Journal of geriatric oncology最新文献

{"title":"Frailty predicts treatment-related toxicity and discontinuation in older adults with chronic lymphocytic leukemia treated with BTK and BCL-2 inhibitors: Findings from a prospective single-center cohort study","authors":"Enrica Antonia Martino ,&nbsp;Ernesto Vigna ,&nbsp;Paola De Luca ,&nbsp;Antonella Bruzzese ,&nbsp;Caterina Labanca ,&nbsp;Francesco Mendicino ,&nbsp;Eugenio Lucia ,&nbsp;Virginia Olivito ,&nbsp;Valentina Fragliasso ,&nbsp;Antonino Neri ,&nbsp;Fortunato Morabito ,&nbsp;Andrea Corsonello ,&nbsp;Massimo Gentile","doi":"10.1016/j.jgo.2025.102219","DOIUrl":"10.1016/j.jgo.2025.102219","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic lymphocytic leukemia (CLL) particularly impacts older adults with multiple comorbidities. The advent of targeted therapies has improved outcomes, but challenges related to treatment adherence and drug interactions persist. Assessment of frailty is recommended to tailor treatment, though its application in clinical settings is often limited due to its complexity. This study aimed to investigate the predictive value of frailty regarding treatment toxicity and discontinuation in older patients with CLL treated with targeted therapies.</div></div><div><h3>Materials and Methods</h3><div>This prospective cohort study involved 82 older adults with CLL (≥65 years) treated with Bruton's tyrosine kinase inhibitors (BTKi) or BCL-2 inhibitors (BCL-2i) from November 2018 to February 2024. Patients were assessed by the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) within a week before starting treatment. Demographics, CLL characteristics, comorbidities, and treatment-related adverse events were collected. Statistical analyses included receiver operating characteristic (ROC) curve analysis to determine the optimal cut-off for predicting treatment discontinuation due to toxicity.</div></div><div><h3>Results</h3><div>The median age of patients was 75 years. Most patients (90.2 %) were at Binet stage B/C, with 14.6 % having 17p deletion and 17.1 % <em>TP53</em> mutations. Overall, 46 patients experienced treatment-related toxicity. The ROC curve analysis showed that the best cut-off for predicting treatment-related toxicity was a CSHA CFS &gt;3. The accuracy was fair, with an area under the curve (AUC) of 0.695 (95 % CI 0.55–0.84; <em>P</em> = 0.02), sensitivity = 85 % and specificity = 53 %. Patients with a score &gt; 3 experienced higher rates of treatment discontinuation (28.6 %) compared to those with a score ≤ 3 (12.5 %; <em>P</em> &lt; 0.05). Other factors such as polypharmacy, cumulative illness rating, and comorbidity indices did not significantly affect treatment discontinuation rates.</div></div><div><h3>Discussion</h3><div>The CSHA CFS is a feasible tool for identifying older adults with CLL at higher risk of treatment toxicity and discontinuation. Patients with a CFS &gt;3 had a significantly higher likelihood of treatment interruption due to adverse effects. Therefore, CSHA CFS can aid in stratifying patients and optimizing therapeutic strategies. Further validation in multicenter studies is warranted to confirm these results and explore the potential for adjusting treatment dosages based on frailty assessments in the era of targeted therapies.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102219"},"PeriodicalIF":3.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578383","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":"Feasibility of home step-tracking using wearable devices for older adults undergoing thoracic surgery: A brief report","authors":"Anupama Singh ,&nbsp;Mary E. Cooley ,&nbsp;Emanuele Mazzola ,&nbsp;Ashley L. Deeb ,&nbsp;Miles McAllister ,&nbsp;Fatemehsadat Pezeshkian ,&nbsp;Clark DuMontier ,&nbsp;Laura N. Frain ,&nbsp;Paula Ugalde Figueroa ,&nbsp;Desiree Steimer ,&nbsp;Michael T. Jaklitsch","doi":"10.1016/j.jgo.2025.102218","DOIUrl":"10.1016/j.jgo.2025.102218","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102218"},"PeriodicalIF":3.