{"title":"Economic Burden of Otitis Media Globally and an Overview of the Current Scenario to Alleviate the Disease Burden: A Systematic Review.","authors":"Ragini Bhatia, Anil Chauhan, Monika Rana, Kulbir Kaur, Pranita Pradhan, Meenu Singh","doi":"10.1055/s-0043-1767802","DOIUrl":"10.1055/s-0043-1767802","url":null,"abstract":"<p><p><b>Introduction</b> The prevalence of otitis media (OM) is substantial all over the world. Epidemiological data related to the economic burden of OM globally is minimal. The present systematic review was undertaken to estimate the economic burden of this disease in various parts of the world. <b>Objectives</b> An extensive literature search was done using PRISMA guidelines to identify relevant studies that estimated the economic burden of OM in monetary terms. The databases searched were PubMed Central, Ovid, and Embase. The cost estimation was done for one specific year and then compared considering the inflation rate. <b>Data Synthesis</b> The literature search led to the inclusion of 10 studies. The studies evaluated direct and indirect costs in monetary terms. Direct costs (health system and patient perspective) ranged from USD (United States Dollar) 122.64 (Netherlands) to USD 633.6 (USA) per episode of OM. Looking at only the patient perspective, the costs ranged from USD 19.32 (Oman) to USD 80.5 (Saudi Arabia). The total costs (direct and indirect) ranged from USD 232.7 to USD 977 (UK) per episode of OM. The economic burden per year was highest in the USA (USD 5 billion). The incidence of OM episodes was found more in children < 5 years old. Introduction of pneumococcal conjugate vaccines decreased the incidence in children and now the prevalence in adults is of concern. <b>Conclusion</b> The economic burden of OM is relatively high globally and addressing this public health burden is important. Approaches for the prevention, diagnosis, and treatment should be undertaken by the health system to alleviate this disease burden.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 3","pages":"e552-e558"},"PeriodicalIF":1.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554690","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":"Hearing Function after CyberKnife for Vestibular Schwannoma: A Systematic Review.","authors":"Matheus Pedrosa Tavares, Fayez Bahmad","doi":"10.1055/s-0044-1787736","DOIUrl":"10.1055/s-0044-1787736","url":null,"abstract":"<p><p><b>Introduction</b> CyberKnife (CK) radiosurgery is a treatment strategy for vestibular schwannoma (VS). <b>Objectives</b> To evaluate hearing preservation (HP) after CK for VS. <b>Data Synthesis</b> The study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, and it was registered at the International Prospective Register of Systematic Reviews (PROSPERO, under number CRD42021250300). The inclusion criteria were based on the population, intervention, comparison, outcome, timing and study design (PICOTS) strategy: population - patients with VS; intervention - CK; Comparison - none; Outcome - serviceable HP defined by Gardner and Robertson as grades I or II, or by the American Academy of Otolaryngology and Head and Neck Surgery as classes A or B; timing - mean follow-up longer than 1 year; and study design - retrospective or prospective studies. The exclusion criteria were: studies not published in English; studies published before January 2000 and after October 2021; and studies only including patients with neurofibromatosis type 2 or submitted to a previous treatment. The PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, LILACS, and IBECS databases were used and last searched on October 27th, 2021. Statistical heterogeneity was assessed using <i>I</i> <sup>2</sup> statistics. The appraisal checklist was used to assess the risk of bias in the included studies. A total of 222 studies were analyzed, and 13 were included in the synthesis, which represents 493 participants with serviceable hearing before intervention. The mean HP rate after CK using a random effects model was of 68% (95% confidence interval [95%CI]: 59-76%) at a mean follow-up of 42.96 months. <b>Conclusion</b> The longer follow-up period was associated with a lower HP rate after CK radiosurgery for VS in the qualitative synthesis.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 3","pages":"e543-e551"},"PeriodicalIF":1.