Journal of Clinical and Experimental Hepatology最新文献

{"title":"Managing Complex Hepatocellular Carcinoma Subtypes: Diffuse Infiltrative, Large Tumours, and Tumour Rupture—The Challenges and Strategies","authors":"Ashok Choudhury ,&nbsp;Akash Roy ,&nbsp;Amar Mukund ,&nbsp;Deepti Sharma ,&nbsp;Subin Heo ,&nbsp;Won-Mook Choi","doi":"10.1016/j.jceh.2025.102505","DOIUrl":"10.1016/j.jceh.2025.102505","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) is the sixth most common cause of cancer globally, third most common cause of cancer-related death, and most common primary liver malignancy. Whilst nodular well-defined HCC remains the classical phenotype, presentations with infiltrative phenotype, very large HCC, and complications as tumour rupture provide immense diagnostic and therapeutic challenges. Infiltrative HCC is difficult to distinguish against the background cirrhotic liver. They are ill defined on imaging, have poor vascularity, and aggressive biological behaviour. Vascular invasion, metastasis, and poor response to loco-regional, as well as systemic therapy, leads to dismal prognosis. Very large HCCs have a relatively better prognosis than infiltrative HCC and mandate multimodal therapies to downstage for a curative response including liver transplant. Improvement in interventional radiology techniques, emerging evidence with systemic therapies including immunotherapy, and better understanding of tumour biology have opened newer avenues in the management of such complex cases. HCC rupture is a catastrophic moment in the natural history of HCC which has an exponential increase in mortality. Clinical presentation of pain abdomen, hypotension/syncope, new onset, or sudden increase in ascites mandates a strong suspicion of rupture. Presence of hemoperitoneum on diagnostic tap and contrast extravasation in a computed tomography/magnetic resonance imaging are the diagnostic hallmarks. Emergency surgical intervention, locoregional therapies in the form of bland embolisation, or chemoembolisation forms the management cornerstone. The long-term survival and liver transplant as a curative therapy still needs more data as fear of tumour spread is a possibility. This review summarises the clinical challenges with this advance HCC and provides an algorithmic approach for management.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102505"},"PeriodicalIF":3.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living-Donor Liver Transplantation—The Need for Greater Transparency","authors":"Anil C. Anand,&nbsp;James Neuberger","doi":"10.1016/j.jceh.2025.102507","DOIUrl":"10.1016/j.jceh.2025.102507","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102507"},"PeriodicalIF":3.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stanozolol-induced Liver Injury: A Distinctive Cholestatic Clinical and Biochemical Phenotype at Presentation","authors":"Vinícius Nunes ,&nbsp;Maria I. Schinoni ,&nbsp;Fernando Bessone ,&nbsp;Maria I. Lucena ,&nbsp;Inmaculada Medina-Cáliz ,&nbsp;Nelia Hernandez ,&nbsp;Maria C. Moura Costa ,&nbsp;Isadora Lins ,&nbsp;Ana J. Cardoso ,&nbsp;Barbara Freire ,&nbsp;Leonardo Schiavon ,&nbsp;Marcelo Silva ,&nbsp;Eduardo R. Cançado ,&nbsp;Raymundo Paraná","doi":"10.1016/j.jceh.2025.102506","DOIUrl":"10.1016/j.jceh.2025.102506","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>The misuse of Anabolic Androgenic Steroids (AAS), including Stanozolol, for performance enhancement has emerged as a significant cause of liver damage. This study aims to elucidate the distinctive hepatotoxicity profiles induced by Stanozolol.</div></div><div><h3>Methods</h3><div>Eighteen individuals were prospectively evaluated by the Latin American DILI Registry from 2013 to 2023. Data regarding Stanozolol administration, symptoms onset, and clinical manifestations were collected. Comprehensive assessments including serologies, abdominal imaging, and in some cases, liver biopsies were performed to identify Stanozolol-induced liver injury and exclude other etiologies.</div></div><div><h3>Results</h3><div>All patients were young males aged between 19 and 48, utilizing Stanozolol for aesthetic purposes. The mean latency to symptom onset was 55 days. Predominant symptoms included jaundice and pruritus. Elevated total bilirubin levels were observed in all cases, while gamma-glutamyl transferase levels remained within or slightly above normal ranges. Concurrent use of other substances was reported in ten cases, showcasing a trend of poly-substance abuse.