Journal of adolescent and young adult oncology最新文献

{"title":"<i>In Vitro</i> Maturation of Oocytes Obtained from Ovarian Cortex Among Postpubertal Hematological Cancer Patients Undergoing Fertility Preservation.","authors":"Gilad Karavani, Einat Gutman-Ido, Aharon Dick, Koral Vedder, Nir Cohen, Talya Mordechai-Daniel, Raizl Gruda Sussman, Tal Imbar","doi":"10.1089/jayao.2023.0157","DOIUrl":"10.1089/jayao.2023.0157","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> <i>In vitro</i> maturation (IVM) of oocytes obtained from ovarian tissue during ovarian tissue cryopreservation (OTC) is a technique for fertility preservation in patients with cancer obviating the need to postpone chemotherapy initiation. Little is known about IVM outcomes in hematological malignancies, especially post-chemotherapy. The purpose of this study was to evaluate the effect of cytotoxic treatment on the potential to retrieve immature oocytes and mature them <i>in vitro</i> and examine the association between serum inflammatory markers and these results. <b><i>Methods:</i></b> In this retrospective study, we evaluated inflammation markers, including B symptoms and IVM outcomes of 78 chemotherapy-naive and exposed patients diagnosed with Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), or acute myeloid leukemia (AML). <b><i>Results:</i></b> The mean number of oocytes found was 7.2 ± 7.2. The average number of oocytes matured by IVM was 2.8 ± 3.5, and a mean IVM rate was 32.1 ± 27.7%. All patients in the ALL and AML groups had previous exposure to chemotherapy before OTC, compared with 50.0% (7/14) and 31.9% (15/47) in the NHL and HL groups, respectively. Among patients with lymphoma, chemotherapy exposure was associated with the reduced number of retrieved oocytes (9.8 ± 7.7 vs. 5.3 ± 5.7 oocytes, <i>p</i> = 0.049) in the HL group but not with the number of mature oocytes or IVM rate. B symptoms were not associated with IVM outcomes. Lymphocyte count (ß = 1.584; <i>p</i> = 0.038) and lactate dehydrogenase (ß = 0.009; <i>p</i> = 0.043) were the only significant parameters associated with the number of matured oocytes in a linear regression model. <b><i>Conclusion:</i></b> IVM is a promising assisted reproductive technology, which holds great potential for patients in need of urgent fertility preservation or those who cannot receive hormonal stimulation. Our results demonstrate the feasibility of the technique even in the presence of B symptoms and elevated inflammation markers and in patients with previous exposure to chemotherapy.</p>","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141766162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Pon1</i> and <i>Sult1a1</i> Polymorphisms and Breast Cancer Among Young Women in Brazil.","authors":"Rafaela Soares Senra da Costa, Nara de Almeida Souza, Ketiuce de Azevedo Zukeram, Carmen Freire, Guillermo Patricio Ortega Jácome, Rosalina Jorge Koifman, Cynthia Chester Cardoso, Sabrina da Silva Santos","doi":"10.1089/jayao.2023.0176","DOIUrl":"https://doi.org/10.1089/jayao.2023.0176","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> To investigate the association of genetic polymorphisms Gln¹⁹²Arg and Leu⁵⁵Met of Paraoxonase 1 (<i>PON1</i>) gene, and Arg²¹³His of Sulfotransferase 1A1 (<i>SUT1A1</i>) gene with occurrence of breast cancer among young women living in Rio de Janeiro city. <b><i>Methods:</i></b> This is a hospital-based case-control study including 265 women aged 18-35 years, diagnosed with breast cancer at National Cancer Institute; and 277 controls in the same age group selected among women patients and companions of three general hospitals from Rio de Janeiro public health network. Polymorphisms genotyping was performed using the PCR-RFLP technique. <b><i>Results:</i></b> For <i>PON1</i> gene, breast cancer women had a greater chance of being homozygote for Leu⁵⁵Met polymorphism (OR_adjusted = 1.42, 95% CI= 0.67-3.00, recessive model) and a lower chance of having at least one allele of Gln¹⁹²Arg polymorphism (OR_adjusted = 0.75, 95% CI = 0.50-1.13, dominant model), but without statistical significance. Accordingly, frequency of the haplotype Met⁵⁵/Arg¹⁹² was lower among breast cancer women, but no statistically significant association was observed (OR_adjusted = 0.85; 95% CI = 0.48-1.51). <i>SULT1A1</i> His/His genotype was significantly associated with a protective effect for breast cancer (OR _adjusted = 0.51, 95% CI = 0.28-0.91, recessive model). <b><i>Conclusion:</i></b> Arg²¹³His polymorphism of <i>SUT1A1</i> gene showed a protective effect against breast cancer among Brazilian young women. More studies with different designs are needed to understand the role of <i>PON1</i> and <i>SULT1A1</i> polymorphisms in breast cancer development in young Brazilian women.