes, neurotransmission of pain, and liver disease regulation. Clodronate influences these processes due to its strong inhibitory effect on VNUT-mediated ATP release. The aim of this review is to highlight the therapeutic potential offered by appropriate modulation of cellular ATP release and the inhibitory effects of Clodronate on the channel through which ATP penetrates transport vesicles.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946218","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":"Updates on Recent Advances in the Therapy of Adult Psoriatic Disease.","authors":"Fadi Kharouf, Dafna D Gladman","doi":"10.2174/0115733971339350240830104424","DOIUrl":"https://doi.org/10.2174/0115733971339350240830104424","url":null,"abstract":"<p><p>Psoriatic arthritis (PsA) is a heterogeneous inflammatory disease with various joint and skin manifestations and multiple associated comorbidities. The management of PsA is important not only in controlling disease activity and preventing subsequent damage but also in improving the quality of life and reducing mortality. Over the years, numerous drugs have been introduced into the therapeutic armamentarium of the disease. While non-steroidal anti-inflammatory drugs (NSAIDs) and conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) have contributed to management, it was not until the advent of biologics (and later on targeted synthetic DMARDs) that therapy was revolutionized, with the achievement of significantly better clinical and radiographic outcomes. Several drugs and treatment approaches are currently being tested in clinical trials at different phases. Despite all the success, there are still various challenges and unmet needs in the field of PsA, reflected by difficult-to-treat disease course, secondary failure of therapy, and lack of consensus on accepted treatment withdrawal protocols, among others. In this review, we have discussed the most recent advances in the therapy of psoriatic disease, with a particular focus on phase III studies completed (or ongoing) since 2020. We also mentioned the challenges and unmet needs in our clinical practice, which we expect current and future research to provide answers to.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926558","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":"A Review on Pyrazole Derivatives Used in the Treatment of Rheumatoid Arthritis: Recent Advancement and Drug Development.","authors":"Nisha Chaudhary, Neeraj Sharma","doi":"10.2174/0115733971267325231227092819","DOIUrl":"10.2174/0115733971267325231227092819","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is an autoimmune disorder where inflammation and destruction of bone are the hallmarks of the disease. This review focuses on the etiology, pathophysiology, and treatment strategies for RA, along with the different approaches used for the synthesis of pyrazoles, the characterization of various properties, and their biological significance for curing RA. The activated immune system of the body causes inflammation of the synovial joint due to the interaction of immune cells, such as T and B lymphocytes, macrophages, plasma cells, dendritic cells and mast cells. The treatment for RA has been revolutionized with the discovery of new chemical compounds and an understanding of their mechanism in the treatment of the disease. Pyrazoles are the starting materials for the synthesis of heterocyclic compounds and possess great relevance in the pharmaceutical field for the development of new drugs. They are versatile bio-scaffolds in medicinal chemistry and organic synthesis. This has been followed by a deep analysis of pyrazoles and their derivatives on the basis of medical significance in the treatment of RA. This follow-up and information may help the chemists, scientists, and researchers to generate new pyrazole compounds with high efficacy for better treatment of patients with RA. We summarize the review with an understanding of the core of pyrazoles and a claim that their derivatives may be helpful in the development of efficient drugs against RA.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":"54-69"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140038937","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":"Saudi National Clinical Practice Guidelines for Management of Adult Systemic Lupus Erythematosus.","authors":"Ahmed H Al-Jedai, Hajer Y Almudaiheem, Ibrahim A Al-Homood, Ibrahim Almaghlouth, Sami M Bahlas, Abdulaziz Mohammed Alolaiwi, Mohammad Fatani, Maysa Tariq Eshmawi, Bedor A AlOmari, Khalidah Ahmed Alenzi, Rayan G Albarakati, Nayef Al Ghanim","doi":"10.2174/0115733971275638240429063041","DOIUrl":"10.2174/0115733971275638240429063041","url":null,"abstract":"<p><strong>Objective: </strong>To provide evidence-based clinical practice recommendations for managing Systemic Lupus Erythematosus (SLE) in Saudi Arabia.</p><p><strong>Methods: </strong>This EULAR-adapted national guideline in which a multidisciplinary task force utilized the modified Delphi method to develop 31 clinical key questions. A systematic literature review was conducted to update the evidence since the EULAR publication. After reaching a consensus agreement, two rounds of voting and group discussion were conducted to generate consolidated recommendations/ statements.