International Journal of Gynecology & Obstetrics最新文献

{"title":"Accuracy of sonographic fetal biometry in estimating intertwin size discordance at birth.","authors":"Arietta Vayenas, Sophia Rahimi, Nir Melamed","doi":"10.1002/ijgo.70036","DOIUrl":"https://doi.org/10.1002/ijgo.70036","url":null,"abstract":"<p><strong>Objective: </strong>To determine the accuracy of estimated fetal weight (EFW) and abdominal circumference (AC) discordance in diagnosing large birthweight (BW) discordance and selective fetal growth restriction (sFGR).</p><p><strong>Methods: </strong>Retrospective cohort study of patients with twin pregnancies followed at a tertiary center (N = 1065). We determined the accuracy of intertwin fetal size discordance (based on either EFW or fetal AC) at the last ultrasound exam before birth in estimating birthweight discordance and in diagnosing sFGR at birth.</p><p><strong>Results: </strong>EFW discordance was more accurate than AC discordance in estimating BW discordance as reflected by a smaller systematic error (-0.97% vs. -6.43%, respectively, P < 0.001) and mean absolute percentage error (5.70% vs. 7.35%, respectively, P < 0.001), and a larger proportion of cases with discordance within 5%, 10%, or 15% of BW discordance (53.1% vs. 45.4%, 84.3% vs. 72.4%, and 95.1% vs. 87.0%, respectively). Still, both EFW discordance and AC discordance had low diagnostic accuracy for large BW discordance and sFGR. For example, EFW discordance >20% had a sensitivity of 49.1% and a positive predictive value of 57.0% for BW discordance >20%, and the antenatal diagnosis of sFGR had a sensitivity of 45.8%-54.4% and a positive predictive value of 50.9%-55.2% for the postnatal diagnosis of sFGR.</p><p><strong>Conclusion: </strong>While EFW discordance was more accurate than AC discordance in estimating BW discordance, both measures had low diagnostic accuracy for large BW discordance and sFGR. Care providers should consider the limited diagnostic accuracy when making management decisions on the timing and mode of delivery.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A risk scoring model for predicting adverse maternal outcomes in pregnancy with pre-eclampsia.","authors":"Manaphat Suksai, Alan Geater, Pawinee Amornchat, Chitkasaem Suwanrath","doi":"10.1002/ijgo.70044","DOIUrl":"https://doi.org/10.1002/ijgo.70044","url":null,"abstract":"<p><strong>Objective: </strong>Pre-eclampsia can lead to mortality and morbidity. The aim of this study was to establish a multivariate model to predict the adverse maternal events associated with pre-eclampsia in the Thai population and to provide the composite measure of adverse perinatal events.</p><p><strong>Methods: </strong>A retrospective study was conducted at the Songklanagarind Hospital between January 2011 and December 2020. Multivariable logistic regression analysis was used to identify clinical risk factors for adverse maternal outcomes in pregnancies complicated with pre-eclampsia and to establish a predictive model. A nomogram was generated to determine the probability of adverse event in pre-eclampsia patient.</p><p><strong>Results: </strong>Of the 1094 cases of pre-eclampsia identified, 202 (18.46%) developed adverse outcomes. The majority of adverse consequences were cardiorespiratory complications (110 cases, 54.46%), intensive care unit admissions (66 cases, 32.67%), and hematologic disorders (50 cases, 24.75%). Maternal death occurred in four cases (0.37%). Significant risk factors included a history of drug abuse, dyspnea, visual disturbance, systolic blood pressure ≥180 mmHg, hemoglobin <10 g/dL, platelet count <150 000/μL, total bilirubin >0.8 mg/dL, aspartate aminotransferase >35 IU/L, lactate dehydrogenase >500 IU/L, INR >1, creatinine >1 mg/dL, urine protein/creatinine ratio >1 mg/mg, and uric acid >7.5 mg/dL. The regression model for prediction of adverse maternal outcomes in pre-eclampsia achieved a receiver operating characteristic area of 0.86 (95% confidence interval: 0.83-0.89). Pre-eclampsia patients with a total score of ≥3 had an increased risk of developing adverse maternal outcomes (sensitivity: 80%, specificity: 78%).</p><p><strong>Conclusion: </strong>A new simplified scoring model and nomogram based on clinical characteristics and laboratory tests were developed to facilitate risk stratification of adverse maternal outcomes associated with pre-eclampsia in routine clinical practice.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An early prediction model for gestational diabetes mellitus created using machine learning algorithms.","authors":"Zhifen Yang, Xiaoyue Shi, Shengpu Wang, Lijia Du, Xiaoying Zhang, Kun Zhang, Yongqiang Zhang, Jinlong Ma, Rui Zheng","doi":"10.1002/ijgo.70055","DOIUrl":"https://doi.org/10.1002/ijgo.70055","url":null,"abstract":"<p><strong>Objective: </strong>To investigate high-risk factors for gestational diabetes mellitus (GDM) in early pregnancy through an analysis of demographic and clinical data, and to develops a machine-learning-based prediction model to enhance early diagnosis and intervention.