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554731","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":"Anatomical Measurement as a Reference for Functional Endoscopic Sinus Surgery Based on CT Scans and Dissections.","authors":"Andressa Vinha Zanuncio, Flávia Gontijo Amaral, Marcell de Barros Duarte Pereira, Flávio Barbosa Nunes, Roberto Eustáquio Santos Guimarães","doi":"10.1055/s-0043-1777447","DOIUrl":"10.1055/s-0043-1777447","url":null,"abstract":"<p><p><b>Introduction</b> Diseases of the paranasal sinuses, nasal cavities, and those related to the skull base can be treated with nasal endoscopic surgery. Anatomical references are essential to safely perform these surgeries. <b>Objective</b> To measure and compare the distance from the posterior wall of the maxillary sinus to the anterior skull base in cadavers and on computed tomography (CT) scans to determine a measurement as an anatomical reference in imaging exams for sinus and anterior skull base surgery. <b>Methods</b> In dissections and CT scans, we took measurements from the most upper and medial point of the posterior wall of the maxillary sinus (point A) to the point where the skull base deflects and the anterior sphenoid wall is formed (Δ 90°; point B), in the right and left nasal cavities. We used 51 cadavers aged ≥ 18 years in the present research. <b>Results</b> The measurements obtained from CT scans and dissections were greater than 1.5 cm in all cadavers, and they were positively correlated. The 1-cm increase in the AB-tomography measurement corresponded to the 1.08-cm increase to the right and 1.07-cm to the left in the AB-dissection measurement. <b>Conclusion</b> The CT measurements may be considered a reliable tool to promote safe and effective access to the paranasal sinuses, matching the distance that should be dissected until the anterior base of the skull.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 3","pages":"e424-e431"},"PeriodicalIF":1.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554687","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":"Study of Otorhinolaryngological Manifestations in Symptomatic COVID-19-Positive Patients at Tertiary Health Care Hospital: A Cross-sectional Study.","authors":"Disha Amar Methwani, Nitin Deosthale, Sonali Khadakkar, Kanchan Dhote, Vivek Harkare","doi":"10.1055/s-0044-1786831","DOIUrl":"10.1055/s-0044-1786831","url":null,"abstract":"<p><p><b>Introduction</b> The coronavirus disease 2019 (COVID-19), also referred to as the 2019 novel coronavirus, is caused by a single-stranded positive-sense RNA virus. This infectious agent spreads through respiratory routes, primarily utilizing aerosols. In our study, we shed light on ear, nose, and throat (ENT) manifestations, which can be considered as prognostic clinical biomarkers to reduce forthcoming complications among such critically ill patients. This makes it feasible for researchers to investigate or fetch early diagnosis in such cases with ease without the use of large, extensive hospital-base setups. <b>Objective</b> To study the otorhinolaryngological (ENT) manifestations in symptomatic COVID-19 patients. <b>Methods</b> From January to December 2021, a cross-sectional observational study was conducted at the Department of ENT of a tertiary care hospital in central India. All eligible symptomatic COVID-19 patients admitted to this institution during the study period were consecutively enrolled. The Institutional Ethics Committee gave its permission for the project. <b>Results</b> Out of the total of 1,375 patients, 78% of the patients diagnosed with COVID exhibited symptoms related to the ENT, while the remaining 22% did not display any ENT manifestations. Anosmia (71.2%), sore throat (55.62%), headache (44.3%), and loss of taste (66.3%) were among the most common ENT symptoms. <b>Conclusion</b> The present study highlights ENT manifestations, which play a crucial role in the early diagnosis of COVID-19 patients, ensuring faster treatment and isolation for better containment of the disease. Symptomatic treatment has shown efficacy, but objective tests are needed to prevent overestimation, understand pathogenesis, and enhance treatment.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 4","pages":"e597-e602"},"PeriodicalIF":1.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11511268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499815","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":"Peripheral Auditory Pathway and ABR Characterization in Adults with Williams Syndrome.","authors":"Jacqueline Aquino do Nascimento, Liliane Aparecida Fagundes Silva, Alessandra Gianella Samelli, Carla Gentile Matas","doi":"10.1055/s-0044-1785457","DOIUrl":"10.1055/s-0044-1785457","url":null,"abstract":"<p><p><b>Introduction</b> Williams syndrome (WS) is a genetic disorder caused by a microdeletion in chromosome 7, affecting ∼ 28 genes. Studies have demonstrated conductive losses seemingly related to the absence of the <i>elastin</i> gene and mild to profound sensorineural losses due to cochlear fragility. <b>Objective</b> To characterize and compare the peripheral auditory system and auditory brainstem response (ABR) of adults with WS and neurotypical adults matched by age and gender. <b>Methods</b> We conducted a cross-sectional observational study with 30 individuals of both sexes, aged 18 to 37 years - 15 of them with WS (study group) and 15 with neither the syndrome nor hearing complaints (control group), matched for sex and age. The subjects underwent pure-tone and speech audiometry, acoustic immittance, transient-evoked otoacoustic emissions (TEOAEs), and ABR. <b>Results</b> Early-onset sensorineural hearing loss was found in 53.3% of the study sample, mostly mild, occurring above 3 kHz. The TEOAEs were absent in 53.3% of assessed subjects; for those in whom they were present, the signal-to-noise responses were significantly lower than in the control group. In the ABR, increased absolute latencies were observed in waves I and III. <b>Conclusion</b> Individuals with WS have early and progressive cochlear impairments, mainly affecting the basal region of the cochlea. They may have low brainstem changes which seem to begin in adulthood.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 3","pages":"e502-e508"},"PeriodicalIF":1.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554734","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}