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534306","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":"Disparities in electronic health record patient portal activation and use among people with hematological malignancies","authors":"Angela M. Trammel ,&nbsp;Bryan A. Sisk ,&nbsp;Mark A. Fiala","doi":"10.1016/j.jgo.2024.102135","DOIUrl":"10.1016/j.jgo.2024.102135","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102135"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of nutrition interventions in older patients with cancer: A synthesis of evidence and a future research priority","authors":"Brenton J. Baguley ,&nbsp;Hannah Arnold ,&nbsp;Ashlee Bence ,&nbsp;Emma Bryant ,&nbsp;Eliza Martino ,&nbsp;Kiara Stojanoski ,&nbsp;Samantha Ackerly ,&nbsp;Erin Laing ,&nbsp;Jessica Jong ,&nbsp;Nicole Kiss ,&nbsp;Jenelle Loeliger","doi":"10.1016/j.jgo.2024.102181","DOIUrl":"10.1016/j.jgo.2024.102181","url":null,"abstract":"<div><h3>Introduction</h3><div>Older patients with cancer (65 years and older) are a growing population with unique nutrition-and treatment-related issues that accelerate aging. Nutrition interventions attenuate nutritional decline, muscle loss, and risk of malnutrition and sarcopenia in patients with cancer, however the evidence for older patients with cancer is limited. The aim of this systematic review was to evaluate the efficacy of nutrition interventions on nutritional status, body weight/composition and clinical outcomes in older patients with cancer and to identify future research priority areas.</div></div><div><h3>Materials and Methods</h3><div>Three databases were systematically searched from inception until January 2024. Eligible studies were randomised controlled trials (RCT) evaluating a nutrition intervention in older patients with cancer that reported nutrition-related and clinical outcomes. Studies including older patients were determined by the mean age ≥ 65 years with the error to the mean &gt; 60 years. Between-group differences in nutritional and clinical outcomes were extracted.</div></div><div><h3>Results</h3><div>Eleven studies describing nine RCTs were included in this review. Three trials specifically included patients 65 years and older. Most interventions intended to reduce malnutrition risk across a mix of cancer types and treatments, and one trial was designed to reduce comorbidities after treatment. Changes in dietary intake (<em>n</em> = 4), nutrition status (<em>n</em> = 1), weight (<em>n</em> = 5), and muscle mass (<em>n</em> = 3) were inconsistently reported, but preliminary evidence showed dietary counselling with oral nutrition supplements (ONS) resulted in improved weight maintenance in patients with pancreatic cancer. There was limited evidence of a benefit from nutrition interventions on treatment tolerance or quality of life. The heterogeneous findings in methodological design, including dietary prescription and frequency of consultations and reporting of outcomes, inhibits evidence-based recommendations for older adults with cancer.</div></div><div><h3>Discussion</h3><div>Nutrition interventions designed specifically to address nutrition-related issues unique to older patients with cancer is a clear research priority. Research specifically targeting older patients post treatment, a period during which treatment-related side effects still occur, is limited. To support the growing population of older patients with cancer, future research must consistently report the dietary prescription, adherence to nutritional requirements, and clearly-defined nutrition-related parameters and clinical outcomes that are specific to older patients.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102181"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving beyond studying mere association: A methodological perspective","authors":"Sophie Pilleron","doi":"10.1016/j.jgo.2024.102178","DOIUrl":"10.1016/j.jgo.2024.102178","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102178"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828714","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":"Examining unmet needs in older adults with lung cancer: A systematic review and narrative synthesis","authors":"Nicole Knox ,&nbsp;Meera R. Agar ,&nbsp;Shalini Vinod ,&nbsp;Louise Hickman","doi":"10.1016/j.jgo.2024.102161","DOIUrl":"10.1016/j.jgo.2024.102161","url":null,"abstract":"<div><h3>Introduction</h3><div>Unmet needs in the older population with cancer are complex due to aging-related health conditions. A review of unmet needs in older people with cancer showed that needs varied among different cancer types. In lung cancer, a higher incidence of geriatric syndromes and comorbidities exist compared to other cancer cohorts, impacting treatment tolerance and completion. Consequently, it is crucial to identify and understand unmet needs to address supportive care needs beyond cancer diagnosis and treatment. This systematic review aims to synthesise the available literature to analyse the number and nature of unmet needs experienced by older patients with lung cancer.</div></div><div><h3>Materials and Methods</h3><div>We performed a systematic search following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, which was registered in PROSPERO(CRD42022311105). We searched CINAHL, Medline, Embase, and Scopus electronic databases for published literature (January 2002 to November 2023) on unmet needs of patients ≥65 years diagnosed with lung cancer. We used a narrative synthesis approach to summarise the results and identify themes.