</div></div><div><h3>Conclusions</h3><div>The study identified a specific biochemical profile of Stanozolol-induced liver injury in young men using it for aesthetic purposes. The characteristic liver injury profile has marked elevation of bilirubin, mild rise in transaminases, and near-normal GGT.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102506"},"PeriodicalIF":3.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut Microbiota and Genetic Polymorphisms Appear to Drive Disease Expression of Nonalcoholic Fatty Liver Disease in Lean Individuals","authors":"Prajna Anirvan ,&nbsp;Zaiba H. Khan ,&nbsp;Pallavi Bhuyan ,&nbsp;Sujata Dixit ,&nbsp;Rishikesh Dash ,&nbsp;Priyanka Mishra ,&nbsp;Giriprasad Venugopal ,&nbsp;Gowri M. Balachander ,&nbsp;Pankaj Bharali ,&nbsp;Mrinal Gogoi ,&nbsp;Manas K. Panigrahi ,&nbsp;Manoranjan Ranjit ,&nbsp;Balamurugan Ramadass ,&nbsp;Shivaram P. Singh","doi":"10.1016/j.jceh.2025.102503","DOIUrl":"10.1016/j.jceh.2025.102503","url":null,"abstract":"<div><h3>Background/Objectives</h3><div>There are very few comparative studies worldwide between ‘lean’ and ‘nonlean/obese nonalcoholic fatty liver disease (NAFLD)’ patients analyzing the differences in gut microbiome, genotype, and serum bile acids. Our aim was to compare the genotype, gut microbiome, bile acid profile, and metabolic patterns of lean NAFLD and obese NAFLD patients with special reference to hepatic fibrosis.</div></div><div><h3>Methods</h3><div>Both lean and obese NAFLD patients diagnosed by ultrasonography along with matched controls were included. Genotyping, fecal microbiome analysis and estimation of serum total bile acid levels were done for patients as well as controls.</div></div><div><h3>Results</h3><div>Biochemical and metabolic patterns of lean and obese NAFLD patients were comparable. Lean NAFLD patients had lower fasting plasma glucose (FPG) and homoeostasis model assessment-insulin resistance (HOMA-IR), although the proportions of patients having elevated HOMA-IR and metabolic syndrome (MS) were comparable. Noninvasive scores of liver fibrosis were also comparable. A greater proportion of lean NAFLD patients had the PNPLA3 rs738409 (G/G) genotype. However, there was no association of genetic polymorphisms with steatosis or fibrosis. Nonlean and lean NAFLD patients had comparable serum total bile acid levels. On microbiome analysis, lean NAFLD patients were found to have distinct expression of bacterial species while beta diversity was found to be significantly different across all groups.</div></div><div><h3>Conclusion</h3><div>Lean NAFLD patients were found to have the PNPLA3 rs738409 (G/G) genotype. Lean NAFLD patients were also found to have unique gut microbial signatures, while beta diversity significantly differed across all groups. Differential expression of gut microbiota and genetic polymorphisms could underlie the pathogenesis of lean NAFLD.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102503"},"PeriodicalIF":3.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of Terlipressin and Noradrenaline as Vasopressors in Patients With Acute-on-chronic Liver Failure and Septic Shock: A Randomized Controlled Trial","authors":"Tarana Gupta,&nbsp;Anjali Saini,&nbsp;Vaibhav Gaur,&nbsp;Ashank Goel","doi":"10.1016/j.jceh.2024.102494","DOIUrl":"10.1016/j.jceh.2024.102494","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is the most common acute insult in patients with acute-on-chronic liver failure (ACLF), and circulatory failure portends a poor prognosis in them.</div></div><div><h3>Aim</h3><div>This study aimed to compare terlipressin and noradrenaline as first-line vasopressors in patients with ACLF and septic shock.</div></div><div><h3>Methods</h3><div>This prospective, open-label, randomized controlled study was conducted from January 2021 to June 2022 at a tertiary care center. All patients presenting with ACLF as per the chronic liver failure consortium acute on chronic liver failure in cirrhosis study and septic shock were screened. Shock was defined as a mean arterial pressure (MAP) &lt;65 mmHg/systolic blood pressure &lt;90 mmHg. Patients with septic shock nonresponsive to crystalloids/colloids were randomized to receive terlipressin (group I) at 2.6 μg/kg/min and noradrenaline (group II) at 0.1 μg/kg/min. The primary outcome was an MAP &gt;65 mmHg at 6 h. The secondary outcomes were 3-, 7-, 14-, and 28-day mortality, duration of hospital stay, cumulative dose of drug, and new events such as upper gastrointestinal bleed, acute kidney injury, jaundice, and hepatic encephalopathy within 28 days.