</p><p><strong>Methods: </strong>A retrospective study was performed involving 942 pregnant women. A stacking ensemble (machine learning [ML]) was applied to demographic and clinical variables, creating a predictive model for GDM. Model performance was evaluated through receiver-operating characteristics (ROC) analysis, and the area under the curve (AUC) was calculated. Risk stratification was performed using quartile-based probability thresholds, and predictive accuracy was validated using an independent dataset.</p><p><strong>Results: </strong>Significant predictors for GDM included age, pre-pregnancy body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters), history of GDM, family history of diabetes, history of fetal macrosomia, education level, history of hypertension, and gravidity. These factors, which can be collected non-invasively at the first prenatal visit, formed the basis of a robust predictive model (AUC = 0.89). The model demonstrated a strong ability to exclude GDM, at a threshold of 28.53%.</p><p><strong>Conclusions: </strong>The machine-learning-based prediction model effectively identifies populations at high risk for GDM before invasive testing and oral glucose tolerance test, facilitating early clinical intervention and resource optimization.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of transvaginal or transumbilical tissue extraction at laparoscopic gynecologic surgery: A 12-year experience.","authors":"Osman Aşıcıoğlu, Berhan Besimoglu, Sinan Ateş","doi":"10.1002/ijgo.70050","DOIUrl":"https://doi.org/10.1002/ijgo.70050","url":null,"abstract":"<p><strong>Objective: </strong>To present our surgical outcomes by comparing the transumbilical and transvaginal methods for the removal of specimens in laparoscopic surgery of fibroids and adnexal masses during our 12 years of experience.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at our referral center between January 2012 and April 2024. We evaluated surgical outcomes, patients' clinical-demographic characteristics, cosmetic-pain scores and dyspareunia by comparing the two methods that we use routinely.</p><p><strong>Results: </strong>We retrospectively reviewed 285 patients. Visual analog scale (VAS) scores at 24 h were lower in the transvaginal group than in the transumbilical group (0.4 ± 0.6 vs. 0.8 ± 0.8, P < 0.001). The 3-month postoperative cosmetic score (CS) was higher in the transvaginal group than in the transumbilical group (4.5 ± 0.5 vs. 4.1 ± 0.6, P < 0.001). Furthermore, myomectomy and transumbilical were independent risk factors for lower VAS scores 24 h post surgery (myomectomy: odds ratio [OR] 3.42, P = 0.001, transvaginal route: OR 0.41, P = 0.005). Finally, the transumbilical extraction route and extension of the umbilical incision were independent risk factors for lower CS (P = 0.035 and P = 0.028).</p><p><strong>Conclusion: </strong>Removal of the specimen via the transvaginal route in laparoscopic adnexal mass and fibroid surgeries may lead to less pain in the early postoperative period and better cosmetic results without increasing the duration of the operation, the rate of intraoperative complications, and the rate of dyspareunia.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy outcomes following different surgical approaches for heterotopic interstitial and angular pregnancy.","authors":"Dan Feng, Tianjiao Liu, Li He, Li Lei","doi":"10.1002/ijgo.70054","DOIUrl":"https://doi.org/10.1002/ijgo.70054","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the perioperative and pregnancy outcomes among different surgical approaches and methods for treating heterotopic pregnancy (HP) and to identify the risk factors for the loss of intrauterine pregnancy (IUP).</p><p><strong>Methods: </strong>We retrospectively reviewed 59 cases of interstitial and angular HP treated surgically between 2014 and 2024 in two women's health centers in southwest China. Surgical methods included multi-port laparoscopy (MPL), transumbilical laparoendoscopic single-site surgery (TU-LESS), and conventional laparotomy (CL), along with cornual wedge resection and linear incision. Clinical outcomes were compared among IUP loss and successful IUP delivery; MPL, TU-LESS, and CL; and cornual wedge resection and linear incision groups. Binary logistic regression analysis was used to assess factors for predicting IUP loss.