Journal of obstetrics and gynaecology Canada最新文献

{"title":"Reconsidering RhIg Following Threatened, Spontaneous, or Induced Abortions in the First Trimester","authors":"Justin Wei-Jia Lim MD ,&nbsp;Adam Suleman MD ,&nbsp;Karen Fung-Kee-Fung MD, MHPE ,&nbsp;Julie Thorne MD, MPH ,&nbsp;Gwen Clarke MD ,&nbsp;Lani Lieberman MD","doi":"10.1016/j.jogc.2025.103039","DOIUrl":"10.1016/j.jogc.2025.103039","url":null,"abstract":"<div><div>Routine Rh(D) immunoglobulin (RhIg) administration following first-trimester threatened, spontaneous, or induced abortions is a long-standing practice, but emerging evidence suggests limited benefit. This editorial reviews the outdated data that have informed current guidelines and presents contemporary literature demonstrating a negligible risk of RhD alloimmunization at early gestational ages. Recent studies challenge the necessity of RhIg in the first trimester and highlight the clinical, resource, and equity-related harms of routine use. In light of evolving evidence and the need to optimise health care delivery, we recommend against routine RhD testing and RhIg administration for first-trimester threatened, spontaneous, or induced abortions.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103039"},"PeriodicalIF":2.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629291","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":"The Impact of the HPV Vaccine on Preterm Birth in British Columbia","authors":"Elisabeth McClymont PhD ,&nbsp;Arianne Albert PhD ,&nbsp;Sela Grays BSc ,&nbsp;Gal Av-Gay MSc ,&nbsp;Marette Lee MD, MPH ,&nbsp;Gina Ogilvie MD, DrPH ,&nbsp;Deborah Money MD ,&nbsp;Chelsea Elwood MSc, MD","doi":"10.1016/j.jogc.2025.103032","DOIUrl":"10.1016/j.jogc.2025.103032","url":null,"abstract":"<div><h3>Objectives</h3><div>Recent evidence has suggested that human papillomavirus (HPV) vaccination may reduce the risk of preterm birth. The objective of this study was to determine the feasibility of linking existing provincial databases to begin to understand whether the risk of preterm birth is lower in HPV-vaccinated women in British Columbia (BC).</div></div><div><h3>Methods</h3><div>In this population-based retrospective cohort study of women delivering infants in BC, data on birth outcomes and HPV vaccination status from the BC Perinatal Data Registry and the Panorama Public Health Information System were linked. We compared the overall and spontaneous preterm birth rates between vaccinated and unvaccinated women using logistic regression.</div></div><div><h3>Results</h3><div>Among women who were age-eligible for HPV vaccination in school-based programs, there were 5447 deliveries from 5399 individuals between 2015 and 2018. Of these, 2925 (54.2%) women had been vaccinated in the school-based program. Overall and spontaneous preterm birth were significantly associated with previous preterm delivery and maternal substance use, but were not found to be associated with HPV vaccination status.</div></div><div><h3>Conclusions</h3><div>We were readily able to link provincial databases to assess the role of HPV vaccination in preterm birth risk. These pilot data did not show a significant association between HPV vaccination status and preterm birth. Subsequent larger studies are warranted to better assess the presence of a relationship, which may promote vaccination and result in improved reproductive outcomes for women and their infants.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103032"},"PeriodicalIF":2.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621687","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":"Provider Perspectives on Intrauterine Device Practices in Adolescent Patients","authors":"Amber Sucharov MD ,&nbsp;Kristina Arion MD ,&nbsp;Sarah McQuillan MD","doi":"10.1016/j.jogc.2025.103031","DOIUrl":"10.1016/j.jogc.2025.103031","url":null,"abstract":"<div><h3>Objectives</h3><div>Adolescent pregnancy is a worldwide public health concern, and the intrauterine device (IUD) is known to be a safe and effective method of long-acting reversible contraception in this group. Pediatric and gynaecologic societies have recommended the IUD as a first-line contraceptive for adolescents, given its safety and efficacy. This study aims to understand current IUD practices and elucidate barriers to insertion.</div></div><div><h3>Methods</h3><div>A survey was disseminated to North American Society for Pediatric and Adolescent Gynecology members via the listserv on 2 separate occasions. Consent was obtained prior to initiation of the survey. Results from the survey were anonymous and tabulated using descriptive statistics. Ethics approval was obtained (REB22-0269).