JAMA ophthalmology最新文献

{"title":"Digital Defocus Vision Training Using Virtual Reality for Myopia Control","authors":"Jing Zhong, Yu Liu, Tianli Peng, Jing Ma, Ziting Huang, Xiao Yang, Shi-Ming Li, Jin Yuan","doi":"10.1001/jamaophthalmol.2026.3490","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.3490","url":null,"abstract":"Importance Virtual reality–based digital defocus vision training (DDVT) may offer a home-based strategy to slow myopia progression in children, but evidence is limited. Objective To evaluate efficacy and safety of a head-mounted virtual reality–based DDVT system on myopia progression. Design, Setting, and Participants This randomized clinical trial was conducted among children aged 6 to 12 years with myopia enrolled in July 2024, with follow-up completed in September 2025. The trial was conducted at a single center in Guangzhou, China. Data were analyzed from September 2025 to October 2025. Intervention Participants were randomized to DDVT plus single-vision spectacles (SVS) or SVS alone. Participants in the DDVT group used a head-mounted virtual reality device at home for 15 minutes per day under parental supervision after an initial in-hospital training session. Main Outcomes and Measures The primary outcome was the between-group difference in axial length (AL) change from baseline to 6 months. The secondary outcome was between-group difference in spherical equivalent refraction (SER) change. Results Of 120 randomized participants, 57 of 60 participants in the DDVT group (95%) and 59 of 60 participants in the SVS group (98%) completed the study. At baseline, mean (SD) ages in the DDVT and SVS groups were 9.42 (1.52) years and 9.31 (1.13) years, respectively, and 53 of 116 participants (45.7%) were female. Mean (SD) AL and spherical equivalent in the DDVT and SVS groups were 24.35 (0.81) mm and 24.40 (0.81) mm and −1.91 (1.11) diopter (D) and −2.04 (1.06) D, respectively. Mean best-corrected visual acuity was −0.04 logMAR (Snellen equivalent, 20/18) and −0.03 logMAR (20/19), respectively. At 6 months, AL increased by 0.15 mm and 0.25 mm in the DDVT and SVS groups, respectively (difference = 0.11 mm; 95% CI, 0.07-0.15 mm; <jats:italic>P</jats:italic> < .001). SER changed by −0.23 D and −0.46 D (difference = −0.23 D; 95% CI, −0.35 to −0.11 D; <jats:italic>P</jats:italic> = .003). Visual acuity change at 6 months was −0.02 logMAR (Snellen equivalent, 20/18) and 0.01 logMAR (20/20) in the DDVT and SVS groups, respectively (difference = 0.03 logMAR [Snellen equivalent, 20/21]; 95% CI, 0.02-0.05 [20/21-20/22]; <jats:italic>P</jats:italic> < .001). No training-related adverse events were observed. Conclusions and Relevance In this randomized clinical trial, the DDVT group had a small absolute reduction in AL and SER myopic progression compared with SVS alone over 6 months in 120 children with myopia aged 6 to 12 years. The clinical relevance of these differences over the short and long term cannot be determined from this trial but support additional studies to assess this intervention as a promising adjunctive approach for pediatric myopia control. Trial Registration ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT07042022?","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"189 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148836183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral CRAO in a Healthy Young Adult After Cocaine Use","authors":"Paola Marolo, Enrico Borrelli, Michele Reibaldi","doi":"10.1001/jamaophthalmol.2026.3277","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.3277","url":null,"abstract":"This case report discusses bilateral central retinal artery occlusion (CRAO) in a young adult with no cardiovascular history who presented with bilateral vision loss 3 days after recreational cocaine use.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"186 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148768019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra–Long-Distance Robotic-Assisted Subretinal Injection for Submacular Hemorrhage","authors":"Andi Xu, Bo Yang, Bingqian Liu, Lin Lu, Zhangkai Lian, Wenben Chen, Rihui Song, Wang Guo, Subinuer Alimu, Zhenzhen Liu, Dong Liu, Yanlin Li, Wei Xiao, Mohammad Ali Nasseri, Kai Huang, Haotian Lin","doi":"10.1001/jamaophthalmol.2026.3303","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.3303","url":null,"abstract":"Importance Submacular hemorrhage (SMH) is a vision-threatening condition sometimes requiring timely intervention to try to reduce retinal damage. However, access to experienced vitreoretinal surgeons remains limited in many geographically remote regions, and further studies with controlled comparisons are needed to evaluate potential solutions. Objective