</p><p><strong>Results: </strong>A significant number of patients in Saudi Arabia experience delays in accessing rheumatologists, highlighting the significance of timely referral to SLE specialists or rheumatologists to ensure accurate diagnosis and prompt treatment. The primary goal of Glucocorticoid (GC) therapy in SLE patients is to establish disease control with a minimum dose and duration. Steroid-sparing agent utilization facilitates steroid-sparing goals. Hydroxychloroquine is recommended for all SLE patients, though physicians must carefully monitor toxicity and prioritize regular medication adherence assessment. SLE management during pregnancy starts from preconception time by assessing disease activity, major organ involvement, hypercoagulability status, and concomitant diseases that may negatively impact maternal and fetal outcomes. Multidisciplinary care with close monitoring may optimize both maternal and fetal outcomes. For patients with antiphospholipid antibodies, low-dose aspirin prophylaxis is recommended. Also, Long-term anticoagulant medications are fundamental to prevent secondary antiphospholipid syndrome due to high thrombosis recurrence.</p><p><strong>Conclusion: </strong>This Saudi National Clinical Practice guidelines for SLE management provide evidence- based recommendations and guidance for healthcare providers in Saudi Arabia who are managing patients with SLE. These guidelines will help to standardize healthcare service, improve provider education, and perhaps lead to better treatment outcomes for SLE patients.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":"70-96"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862447","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":"Efficiency of Glucosamine in Treating Temporomandibular Joint Osteoarthritis: A Meta-Analytic Umbrella Review.","authors":"Sasidharan Sivakumar, Prabhakaran Prem Kumar, Palindla Lakshmi Prasanna, Gowardhan Sivakumar, Sesuraj Balasamy, Ashok K Sundramoorthy","doi":"10.2174/0115733971309907240527105306","DOIUrl":"10.2174/0115733971309907240527105306","url":null,"abstract":"<p><strong>Background: </strong>Temporomandibular joint osteoarthritis (TMJ OA) is a chronic disease that is a consequence of undue occlusal forces and is characterized by irreversible damage to the articular surfaces. Symptomatic slow-acting so-called nutraceutical drugs have been proposed as a treatment for osteoarthritis in comparison to non-steroidal anti-inflammatory drugs (NSAIDs). Oral glucosamine and chondroitin, slow-acting drugs, have been found to reduce pain and increase mouth opening in patients with TMJ OA. However, there is limited scientific evidence to confirm their clinical effectiveness.</p><p><strong>Aim: </strong>This systematic review was conducted to bolster the evidence supporting the assessment of the efficacy of glucosamine in the context of temporomandibular joint osteoarthritis (TMJ OA).</p><p><strong>Methodology: </strong>This review identified four review articles from databases like Medline (via PubMed), Web of Science, Scopus, and EMBASE till September 2023 after screening at the title, abstract, and full-text level. They were assessed for risk of bias with the JBI risk of bias assessment tool.</p><p><strong>Results: </strong>This review with meta-analysis focused on pooled estimate mean differences, revealing non-significant but discernible effects of glucosamine on maximum mouth opening (SMD = 0.288, p = 0.15) and pain reduction (SMD = 0.217, p = 0.476) in TMJ-related disorders.</p><p><strong>Conclusion: </strong>Compared to control groups with ibuprofen and tramadol, glucosamine showed slightly more favourable outcomes. However, the variability in methodology and study characteristics warrants further longitudinal studies to confirm its efficacy.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":"194-201"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310261","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":"Methotrexate - Safe Backbone for the Treatment of Rheumatoid Arthritis.","authors":"Marco Krasselt","doi":"10.2174/0115733971317122240626053727","DOIUrl":"10.2174/0115733971317122240626053727","url":null,"abstract":"<p><p>Methotrexate (MTX) is the primarily used disease-modifying antirheumatic drug (DMARD) for the treatment of Rheumatoid Arthritis (RA). MTX is a safe agent, even when used for years - provided that treatment is regularly monitored and prescribers follow some simple rules, such as prescribing tablets of a single strength only. Proper patient education contributes greatly to safe treatment. The knowledge of important pharmacologic facts, possible interactions, and clinical warning signs also helps to prevent or recognize intoxications early. Therefore, this review addresses key aspects regarding the safety of MTX. In this respect, it includes adverse events, possible interactions with frequently used drugs and details on the rare but life-threatening intoxication, e.g., due to erroneous daily intake.</p>","PeriodicalId":11188,"journal":{"name":"Current rheumatology reviews","volume":" ","pages":"169-181"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562932","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}