</div></div><div><h3>Results</h3><div>There were 55 respondents, mostly in North America (93%). According to providers, adolescents most frequently seek out the IUD for contraception (45%) and abnormal uterine bleeding (24%). Providers felt the most common barriers were misconceptions (25%) and pain with insertion (24%). Although many physicians perform office insertions, several found that a Procedural Sedation Centre optimized wait times (38%) or felt that such a centre would be helpful (33%).</div></div><div><h3>Conclusions</h3><div>This study demonstrated that misconceptions surrounding the IUD remain. Education on contraception, specifically long-acting reversible contraceptives, is pivotal in decreasing adolescent pregnancy, reducing barriers, and improving adolescents’ attitudes toward the IUD. Pain with insertion is a limiting factor, and procedural sedation may help in managing expectations and increasing acceptance.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103031"},"PeriodicalIF":2.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621685","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":"Transfusion Testing During Routine Pregnancies: Consensus Recommendations from a Modified Delphi Process","authors":"Heather VanderMeulen MD, MSc ,&nbsp;Mira Shuman MD, CFFP, MScCh ,&nbsp;Poh Nyuk Fam MD, RM, RN ,&nbsp;Robyn Berman RM, MBA ,&nbsp;Jeannie Callum BA, MD ,&nbsp;Gwen Clarke MD ,&nbsp;Lani Lieberman MD ,&nbsp;Catharine Walsh MD, MEd, PhD ,&nbsp;Julie Thorne MD, MPH ,&nbsp;Matthew T.S. Yan MD","doi":"10.1016/j.jogc.2025.103034","DOIUrl":"10.1016/j.jogc.2025.103034","url":null,"abstract":"<div><h3>Objectives</h3><div>To standardize perinatal transfusion testing and Rh immunoglobulin (RhIG) administration in low-risk pregnancies through the creation of expert consensus statements.</div></div><div><h3>Methods</h3><div>A modified Delphi consensus process involving iterative rounds of voting on statements by a national expert panel. After each round, responses were analyzed and resent to the panel for further ratings until consensus was achieved, defined as Cronbach’s alpha &gt;0.95 or a maximum of 3 voting rounds. Once consensus was achieved, statements with a median score ≥4 out of 5 were included.</div></div><div><h3>Results</h3><div>Forty-six expert panellists participated, with representation across Canadian provinces and care providers including maternal–fetal medicine, obstetrics, family practice, transfusion medicine, neonatology, midwifery, nursing, and a patient representative. Twenty-one statements related to perinatal transfusion testing and RhIG administration met criteria for inclusion in the final set of statements. The 2 statements with the lowest proportion of “strongly agree” votes pertained to eliminating the 28-week group and screen in those with negative first-trimester screens and eliminating the need for RhIG before 12⁰ weeks in threatened, spontaneous, or therapeutic abortions.</div></div><div><h3>Conclusions</h3><div>These 21 expert consensus statements aim to harmonize perinatal practice across Canada, addressing conflicting guidelines and resource limitations, especially in rural settings. This is the first set of expert consensus statements that captures the Canadian context, with coverage from the first trimester to the birth of the neonate. These statements follow Choosing Wisely principles. Some are practice-changing and will require efforts to ensure implementation into practice.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103034"},"PeriodicalIF":2.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621689","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":"Replacing Iron and Preventing Anemia in Pregnant patients of Limited Economic means (RIPPLE): The Impact of Funding Iron Supplementation in Pregnancy","authors":"Suman Memon MD ,&nbsp;Jeannie Callum BA, MD ,&nbsp;Chantal Armali BSc, CCRP ,&nbsp;Elaine Herer BSc, MD ,&nbsp;Amie Malkin BSc, MSc, CCRP ,&nbsp;Anne McLeod MD ,&nbsp;Harley Meirovich BA ,&nbsp;Michelle Sholzberg MDCM, MSc ,&nbsp;Yulia Lin MD ,&nbsp;Heather VanderMeulen MD, MSc, DRCPSC","doi":"10.1016/j.jogc.2025.103035","DOIUrl":"10.1016/j.jogc.2025.103035","url":null,"abstract":"<div><h3>Objectives</h3><div>Can funding iron supplementation for low-income pregnant patients reduce socioeconomic disparities in anemia rates at delivery?