To evaluate the feasibility and safety issues of ultra–long-distance robotic-assisted subretinal injection for the treatment of SMH. Design, Setting, and Participants This single-case report conducted between October 2025 and January 2026 at the following 2 centers separated by approximately 4000 km: Zhongshan Ophthalmic Center in Guangzhou, China (remote control center), and Xinjiang Production and Construction Corps Hospital in Urumqi, China (patient site). One patient with SMH was enrolled. Intervention Following pars plana vitrectomy performed manually, while the participant still was under general anesthesia, a retinal surgeon remotely teleoperated an ophthalmic robotic system to perform subretinal injection of recombinant tissue plasminogen activator. Main Outcomes and Measures Primary outcomes were procedural feasibility and safety, defined as successful completion of robotic subretinal injection without conversion to manual surgery and absence of intraoperative complications or serious postoperative adverse events. Secondary outcomes included hemorrhage resolution and best-corrected visual acuity during follow-up. Results The robotic-assisted procedure was successfully completed without intraoperative complications, with 7 minutes of robotic teleoperation during a total surgical time of 46 minutes. Mean (range) network latency was 77.9 milliseconds (71-90 milliseconds). A total of 0.056 mL of recombinant tissue plasminogen activator was delivered. No serious adverse events occurred during 3 months of follow-up. Optical coherence tomography demonstrated progressive hemorrhage reduction, with complete absorption by postoperative day 26. Preoperative best-corrected visual acuity measured 1 day before surgery was 0.6 logMAR (Snellen equivalent, 20/80) and remained stable at 0.6 logMAR (20/80) at 3 months postoperatively. Conclusions and Relevance In this single-case report, robotic-assisted intraocular microsurgery was feasible and safe across 4000 km. These findings provide proof-of-concept evidence that telesurgical robotic systems like this subretinal injection may expand access to specialized retinal procedures in geographically remote regions.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"73 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148768024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angioid Streaks in a 60-Year-Old Man","authors":"Dorian T’Sjoen, Julie De Zaeytijd, Olivier Vanakker","doi":"10.1001/jamaophthalmol.2026.3324","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.3324","url":null,"abstract":"A 60-year-old man presented with progressive vision loss over several weeks in his right eye, noting a dark spot in his central vision and metamorphopsia. What would you do next?","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"6 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148768020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spectacle Lenses With Highly Aspherical Lenslets for Myopia Control","authors":"Jason Shen, Chris Hunt, Graeme Young, Björn Drobe","doi":"10.1001/jamaophthalmol.2026.3288","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.3288","url":null,"abstract":"Importance Myopia prevalence is rising in the US. Spectacle lenses with highly aspherical lenslets (HAL) are effective in Asian populations but unproven in US children. Objective To evaluate the 24-month safety and effectiveness of HAL spectacle lenses compared with single-vision spectacle lenses (SVL) in US children with myopia. Design, Setting, and Participants This double-masked randomized clinical trial took place at 9 investigational sites in the US and included children aged 6 to 12 years with a manifest spherical equivalent refraction (SER) of −0.75 to −4.50 diopters (D). Key exclusion criteria included a history of prior myopia control intervention, strabismus, amblyopia, or any ocular or systemic conditions and medications affecting refractive status. Enrollment was from December 2021 to July 2022, and the 24-month follow-up reported here was completed in October 2024. Interventions Participants were randomized (1:1) to HAL or SVL. Main Outcomes and Measures Primary outcomes were 24-month changes in cycloplegic SER (cSER) and axial length. Results Of 159 randomized participants (80 [50.3%] male; mean [SD] age, 9.7 [1.6] years), 135 (84.9%) completed the 24-month assessment. The baseline mean (SD) cSER was −2.21 (1.07) D in the HAL group and −2.05 (1.22) D in the SVL group. At 24 months, adjusted mean (SE) myopia progression was −0.25 (0.05) D in the HAL group and −0.90 (0.05) D in the SVL group (difference, 0.64 D; 95% CI, 0.50 to 0.79; <jats:italic>P</jats:italic> &amp;amp;lt; .001), a 71% relative reduction. The baseline mean (SD) axial length was 24.26 (0.92) mm in the HAL group and 24.32 (0.83) mm in the SVL group. Adjusted mean (SE) axial elongation was 0.21 (0.02) mm in the HAL group and 0.45 (0.02) mm in the SVL group (difference, −0.24 mm; 95% CI, −0.29 to −0.19; <jats:italic>P</jats:italic> &amp;amp;lt; .001), a 53% relative reduction. Best-corrected visual acuity was equivalent between groups (mean difference, −0.01 logMAR; 95% CI, −0.02 to 0.00; <jats:italic>P</jats:italic> = .23). Ocular adverse events occurred in 9 of 77 participants the HAL group (11.7%) vs 12 of 82 in the SVL group (14.6%); none were serious or lens related. The total number of subjective symptom reports were 19 (HAL) and 25 (SVL). Conclusions and Relevance In this randomized clinical trial of US children, spectacle lenses with HAL provided a reduction in myopia progression and axial elongation over 24 months. While longer-term data are needed to evaluate sustained treatment efficacy, these findings support HAL as a safe and effective myopia control intervention and underlie US Food and Drug Administration authorization of the study device. Trial Registration ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT05174780?id=NCT05174780&amp;amp;amp;viewType=Card&amp;amp;amp;rank=1\">NCT05174780</jats:ext-link>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"16 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148768022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Lacrimal Sac Massage vs Probing for Congenital Nasolacrimal Duct Obstruction in Infants","authors":"Xinyu Zheng, Xinyue Yu, Guangsen Wu, Jiayi Zhang, Kerui Wang, Ling Jin, Siyu Huang, Rongxin Chen, Huiying Yu, Weifeng Huang, Zuohong Li, Xuanwei Liang","doi":"10.1001/jamaophthalmol.2026.3169","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.3169","url":null,"abstract":"Importance Congenital nasolacrimal duct obstruction (CNLDO) is a common condition in infants. While observation and surgical probing are commonly used in clinical practice, evidence to guide the choice between these approaches is lacking, and the efficacy of lacrimal sac massage remains controversial. Objective To assess whether lacrimal sac massage is noninferior to lacrimal duct probing for treating CNLDO in infants. Design, Setting, and Participants This noninferiority randomized clinical trial took place at an outpatient clinic in Guangzhou, China, from April to September 2025 and included 160 infants younger than 1 year with CNLDO, presenting with epiphora or discharge in 1 or both eyes since birth. Children with bilateral eye disease were only analyzed for the right eye. Patients were excluded if they had previously undergone surgery for CNLDO or had another systemic disease or ocular infection. Interventions Patients were randomly assigned to receive lacrimal duct probing in the consultation room (n = 80) or standardized, regular lacrimal sac massage performed by parents (n = 80). Main Outcomes and Measures The primary outcome was the resolution rate at 3 months, defined as complete or substantial resolution of epiphora, alongside the complete resolution of purulent discharge. The prespecified noninferiority margin was −10 percentage points. Results The mean (SD) age of the participants was 6.2 (2.5) months, and 98 (61.3%) were male. Resolution occurred in 69 of 80 participants (86.2%) in the massage group compared with 67 of 80 (83.7%) in the probe group (difference, 2.5 percentage points; 95% CI, −8.78 to 13.76). No serious complications occurred. The mean (SD) symptom resolution time was 1.1 (0.5) weeks in the probe group and 3.8 (2.8) weeks in the massage group (difference, 2.7 weeks; 95% CI, 1.96 to 3.38; <jats:italic>P</jats:italic> &amp;amp;lt; .001). Conclusions and Relevance For infants younger than 1 year with CNLDO, lacrimal sac massage for 3 months was noninferior to lacrimal duct probing in efficacy, with no serious complications in either group. These findings support lacrimal sac massage as an alternative to surgical probing for CNLDO in infants younger than 1 year similar to those enrolled in this trial. Trial Registration ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT06924723?id=NCT06924723&amp;amp;amp;viewType=Card&amp;amp;amp;rank=1\">NCT06924723</jats:ext-link>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"15 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148717832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden-Onset Ptosis in a Young Female Patient","authors":"Sarah Munger, Sruti S. Akella, Craig Munger","doi":"10.1001/jamaophthalmol.2026.3190","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.3190","url":null,"abstract":"A 25-year-old female patient with a recent history of left-sided root canal, tooth extraction, and