</p>","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harmonization of the Upfront Osteosarcoma Treatment Paradigm for Adolescents and Young Adults.","authors":"Nicole P Daukshus, Viswatej Avutu, Emily Long Sarro, Michael D Kinnaman, Emily K Slotkin, Katherine Thornton, Mark A Dickson, Nancy T Sklarin, William D Tap, Julia Glade Bender","doi":"10.1089/jayao.2024.0054","DOIUrl":"https://doi.org/10.1089/jayao.2024.0054","url":null,"abstract":"<p><p>Limited guidance exists on streamlining cancer therapy for adolescent and young adult (AYA) patients 15-39 years of age, as much of the current data are extrapolated from pediatric or adult counterparts and can differ significantly between the two care models. Harmonization of standard treatment approaches has the potential to improve outcomes and establish a foundation for the development of future clinical trials. We present our experience harmonizing treatment and supportive care regimens for AYA patients with osteosarcoma receiving treatment with methotrexate, doxorubicin, and cisplatin (MAP) therapy on the pediatric and adult sarcoma services at the Memorial Sloan Kettering Cancer Center.</p>","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Experience of Adolescents and Young Adults in Their Cancer Journeys in Japan: I Try to Move Forward With Feeling That I Would Be Okay With \"My Cancer\".","authors":"Naoko Takenouchi, Mari Matsuoka","doi":"10.1089/jayao.2024.0017","DOIUrl":"https://doi.org/10.1089/jayao.2024.0017","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> A cancer diagnosis can greatly affect adolescents and young adults (AYAs), especially those in their late teens and early twenties, who might have their special needs. This study aimed to understand the experiences of the AYAs who were diagnosed between 15 and 24 years of age in Japan, thinking about the care guide supporting them, from the time of their cancer diagnosis through the rest of their lives. <b><i>Methods:</i></b> Data were collected using semi-structured interviews, which were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts was used to categorize these into themes for comprehensive interpretation. <b><i>Results:</i></b> Twenty AYAs participated; they were diagnosed between the ages 15 and 23 and were 19-29 years old at the time of the interview. In total, 14 core categories were identified, consisting of three themes (1) There is a feeling of distance between the cancer and me, (2) I face \"my cancer\" in my way, and (3) I feel that I would be okay with \"my cancer.\" <b><i>Conclusions:</i></b> AYAs had their way of dealing with cancer while experiencing a distant feeling between themselves and the presence of the disease during their cancer journey. Although the process was not simple, they tried to live their lives in their own way, believing that they would be okay. Nurses must respect and understand that AYAs have a process of facing their own cancer with time and watch over AYAs' experiences to appropriately support them to successfully proceed further.</p>","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of the Gonadotoxicity and Risk of Infertility of Soft Tissue Sarcoma Chemotherapies in Pre- and Postpubertal Females and Males.","authors":"Marcel Steinmann, Anita Rietschin, Flavia Pagano, Tanya Karrer, Attila Kollár, Susanna Weidlinger, Michael von Wolff","doi":"10.1089/jayao.2024.0057","DOIUrl":"https://doi.org/10.1089/jayao.2024.0057","url":null,"abstract":"<p><p>Increasing awareness of gonadotoxicity in cancer treatments and infertility risk is essential for counseling young cancer patients. While fertility preservation options are available in many countries, limited data on gonadotoxicity hinder recommendations, especially for soft tissue cancers. This review, part of the FertiTOX project (www.fertitox.com), organized by FertiPROTEKT (www.fertiprotekt.com), aims to address this knowledge gap to improve fertility preservation guidance. We performed a systematic literature search on gonadotoxicity in soft tissue sarcoma (STS) cancer treatments. Only patients without metastases or recurrent disease were considered. \"Suspected infertility\" was defined based on low ovarian reserve parameters, low inhibin B levels, high gonadotropin concentration, gonadal dysfunction, amenorrhea, oligomenorrhea, azoospermia, or oligozoospermia due to limited infertility data. The study quality was assessed using the Newcastle-Ottawa Scale. The search yielded 3309 abstracts, with 138 undergoing full-text analysis. Eight studies on STS were included. Suspected infertility was observed in 20 of 28 females (71.4%, range 0-100%) and 38 of 63 males (60.3%, range 34.8-100%) with STS. Six of the eight studies received high-quality scores on the NOS, while two received a fair score. Our data suggest a high risk of infertility from chemotherapy in pre- and postpubertal STS survivors. This underscores the importance of considering fertility preservation measures when counseling these patients.