</div></div><div><h3>Results</h3><div>The search yielded 1356 articles, of which 35 met the inclusion criteria. A significant portion of older patients with lung cancer reported experiencing unmet needs, ranging from 78 % to100 %. Compared to other cancer streams, older patients with lung cancer experienced a higher burden of unmet needs, with a mean of seven unmet needs per person. Most studies identified psychological and physical/daily living domains as having the greatest prevalence and highest burden of unmet need.</div></div><div><h3>Discussion</h3><div>Increased psychological distress and poorer quality of life correlated with increased unmet needs. Identifying and addressing unmet needs is critical for patient wellbeing and should be prioritised when developing models of care and tailored interventions for older people with lung cancer.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102161"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential drug-drug interactions between cancer therapies and active antiretroviral treatments among Medicare-enrolled patients with cancer and HIV","authors":"Jessica Y. Islam ,&nbsp;Xi Zhou ,&nbsp;Christopher Baggett ,&nbsp;Christine Jamjian ,&nbsp;Anna Coghill ,&nbsp;Gita Suneja ,&nbsp;Jennifer L. Lund","doi":"10.1016/j.jgo.2024.102158","DOIUrl":"10.1016/j.jgo.2024.102158","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102158"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729500","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":"“Start low, go slow,” a strategy to tailor treatment dosing in older or vulnerable adults with advanced solid cancer: A systematic review and meta-analysis","authors":"Gabriel Aleixo ,&nbsp;Tej Patel ,&nbsp;Julianne Ani ,&nbsp;Will J. Ferrell ,&nbsp;Efrat Dotan ,&nbsp;Samuel U. Takvorian ,&nbsp;Grant R. Williams ,&nbsp;Ravi B. Parikh ,&nbsp;Ramy Sedhom","doi":"10.1016/j.jgo.2024.102153","DOIUrl":"10.1016/j.jgo.2024.102153","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The use of standard-dose cancer treatment can result in a decline in the functional abilities of older adults with cancer. The “start-low, go-slow” (SLGS) strategy involves initiating cancer treatment at lower-than-standard doses in selected patients who are vulnerable to excess toxicity and escalating based on tolerance. We performed a systematic review and meta-analysis to assess the available data and the effectiveness of the SLGS strategy in the treatment of cancer in older adults with incurable solid cancer.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;The review was registered with PROSPERO. Two independent reviewers (GA and TP) conducted a comprehensive search across multiple databases (PubMed/Medline, Journal of Geriatric Oncology, American Society of Clinical Oncology abstracts, and EMBASE) of prospective studies involving patients with solid tumors who received SLGS. SLGS was defined as starting cancer therapy with a lower than standard dose and dose-escalating, if possible. The main objective of this study was to evaluate overall survival (OS) in patients treated with the SLGS strategy. Secondary objectives were to analyze treatment discontinuation and toxicity in patients treated with the SLGS strategy. Additionally, we aimed to compile a comprehensive report on studies employing the SLGS strategy in solid oncology. We utilized a random-effects meta-analysis model to consider the diversity among patient populations with different cancer stages, types, and treatments. Two researchers independently employed the Newcastle-Ottawa Quality (NOQ) assessment for cohort analysis to evaluate the methodological quality and standard of outcomes reporting in the included studies. The quality of evidence was appraised using the Grading recommendations assessment, development and evaluation GRADE summary of findings tool.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The systematic search identified a total of 12,690 articles. Thirteen studies met criteria for inclusion in the systematic review, totaling 8546 patients. Twelve studies evaluated OS. However, only five studies focused solely on older adults, and the studies involved different types of cancer without following a specific pattern. In meta-analysis of survival among three studies, patients who underwent the SLGS approach had lower mortality (hazar ratio 0.91, 95 % confidence interval [CI] 0.85–0.98, &lt;em&gt;p&lt;/em&gt; = 0.01, i2 = 0 %). Toxicity ranged from 5 % to 89 % across studies; SLGS had lower grade 3 and 4 toxicity compared to the standard dose (six studies, meta-analysis relative risk 0.86, 95 % CI 0.75–0.98, &lt;em&gt;p&lt;/em&gt; &lt; 0.02, i2 = 30 %). Treatment discontinuation was not different for SLGS vs. standard dose (seven studies, meta-analysis RR 0.96, 95 % CI 0.87–1.05, &lt;em&gt;p&lt;/em&gt; = 0.37 i2 = 50 %).