Mohamed Mesfer Alessa, Sultan Bin Obaid, Faisal Aldayel, Rakan Almetary, Khaled Alhussinan, Hassan Assiri, Mohamed Farahat
{"title":"Accuracy of Diagnosis of Benign Vocal Fold Lesions among Ear, Nose, and Throat Residents.","authors":"Mohamed Mesfer Alessa, Sultan Bin Obaid, Faisal Aldayel, Rakan Almetary, Khaled Alhussinan, Hassan Assiri, Mohamed Farahat","doi":"10.1055/s-0044-1787168","DOIUrl":"10.1055/s-0044-1787168","url":null,"abstract":"<p><p><b>Introduction</b> Benign vocal fold lesions (BVFLs) disrupt the superficial lamina propria, impacting vocal fold pliability. Investigating the diagnostic competency of ear, nose, and throat (ENT) residents in identifying BVFLs, we hypothesize that factors such as residency year, subspecialty focus, and training center influence diagnostic accuracy. <b>Objectives</b> To assess the accuracy of diagnosis of BVFLs among ENT residents and to correlate diagnostic accuracy with the year of residency. <b>Methods</b> An observational cross-sectional study included all ENT residents in Saudi Arabia. It was performed in August and September 2021 using a self-administered online questionnaire that assessed demographic variables and included three images with open-ended questions on diagnosing vocal fold lesions. <b>Results</b> A total of 61 ENT residents (62.3% male) were included in this study. The images of vocal fold cyst, vocal fold polyp, and vocal fold nodule were correctly diagnosed by 60.7%, 88.5%, and 91.8% of residents, respectively. There was a correlation between the year of residency and the accuracy of diagnosing a vocal fold cyst ( <i>p</i> = 0.029). Residents interested in laryngology correctly diagnosed all three lesions more frequently than other residents. <b>Conclusion</b> The ability of residents to diagnose vocal fold cysts was moderate. In particular, the senior residents were able to diagnose polyps and nodules with excellent accuracy.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 4","pages":"e619-e625"},"PeriodicalIF":1.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11511276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499794","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}
Mauricio Buschle, Rogerio Hamerschmidt, Jorge Eduardo Fouto Matias, Otavio Pereira Lima Zanini, Luiz Otavio de Mattos Coelho, Jose Fernando Polanski
{"title":"The Role of Computed Tomography in the Diagnosis of Congenital Sensorineural Hearing Loss.","authors":"Mauricio Buschle, Rogerio Hamerschmidt, Jorge Eduardo Fouto Matias, Otavio Pereira Lima Zanini, Luiz Otavio de Mattos Coelho, Jose Fernando Polanski","doi":"10.1055/s-0044-1786827","DOIUrl":"10.1055/s-0044-1786827","url":null,"abstract":"<p><p><b>Introduction</b> One of the paths in the investigation of congenital sensorineural hearing loss (CSNHL) is to try to characterize its etiology through the inner ear evaluation using high resolution computer tomography (CT) scans. With minor malformation, it is not always possible for a simple visual inspection to recognize if the structure in the inner ear is normal or not. <b>Objective</b> To verify if measurements of the inner ear are predictive of sensorineural hearing loss (SNHL) and suggest cutoff points of size limits. <b>Methods</b> Retrospective cross-sectional study of inner ear CT scan measurements of 214 patients, 50 with congenital SNHL (CSNHL) and 164 acquired SNHL (ASNHL) (control group). <b>Results</b> In the CSNHL group, central bony island (CBI) were 0.48 mm smaller ( <i>p</i> < 0.001), cochlear nerve aperture was (CNA) 0.10 mm smaller ( <i>p</i> < 0.001), and cochlea height was (CH) 0.15 mm smaller ( <i>p</i> < 0.001). Vestibular aqueduct (VA) and cochlea width (CW) were similar between groups (0.70 vs 0.72, <i>p</i> = 0.19, and 7.20 vs 7.15 <i>p</i> = 0.23). The predictive cutoff points for CSNHL were CBI = 3.6 mm, CAN = 1.4 mm, CH = 3.4 mm, CW = 7.0 mm, and VA = 0.9 mm. <b>Conclusion</b> Congenital sensorineural hearing loss determined a decrease in CBI, opening of the cochlear nerve (OCN), and CW. Thus, these measures, at the cutoff points indicated, should make us aware of the diagnosis of congenital hearing loss.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 3","pages":"e387-e393"},"PeriodicalIF":1.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554738","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}
Alexandre Wady Debes Felippu, Thiago Picolli Morsch, Deusdedit Brandão Neto, Eduarda Montenegro Moretti, André Wady Debes Felippu, Filippo Cascio, Richard Louis Voegels