</div></div><div><h3>Results</h3><div>A total of 70 patients were randomized to group I (n = 35) and group II (n = 35). According to per-protocol analysis, a higher number of patients achieved an MAP &gt; 65 mmHg at 6 h in group II (n = 23/31, 74%) than in group I (5/34, 14%) (<em>P</em> &lt; 0.001). The 3-and 7-day mortality was significantly higher in group I than in group II, with no difference at 14 and 28 days. The 28-day mortality was highest in ACLF grade-3 in both group II (22/25, 88%) and group I (15/20, 75%).</div></div><div><h3>Conclusion</h3><div>Terlipressin did not prove to be noninferior to norepinephrine, and therefore, norepinephrine should be the first-line vasopressor in ACLF patients with septic shock. The mortality rate was highest in ACLF grade-3 patients in both the groups, irrespective of the initial response to vasopressors. This indicates that holistic management of these patients is most important.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102494"},"PeriodicalIF":3.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portal Hypertension as the First Manifestation of Primary Amyloidosis","authors":"Shrey Bhatt,&nbsp;Venkatesh Vaithiyam,&nbsp;Ravi Teja Reddy,&nbsp;Payila S. Raghava Aneesh,&nbsp;Sanjeev Sachdeva,&nbsp;Ajay Kumar,&nbsp;Ashok Dalal,&nbsp;Sarika Singh,&nbsp;Surbhi Goyal,&nbsp;Puja Sakhuja","doi":"10.1016/j.jceh.2025.102502","DOIUrl":"10.1016/j.jceh.2025.102502","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102502"},"PeriodicalIF":3.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Serological Immune Response to Hepatitis B Vaccine Following Rapid or Standard Regimen in People Who Inject Drugs","authors":"Nalinikanta Rajkumar ,&nbsp;Ajay K. Mishra ,&nbsp;Lokeshwar Khumukcham ,&nbsp;Harshita Katiyar ,&nbsp;Dhabali Thangjam ,&nbsp;Rajani Singh ,&nbsp;Giten Khwairakpam ,&nbsp;Amit Goel","doi":"10.1016/j.jceh.2025.102501","DOIUrl":"10.1016/j.jceh.2025.102501","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>The standard regimen of hepatitis B vaccination, i.e., three doses at 0, 1, and 6 months, protects 90–95% of vaccine recipients. Compliance for three doses, administered over six months, is particularly low among people who inject drugs (PWIDs). To prevent hepatitis B virus (HBV) infection, the World Health Organization has recommend to vaccinate PWIDs with an accelerated regimen, i.e., in a 0-, 7-, and 21-day schedule. We compared the serological immune response with standard and accelerated vaccination regimens in PWIDs.</div></div><div><h3>Methods</h3><div>PWIDs were vaccinated with three doses of hepatitis B vaccine as a part of routine preventive services in the past, which was not the part of our research work. Each of them had taken a conscious and informed decision to choose either the standard or accelerated regimen at the time of vaccination. For this cross-sectional observational study, anti-HBs (anti-HBs) titers were measured in vaccine recipients at ≥3 months after the administration of the third dose of vaccine. Vaccine-induced seroconversion was defined as presence of detectable anti-HBs titer, and seroprotection was defined as anti-HBs titer measuring ≥10 mIU/mL. Numerical and categorical data are expressed as median (interquartile range) and percentage (proportion), respectively; groups were compared using nonparametric tests.</div></div><div><h3>Results</h3><div>The study included 567 PWIDs (all men; age: 29 [24–38] years) vaccinated with either the accelerated (n = 356; 62.8%) or standard (n = 211; 37.2%) regimen. Participants’ ages were comparable (<em>P</em> = 0.99) in accelerated (29 [24–38.5] years) and standard (29 [24–37] years) groups. The interval between the last dose of vaccine and anti-HBs titer estimation was significantly longer in the accelerated group (487 [422–625]) than in the standard group (176 [105–211] days) (<em>P</em> &lt; 0.001). A higher proportion achieved seroconversion in the standard group than in the accelerated group (99.5% vs 91.9%; <em>P</em> &lt; 0.001). Among those who achieved seroconversion, a larger proportion in the standard group were seroprotected than in the accelerated group (99.5% vs. 92.1%; <em>P</em> &lt; 0.001). Anti-HBs titer was significantly higher in the standard group (2404 [412–12450] mIU/mL) than in the accelerated group (247 [57–1250] mIU/mL) (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Accelerated regimen of hepatitis B vaccination is well accepted among PWIDs and provides seroprotection to a large proportion of vaccine recipients, though the vaccine-induced antibody titers remain relatively lower. For high-risk groups such as PWIDs and other mobile population groups, an accelerated vaccination regimen may be a reasonable alternative to the standard vaccination schedule.