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;This systematic review and meta-analysis suggests that a SLGS approach to systemic therapy dosing may reduce toxicity without","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102153"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622108","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":"Protocol of a decisional intervention for older adults with newly diagnosed acute myeloid leukemia and their caregivers: UR-GOAL 3","authors":"Kah Poh Loh ,&nbsp;Qiao Ming Rachel Ng ,&nbsp;Supriya G. Mohile ,&nbsp;Sally Norton ,&nbsp;Ronald M. Epstein ,&nbsp;Michael B. Sohn ,&nbsp;Daniel Richardson ,&nbsp;Omer Jamy ,&nbsp;Soroush Mortaz Hedjri ,&nbsp;Rachel Blumberg ,&nbsp;Laura Nafis ,&nbsp;Marielle Jensen-Battaglia ,&nbsp;Ying Wang ,&nbsp;Jason Mendler ,&nbsp;Jane Liesveld ,&nbsp;Eric J. Huselton ,&nbsp;Rachel Rodenbach ,&nbsp;Jozal Moore ,&nbsp;Craig Maguire ,&nbsp;Steve M. Buechler ,&nbsp;Heidi D. Klepin","doi":"10.1016/j.jgo.2025.102187","DOIUrl":"10.1016/j.jgo.2025.102187","url":null,"abstract":"<div><h3>Introduction</h3><div>Therapeutic advances have allowed more adults aged ≥60 years with acute myeloid leukemia (AML) to receive life-prolonging treatments, with improvement in overall survival. In contrast to other cancers, the onset of AML is often sudden, high-risk treatment decisions must be made quickly, and survival is often compromised due to aging-related conditions (e.g., functional impairments). Studies have demonstrated that up to 78 % of older adults with AML and their caregivers experience significant psychological distress. Distress is associated with poor quality of life, increased healthcare utilization, and increased mortality. Shared decision making (SDM) can reduce patient and caregiver distress and is essential to achieve goal-concordant care. Therefore, interventions to alleviate distress and optimize SDM in older adults with AML and their caregivers are needed. We will conduct a multicenter randomized controlled trial to evaluate the efficacy of <u>U</u>niversity of <u>R</u>ochester-<u>G</u>eriatric <u>O</u>ncology assessment for <u>A</u>cute myeloid <u>L</u>eukemia (UR-GOAL) compared to an attention control for reducing patient distress and improving observed SDM, patient-perceived SDM, and decisional conflict.</div></div><div><h3>Material and Methods</h3><div>We will recruit 300 patients aged ≥60 years with newly diagnosed AML, their caregivers (one caregiver per patient when available), and up to 40 oncologists from four institutions: (1) Patients will view an educational video about AML diagnosis, treatment, and prognosis; complete the Best Worst Scaling values clarification process; and review a summary report of their values with tailored question prompts and resources; (2) Caregivers will view the same educational video and receive the same summary report as patients; and (3) Oncologists will review a summary report of the patient's aging-related conditions, perception of prognosis, and values. Patients, caregivers, and oncologists will then meet during clinical visits to discuss aging-related conditions, prognosis, and patient values, and reach a treatment decision. The primary outcome measure is distress (Distress Thermometer). Secondary outcome measures include observed SDM, patient perceived SDM, and decisional conflict.</div></div><div><h3>Discussion</h3><div>This study will address significant knowledge gaps related to reducing distress and decisional conflict and improving SDM in older adults with AML. If successful, this research will inform future decisional interventions for a broader group of patients.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102187"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006706","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":"Smartphone application for longitudinal home gait speed measurement in older adults with blood cancers: A feasibility and acceptability study","authors":"Pei-An Lee ,&nbsp;Clark DuMontier ,&nbsp;Nicholas Groblewski ,&nbsp;Wanting Yu ,&nbsp;Junhong Zhou ,&nbsp;Tammy Hshieh ,&nbsp;Dae Kim ,&nbsp;Tom Travison ,&nbsp;Jane Driver ,&nbsp;On-Yee Lo ,&nbsp;Brad Manor ,&nbsp;Gregory Abel","doi":"10.1016/j.jgo.2024.102132","DOIUrl":"10.1016/j.jgo.2024.102132","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102132"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501987","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}