{"title":"Assessment of the Use of Telemedicine by Brazilian Otolaryngologists through an Online Questionnaire.","authors":"Alexandre Wady Debes Felippu, Thiago Picolli Morsch, Deusdedit Brandão Neto, Eduarda Montenegro Moretti, André Wady Debes Felippu, Filippo Cascio, Richard Louis Voegels","doi":"10.1055/s-0044-1786385","DOIUrl":"10.1055/s-0044-1786385","url":null,"abstract":"<p><p><b>Introduction</b> The coronavirus disease 2019 (COVID-19) pandemic has prompted a transformation in medical practice, including the adoption of telemedicine in Brazil and globally. Otorhinolaryngology, a field at high risk of viral transmission, has witnessed an increasing use of telemedicine tools. However, the extent and challenges of telemedicine in this field in Brazil are not well understood. In the present study, we applied a questionnaire to Brazilian otorhinolaryngologists during the pandemic to assess telemedicine's advantages and challenges, shedding light on its integration and persistent issues in the field. <b>Objective</b> To assess the usage profile of telemedicine in the clinical practice of otolaryngology in Brazil. <b>Methods</b> The present was a cross-sectional observational study with convenience sampling. It was conducted as a web-based questionnaire distributed and advertised to Brazilian otorhinolaryngologists through social media posts on WhatsApp (Meta Platforms, Inc., Menlo Park, CA, USA), Instagram (Meta Platforms, Inc.), Facebook (Meta Platforms, Inc.), as well as direct messaging and email. <b>Results</b> The sample size was 186 participants. A total of 69% of them had already provided or were currently providing telemedicine services, and 34% considered it a frequent or very frequent form of work at the time of data collection. In total, 90% of the respondents considered the lack of physical examination a problem in otolaryngological teleconsultations, while 64% reported frequently or very frequently resolving patient problems through teleconsultations. <b>Conclusion</b> Telemedicine emerged in the context of the COVID-19 pandemic as a promising tool for remote patient care. More studies are needed to elucidate its role in the context of limited physical examination.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 4","pages":"e592-e596"},"PeriodicalIF":1.0,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11511432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499795","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":"Treatments for Olfactory Dysfunction in COVID-19: A Systematic Review.","authors":"Esmaeil Mehraeen, Soudabeh Yarmohammadi, Pegah Mirzapour, Seyed Saeed Tamehri Zadeh, Soheil Dehghani, Leila Molaeipour, Ayoob Molla, Elaheh Karimi, Faeze Abbaspour, SeyedAhmad SeyedAlinaghi","doi":"10.1055/s-0044-1786046","DOIUrl":"10.1055/s-0044-1786046","url":null,"abstract":"<p><p><b>Introduction</b> Olfactory dysfunction (OD) has emerged as a notable symptom among coronavirus disease 2019 (COVID-19) patients, with its prevalence varying among different populations. Recognizing the need to provide therapeutic solutions for these individuals, the present study seeks to comprehensively review the current evidence on potential underlying mechanisms and treatment modalities to manage OD in COVID-19 patients. <b>Objective</b> To review the recent evidence on treatments for OD in COVID-19. From the beginning of the study until August 2nd, 2023, we conducted a systematic search on four electronic databases, PubMed, Scopus, Embase, and Web of Science, to find relevant publications. <b>Data Synthesis</b> In the present study, 37 articles were selected for data extraction and included in the final review. The total number of patients was of 3,560 (2,098 female and 1,462 male subjects). The predominant disorders reported were hyposmia, anosmia, and parosmia. In most of the studies, the pre and postintervention assessments were the same, except for one study, in which the pre-intervention assessment of the disorder was through the SST, Sniffin' Sticks Test (SST), and the post-intervention assessment was through the Visual Analog Scale (VAS) and the 22-item Sinonasal Outcome Test (SNOT-22). The findings suggest olfactory training (OT), ivermectin, palmitoylethanolamide, luteolin, and systemic corticosteroids, in combination with topical corticosteroids, are potential therapies for COVID-19 patients with olfactory impairment. <b>Conclusion</b> Although the review suggested several medications for OD treatment, further research must delve into the specific impact of OT, a non-pharmacological modality, regarding the mitigation of OD. By continuing to investigate and refine these therapeutic approaches, we can better support COVID-19 patients and improve their quality of life while navigating the challenges posed by OD.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 4","pages":"e728-e743"},"PeriodicalIF":1.0,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11511580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499819","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}