</p><p><strong>Results: </strong>There were 47 cases of live births of IUP. The operation duration was longer in the IUP-lost group (94.58 ± 32.51 min) versus the IUP-delivered group (67.29 ± 25.37 min, P = 0.001), and the incidence of hemorrhagic shock was significantly higher in the IUP-lost group (25% vs 2.1%, P = 0.024). There was one case of incomplete uterine rupture in the cornual wedge resection group. A history of biochemical pregnancy or missed abortion (Exp B = 32.610, P = 0.042), and fresh embryo transfer (Exp B = 0.126, P = 0.022) predicts IUP loss.</p><p><strong>Conclusion: </strong>CL, MPL, and TU-LESS, as well as cornual wedge resection and linear incision for treating HP, all showed comparable perioperative and IUP outcomes. Linear incision has relatively better surgical outcomes than cornual wedge resection. Factors such like fresh embryo transfer and a previous history of biochemical pregnancy or missed miscarriage predict IUP loss.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of heat shock proteins in placental ischemic disease: A narrative review of the current literature.","authors":"Athina A Samara, Anastasios Lafioniatis, Maria Ioannou, Sofia Tsiapakidou, Angeliki Gerede, Eleftherios Anastasakis, Alexandros Daponte, Sotirios Sotiriou","doi":"10.1002/ijgo.70039","DOIUrl":"https://doi.org/10.1002/ijgo.70039","url":null,"abstract":"<p><p>Pre-eclampsia, placental abruption, and fetal growth restriction (FGR) are collectively referred to as placental ischemic disease (PID). Heat shock proteins (HSPs), originally considered as a response to the heat shock, have a central role in regulating the cellular functions by quality controlling the newly synthesized proteins. The aim of the present review is to investigate the expression of the HSPs in PID and their potential role as biomarkers, based on the available data in the literature. A considerable amount of research has been conducted in order to determine the significance of HSPs in placental pathology and insufficiency, using both immunochemistry and circulating mRNA approaches. HSPs seem to be promising biomarkers that could be used for screening and monitoring the cellular stress of the placenta and its dysfunction. Yet, in order to be able to reach more solid evidence and draw a safer conclusion regarding their utility in clinical practice there is still a long way to go and further well-designed greater scale studies are required.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From tumor suspicion to tuberculoma discovery: A pregnancy case report and literature review.","authors":"Daniela Vinueza, David E Rebellón-Sánchez, Maria Alejandra Recio, Ana Maria Granados, Luis Alberto Escobar, Fernando Rosso","doi":"10.1002/ijgo.70045","DOIUrl":"https://doi.org/10.1002/ijgo.70045","url":null,"abstract":"<p><p>This article presents the case of a 22-year-old woman at 29 weeks of pregnancy, who exhibited recent onset neurologic symptoms including paresthesia of the right side of the face, involuntary myoclonic movements in the ipsilateral hand, 1 week of weakness in the right side of the body, and imaging features that were highly suggestive of a brain tumor diagnosis. A challenging decision making process was conducted by a team of multidisciplinary experts, leading to a consensus on adopting a conservative approach involving the use of steroids and antiepileptic medications, to which the patient responded favorably. When the patient reached 34 weeks of pregnancy, a cesarean section was performed, without complications, with the delivery of a healthy premature newborn. Upon delivery, surgical resection of the brain lesion was performed. Histopathologic analysis of the biopsy did not show signs consistent with neoplasia. Instead, it highlighted areas of necrosis along with the presence of granulomas and giant cells. Notably, despite extensive testing and staining for tuberculous bacilli across multiple samples yielding negative results, definitive confirmation was only secured via a gene X-pert test on the biopsied tissue. This diagnostic process emphasizes the importance of considering infectious diseases in atypical cases, highlighting the complexity of neurologic symptom assessment during pregnancy and the need to explore epidemiologic, systemic, and personal history factors.