</p>","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141599827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Beliefs, Breast Cancer Awareness, and Prevention Behaviors of Turkish Nursing Students: A Cross-Sectional Study.","authors":"Ayfer Aksuoglu, Esma Ozsaker","doi":"10.1089/jayao.2024.0069","DOIUrl":"https://doi.org/10.1089/jayao.2024.0069","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study was conducted to examine the relationship between nursing students' breast cancer (BC) awareness, health beliefs, and BC prevention behaviors. <b><i>Methods:</i></b> This study sample consisted of 256 female students. Descriptive Information Form, Breast Cancer Awareness Scale (B-CAS), the Factors Affecting Breast Cancer Prevention Behaviors of Women (FABCPB) Scale, and the Champion's Health Belief Model Scale (CHBMS) were used to collect the data. <b><i>Results:</i></b> Breast self-examination was performed in 53.9% of the nursing students. The mean B-CAS score was 1.35 ± 0.58 and the mean FABCPB score was 102.84 ± 9.62. The mean scores of the sub-dimension scores of the CHBMS of nursing students were as sensitivity perception 7.93 ± 2.13, seriousness perception 22.58 ± 5.26, benefit perception 17.25 ± 3.17, obstacle perception 22.89 ± 6.24, confidence 37.71 ± 7.53, and health motivation 26.47 ± 4.41 points. A significant correlation was found between the scores of the nursing students on the B-CAS, FABCPB, and CHBMS scales. <b><i>Conclusions:</i></b> Nursing students' scores on the B-CAS and FABCPB were moderate, CHBMS sensitivity and obstacle perception sub-dimension scores were low, severity perception scores were moderate, and benefit perception, trust, and health motivation sub-dimension scores were high. As the BC awareness of nursing students increased, their cancer prevention behaviors and health beliefs increased.</p>","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141599826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonsuicidal Self-Injury in Adolescent and Emerging Adult Childhood Cancer Survivors: A First Exploration.","authors":"Sara Campens, Laurence Claes, Janne Vanderhaegen, Elise Van Laere, Sofie Prikken, Jurgen Lemiere, Anne Uyttebroeck, Koen Luyckx","doi":"10.1089/jayao.2024.0061","DOIUrl":"https://doi.org/10.1089/jayao.2024.0061","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study examines nonsuicidal self-injury (NSSI) in adolescent and emerging adult survivors of childhood cancer, aiming to gain a first understanding of the phenomenon, its relation to general and cancer-specific functioning, and the stability of NSSI engagement over time. <b><i>Methods:</i></b> Dutch-speaking survivors (<i>n</i> = 125, age range = 14-25 years) participated in the first three annual waves of the Longitudinal Identity Study of Childhood Cancer Survivors study. Descriptive characteristics of lifetime NSSI were calculated. Multivariate analysis of variance (MANOVA) and χ²-analyses were performed to examine differences in demographic and clinical characteristics between survivors with and without lifetime NSSI. To assess differences in general and cancer-specific functioning between survivors with and without lifetime NSSI, two MANOVA analyses were performed. Finally, prevalence rates of current NSSI across the three waves were calculated, followed by χ²-analyses to explore differences in current NSSI over time. <b><i>Results:</i></b> The prevalence and characteristics of lifetime NSSI engagement resembled those in the general population. Although demographic and clinical characteristics were unrelated to NSSI engagement, several meaningful differences were found in both general and cancer-specific functioning between survivors with and without NSSI. Survivors with lifetime NSSI experienced more depressive symptoms and difficulties with identity formation (i.e., lower levels of identity synthesis and higher levels of identity confusion). In addition, they experienced more post-traumatic stress symptoms and cancer-related worries, and identified less as a \"cancer patient.\" <b><i>Conclusions:</i></b> This study provides a first understanding of NSSI engagement in survivors of childhood cancer, mapping the characteristics of NSSI and its associations with both general and cancer-specific functioning.