bone graft presented with left eye pain and blurry vision, ptosis, persistent headache, and neck stiffness. Examination revealed left mydriasis without relative afferent pupillary defect. What would you do next?","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148717830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iris Nodule and Pulmonary Sarcoidosis in a Patient Aged 57 Years","authors":"Jianing Ren, Ping Fei, Peiquan Zhao","doi":"10.1001/jamaophthalmol.2026.3136","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.3136","url":null,"abstract":"This case report describes a woman aged 57 years who presented with a 3-month history of cough and dyspnea, during which a solitary iris nodule was discovered on ophthalmologic consultation and led to a diagnosis of pulmonary sarcoidosis.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"191 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148717838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk Factors for Progression of Pachychoroid Subtype","authors":"Yu Jeat Chong, Angie Hon Chi Fong, Wendy Mei Hua Wong, Noa Gilead, Kelvin Yi Chong Teo, Chui Ming Gemmy Cheung","doi":"10.1001/jamaophthalmol.2026.3168","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.3168","url":null,"abstract":"Importance The incidence and determinants of progression across the pachychoroid subtype remain incompletely characterized, limiting risk stratification and follow-up strategies. Objective To evaluate progression, diagnostic transitions, and associated risk factors in eyes with pachychoroid subtype. Design, Setting, and Participants This prospective, multicenter, observational cohort study included participants with pachychoroid subtype, defined by subfoveal choroidal thickness (SFCT) of 300 µm or greater measured beneath the foveal center point, recruited at centers in Asia. Participants underwent standardized clinical assessment and multimodal imaging and were followed up for 2 years. The study was conducted between July 2020 and November 2023, and data analysis was performed from November 2023 to February 2026. Exposures Baseline pachychoroid subtype phenotype and imaging characteristics. Main Outcomes and Measures The primary outcome was diagnostic progression within the pachychoroid subtype spectrum over 2 years. Secondary outcomes included incident neovascularization, treatment initiations, and changes in best-corrected visual acuity (BCVA) and SFCT. Results A total of 205 eyes from 125 participants (mean [SD] age, 59.0 [8.8] years; 32 female participants [25.6%]) completed 2-year follow-up. At baseline, 39 eyes had uncomplicated pachychoroid (UP), 102 had pachychoroid pigment epitheliopathy (PPE), 47 had central serous chorioretinopathy (CSCR), and 17 had pachychoroid neovasculopathy (PNV). Mean (SD) changes from baseline in BCVA and SFCT were 0.13 (0.18) logMAR (approximate Snellen equivalent, 20/25) to 0.11 (0.24) (20/25; difference, −0.02 logMAR [approximately 1 letter]; 95% CI, −0.05 to 0.02; <jats:italic toggle=\"yes\">P</jats:italic> = .33) and from 419 (83) µm to 424 (90) µm (difference, 6 µm; 95% CI, −5 to 16; <jats:italic toggle=\"yes\">P</jats:italic> = .32), respectively. Eyes with CSCR and PNV had worse baseline BCVA compared to eyes with UP and PPE. Progression occurred in 15 eyes (7.3%; 95% CI, 4.5%-11.6%), including 7 eyes with neovascularization, all of which had shallow, irregular retinal pigment epithelium elevation at baseline, among 116 eyes at baseline with such elevation. Conclusions and Relevance In this study among a relatively small cohort of 4 different levels of pachychoroid subtype, progression to a worse level was infrequent, as was worsening of visual acuity or choroidal thickening. Neovascularization was unusual and occurred exclusively in eyes with shallow, irregular retinal pigment epithelium elevation, suggesting the importance of this imaging feature if confirmed in subsequent studies.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"31 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148717835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Candy-Stripe Sign in Ghost Cell Glaucoma","authors":"Thiago Terzian Ganadjian, Gustavo Moreira Umehara, Sérgio Nakamura Junior","doi":"10.1001/jamaophthalmol.2026.2973","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.2973","url":null,"abstract":"This case report discusses the classic appearance of ghost cell glaucoma in the anterior chamber of a male patient aged 65 years who presented with pain, redness, and decreased visual acuity in his left eye for 1 week.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"453 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148675385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}