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102501"},"PeriodicalIF":3.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human Fascioliasis a Silent Menace: Case Report With Review of Literature","authors":"Rohan Grotra ,&nbsp;Rohan Malik ,&nbsp;Ashwin Varadarajan ,&nbsp;Devasenathipathy Kandasamy ,&nbsp;Rajni Yadav ,&nbsp;Sanchita Gupta","doi":"10.1016/j.jceh.2024.102493","DOIUrl":"10.1016/j.jceh.2024.102493","url":null,"abstract":"<div><div>Fascioliasis is a tropical zoonotic disease caused by liver flukes (<em>Fasciola hepatica</em> and <em>Fasciola gigantica</em>) mostly in sheep, goats, and cattle. It is a prevalent infection in developing countries like Bolivia, Peru, and Egypt, affecting both humans and livestock. It remains under-reported due to lack of awareness. Humans accidentally acquire it by consuming contaminated watercress or water contaminated with infective metacercaria. It affects the hepatobiliary system, manifesting as tender hepatomegaly, bile duct obstruction, liver fibrosis, and secondary cholangitis. Diagnosing fascioliasis is a challenge as it presents with nonspecific symptoms like prolonged fever, anorexia, ascites, and with limited availability of testing. Triclabendazole, currently the only approved drug, is unavailable in India. Fascioliasis has been reported only in reports from India. We here report a case of a 4-year-old patient who presented with fever and tender hepatomegaly. Hepatobiliary imaging showed infiltrative liver disease with small cystic lesions and periportal thickening. Liver biopsy showed microabscesses with eosinophilic infiltration. The patient was tested for Fasciola IgG antibody, which was positive. Triclabendazole was procured from Geneva for treatment. Through this report, we highlight this neglected parasitic infection that presented in a nonendemic region that needs improved diagnostic tools, increased awareness, and control measures to mitigate the disease.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102493"},"PeriodicalIF":3.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Banding Down the Hurdles: Evaluating Endoscopic Variceal Ligation for Rectal Varices","authors":"Umesh Jalihal ,&nbsp;Madduri Pavan Kumar ,&nbsp;Irshad Ali H ,&nbsp;B.S. Puneeth ,&nbsp;Dave Manan Dilipbhai ,&nbsp;Anil Jain ,&nbsp;Bharath Gowda S ,&nbsp;Manoj Gowda A","doi":"10.1016/j.jceh.2024.102499","DOIUrl":"10.1016/j.jceh.2024.102499","url":null,"abstract":"<div><div>Portal hypertension can lead to the formation of rectal varices. Rectal varices are a common manifestation of portal hypertension but tend to bleed less frequently than esophageal or gastric varices. It has been observed that rectal varices can result in significant lower gastrointestinal (GI) bleeding and pose unique therapeutic challenges. This case series evaluates the efficacy and safety of endoscopic variceal ligation (EVL) in treating rectal varices in five patients who presented with lower GI hemorrhage to our center. While Endoscopic Ultrasound (EUS) or Computed Tomography (CT) could provide additional diagnostic insights, these modalities were not routinely used in this series because of the straightforward clinical and endoscopic diagnosis. All patients underwent a successful EVL procedure with complete variceal obliteration. There were no postprocedural complications noted. Six months after the initial course of treatment, a follow-up endoscopy was performed. Overall, one patient required three sessions of EVL, whereas two other patients needed two more sessions. None of the patients had any residual varices at the 5-year follow-up. These findings demonstrate that EVL is an effective treatment modality for rectal varices, particularly in resource-constrained environments. Ongoing endoscopic surveillance is crucial because recurrence is a possibility as seen in many studies. Although our results lend support to the use of EVL, more studies with larger patient populations and longer periods of follow-up are required to validate these findings and improve treatment regimens.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102499"},"PeriodicalIF":3.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing ‘ALD-Met’: Bridging the Gap Between ‘MetALD’ and ‘ALD’ for Heavy Drinkers With Metabolic Dysfunction","authors":"Ashish Kumar","doi":"10.1016/j.jceh.2024.102500","DOIUrl":"10.1016/j.jceh.2024.102500","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102500"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}