</p>","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Clinical Utility of Patient-Reported Outcome Measurement Information System-29 in a Newly Established Adolescent and Young Adult Oncology Program.","authors":"Patrick Smith, Benjamin Snyder, Maria McDaniel, Madeleine St Ville, Elizabeth Cull, Elizabeth J Siembida, Aniket Saha","doi":"10.1089/jayao.2023.0136","DOIUrl":"https://doi.org/10.1089/jayao.2023.0136","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Despite improvements in survival, adolescent and young adult (AYA) oncology patients are at high risk for experiencing negative health-related quality of life (HRQOL) outcomes. AYA cancer programs have attempted to develop assessment tools to identify areas of need. We aimed to demonstrate the feasibility/utility of the Patient-Reported Outcome Measurement Information System^®-29 (PROMIS^®-29) within an AYA oncology program clinic. <b><i>Methods:</i></b> AYA patients were referred by oncologists to the AYA oncology program at Prisma Health. The PROMIS-29 v2.0 survey was administered to AYAs at point of care. Feasibility of distribution and completion rate of surveys were determined. PROMIS surveys were self-reported and subsequently scored using standardized methods. The domains assessed included physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles/activities, pain interference, and pain intensity. Qualitative descriptions of AYA care delivery based on survey responses at the patient level and programmatic level are also presented. <b><i>Results:</i></b> Between May 2017 and 2019, 134 AYAs who were newly diagnosed or in treatment completed the survey. Distribution and completion rates for the PROMIS-29 were both 100%, and meaningful changes in program-level services were implemented as a result of PROMIS-29 score patterns. Within the entire cohort, T-scores for anxiety, fatigue, and physical function reached clinically relevant thresholds. <b><i>Conclusion:</i></b> PROMIS offers a feasible opportunity for AYA programs to measure clinically useful HRQOL outcomes in AYAs. The survey can be used to deliver real-time AYA care to recently diagnosed and in-treatment AYAs and make programmatic changes within AYA oncology programs.</p>","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communicating Adolescent and Young Adult Oncology Treatment Guidelines in Practice: The Importance of Documentation for Ensuring Positive Impacts on Oncology Care.","authors":"Jaya Mallela, Lila Pereira, Emily Simon, Shreya Makkapati, Shannon Forty, Samantha Bruno, Tara Giblin, Jeremy Rosenblum","doi":"10.1089/jayao.2023.0188","DOIUrl":"https://doi.org/10.1089/jayao.2023.0188","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Improvements in outcomes for adolescent and young adult (AYA) oncology patients have lagged behind those of other age-specific cancer populations. Research has indicated that low availability of clinical trials, biological differences of this age-group, and several psychosocial factors including higher emotional distress impact outcomes. To improve care and survival rates for these patients, hospitals have implemented AYA oncology programs. The current study evaluated documentation of care in an AYA program housed in an academic medical center based on three areas emphasized in the National Comprehensive Cancer Network's Clinical Practice Guidelines in Oncology for AYAs: clinical trial enrollment, fertility, and psychosocial care. <b><i>Methods:</i></b> Retrospective chart reviews were conducted for 45 patients treated before the start of the AYA oncology program and 45 patients treated after program initiation. Patients aged 15-39 years with a diagnosis of a malignant tumor were included. Variables evaluated included documentation of clinical trial enrollment, fertility preservation and sexual health considerations, and behavioral health referrals. <b><i>Results:</i></b> Documentation of most clinical trial and fertility variables did not significantly improve from pre- to post-program, although a higher number of patients had these variables documented post-program. Behavioral health referrals increased significantly from 52.8% pre-program to 95.4% post-program. <b><i>Conclusion:</i></b> Access to behavioral health care improved the most following implementation of our AYA program, which is likely because of the integration of a dedicated psychologist for AYAs when the program began. The practice of guideline-based care for this population can be better assessed and improved with designated behavioral health providers and more systematic documentation processes.</p>","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informed Consent and Adolescents with Cancer: Challenges and Tools in Online Studies.","authors":"Maria Carolina Neves, Sara Monteiro, Judith B Prins, Célia M D Sales","doi":"10.1089/jayao.2023.0154","DOIUrl":"https://doi.org/10.1089/jayao.2023.0154","url":null,"abstract":"","PeriodicalId":14769,"journal":{"name":"Journal of adolescent and young adult oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}