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stigma and discrimination experienced by Black women with endometriosis in the Washington, DC, Metropolitan area: A pilot of the ENDO-served study.","authors":"Julia Mandeville, Anna Z Pollack, Lauren Kornegay, Jhumka Gupta","doi":"10.1002/ijgo.70042","DOIUrl":"https://doi.org/10.1002/ijgo.70042","url":null,"abstract":"<p><p>Medical racism perpetuates health inequities contributing to why Black people in the United States (US) experience worse health outcomes when compared to non-Hispanic White populations. In terms of endometriosis, research on endometriosis-associated stigma has included mainly non-Hispanic White populations, with far less research on non-Hispanic Black populations. This leaves a gap in our knowledge on how stigma informs the intersection of racism and endometriosis. Thus, this study assessed the stigma experiences of Black women with endometriosis residing in the Washington, DC, area. An anonymous cross-sectional survey obtained key demographics, healthcare experiences, stigma, and depression. Mean stigma scores were similar (scale of 1 (least) to 5(most): enacted = 2.0 (SD ± 0.9), anticipated = 2.3 (SD ± 1.0), and internalized = 2.5 (SD ± 0.7) (n = 28). Those reporting healthcare providers made assumptions based on racial stereotypes had higher anticipated stigma, compared to those who did not (2.6 vs. 1.7). It was also observed that there was higher anticipated stigma for those changed providers due to racial discrimination, compared to those who did not (2.9 vs. 1.7). It can be theorized that the real-world outcomes from these stigma experiences may include delayed treatment and interruption in care continuity leading to worse health outcomes. This highlights why culturally responsive care practices are needed to address medical racism and stigma.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative blood loss values reveal high rates of undiagnosed postpartum hemorrhage.","authors":"Burhan A Khan, Alexandria Weston, Aubrey Jaeger, Gauri Shevatekar, Yanzhi Wang, Laura Smith, Kelvin E Wynn","doi":"10.1002/ijgo.70037","DOIUrl":"https://doi.org/10.1002/ijgo.70037","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we examined quantitative blood loss (QBL) values and postpartum hemorrhage (PPH) diagnoses in relation to clinical, demographic, and hospitalization related variables.</p><p><strong>Methods: </strong>A retrospective chart review was conducted of deliveries at a regional hospital over a nine-month period, querying patient demographics, PPH diagnosis, blood loss, and hospital stay variables.</p><p><strong>Results: </strong>PPH was substantially underdiagnosed by current USA guidelines (78%). Deliveries with >1000 mL of blood loss were not diagnosed with PPH (78%), including 84% of cesarean deliveries. Deliveries with >500 mL blood loss were not diagnosed with PPH (92%), including 89% of vaginal deliveries. There was no difference between estimated blood loss (EBL) and QBL levels for all deliveries (P = 0.9981); however, when separated by type of delivery, EBL was underestimated for vaginal deliveries (P = 0.02) and overestimated for cesarean deliveries (P = 0.02). PPH values were both associated with longer hospital stays (P < 0.001), and higher cost of care (P < 0.0001). Compared to Caucasian women, African American and Hispanic/Latina women had higher rates of PPH (P < 0.001 and P < 0.05, respectively).</p><p><strong>Conclusion: </strong>Quantitative measurement of blood loss identified many cases of undiagnosed PPH. Additionally, African American and Hispanic/Latina women were more likely to be diagnosed with PPH.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How we treat relapsed refractory gestational trophoblastic neoplasms-An exciting case series.","authors":"Kritthivasan Venkatakrishnan, Jayachandran Perumal Kalaiyarasi, Jayashree Natarajan, Amy Jose, Ujwala Wakpaijan, Gangothri Selvarajan, Sridevi Velusamy","doi":"10.1002/ijgo.70032","DOIUrl":"https://doi.org/10.1002/ijgo.70032","url":null,"abstract":"<p><strong>Objective: </strong>Relapsed/refractory gestational trophoblastic neoplasia (RR-GTN) presents a significant therapeutic challenge, with limited options available for patients who fail first-line treatments. In the present study we describe a few unique cases of RR-GTN and various options available for such situations.</p><p><strong>Methods: </strong>We identified three cases of RR-GTN between January 2021 and December 2022 who failed two or more lines of standard treatment. Clinical characteristics, therapeutic regimens, toxicities, and outcomes were collected from the case records.</p><p><strong>Results: </strong>We present this case series of three patients with RR-GTN treated with distinct therapeutic approaches: (1) Surgery for localized disease, (2) immunotherapy with pembrolizumab, and (3) tandem autologous stem cell transplantations. We also provide a detailed review of the available literature and guidance on managing RR-GTN.</p><p><strong>Conclusion: </strong>Intensified chemotherapy regimens, immune checkpoint inhibitors, and autologous stem cell transplantation offer promising avenues for improving outcomes in these high-risk patients. Clinical trials are warranted to establish the optimal sequencing of these therapies in clinical practice, but it may not be possible due to the paucity of such clinical situations.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}