</div></div><div><h3>Methods</h3><div>This single-centre cohort study reviewed hematologic parameters and iron supplementation patterns in 3 groups: patients from low-income neighbourhoods, non-low-income neighbourhoods, and low-income patients enrolled in the RIPPLE (Replacing Iron and Preventing anemia in Pregnant patients of Limited Economic means) program. RIPPLE provided access to intravenous iron to patients with an annual household income ≤$50 000 CAD and moderate-to-severe iron deficiency anemia, symptomatic iron deficiency with intolerance/inadequate response to oral iron, or iron deficiency anemia with less than 4 weeks to delivery. Patients were referred by their obstetrical provider, hematologist, or pharmacist. The primary outcome was anemia (hemoglobin &lt;110 g/L) at delivery.</div></div><div><h3>Results</h3><div>Among 1206 patients (577 low-income, 603 non-low-income, 26 RIPPLE), anemia at delivery was more frequent in RIPPLE (54%) versus low-income (10%) and non-low-income (7%) groups (<em>P</em> &lt; 0.0001). RIPPLE participants exhibited lower nadir hemoglobin (98.8 ± 9.9 g/L) and ferritin (9.6 ± 6.4 μg/L) compared to low-income (hemoglobin 114.2 ± 10.1 g/L, <em>P</em> &lt; 0.0001; ferritin 30.0 ± 24.0 μg/L, <em>P</em> &lt; 0.0001) and non-low-income groups (hemoglobin 115.9 ± 8.1 g/L, <em>P</em> &lt; 0.0001; ferritin 40.9 ± 44.1 μg/L, <em>P</em> &lt; 0.0001), and received infusions later in pregnancy (≤3 weeks pre-delivery: 42% vs. 27% vs. 9%). The RIPPLE cohort included more racial and ethnic minoritized individuals (73% vs. 58% vs. 33%).</div></div><div><h3>Conclusions</h3><div>While funding for iron supplementation addressed cost barriers, disparities in care persisted. Our findings underscore the need for universal access to early screening and timely escalation from oral to intravenous iron to reduce social, racial, and ethnic disparities in care.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103035"},"PeriodicalIF":2.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621686","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":"Mayer-Rokitansky-Kuster-Hauser Syndrome Associated with Genital Inguinal Hernia","authors":"Huarui Zhang MM ,&nbsp;Yuan Wang MM ,&nbsp;Yingli Wang MD ,&nbsp;Hongliang Li MM ,&nbsp;Qingyu Ji MD","doi":"10.1016/j.jogc.2025.103038","DOIUrl":"10.1016/j.jogc.2025.103038","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103038"},"PeriodicalIF":2.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621684","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":"Asymptomatic Uterine Rupture After Prophylactic Abdominal Cerclage","authors":"Valérie Boulet MD ,&nbsp;Dina Zaki MD ,&nbsp;Simon Benoit-Dubé MD","doi":"10.1016/j.jogc.2025.103036","DOIUrl":"10.1016/j.jogc.2025.103036","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103036"},"PeriodicalIF":2.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621682","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":"The Role of Simulation in Knowledge Dissemination and Improving Clinical Outcomes for the Management of Impacted Fetal Head at Cesarean Delivery","authors":"Christopher M. Nash MD, MSc,&nbsp;Elizabeth Randle MD, MScHQ,&nbsp;Allyson Cruickshank MSc,&nbsp;Jocelyn Stairs MD, MPH","doi":"10.1016/j.jogc.2025.103037","DOIUrl":"10.1016/j.jogc.2025.103037","url":null,"abstract":"<div><h3>Objectives</h3><div>Impacted fetal head (IFH) is an obstetrical emergency associated with maternal and fetal morbidity. The aim of this study was to assess the role of a simulation session on the management of IFH at cesarean delivery as a method of disseminating guideline recommendations to obstetricians. The secondary aim was to assess the clinical impact of this initiative.</div></div><div><h3>Methods</h3><div>An IFH simulation session based on recent guidelines was developed using the PROMPT FLEX enhanced cesarean delivery model to review pull, push, and Patwardhan techniques. All faculty and obstetrical trainees were invited to participate. Participants completed baseline and post-session surveys. Survey scores were compared using a paired <em>t</em>-test and analysis of variance. To assess clinical impact, a 6-month pre/post cohort of all patients who underwent second-stage cesarean delivery was assembled. Multivariable robust Poisson regression models were used to estimate the relative risk of a composite maternal/neonatal morbidity outcome pre-and post-implementation.</div></div><div><h3>Results</h3><div>Thirty-four clinicians participated (21 trainees, 13 faculty). Trainees demonstrated significant, sustained improvement in knowledge following participation (<em>P</em> &lt; 0.001). Trainees reported sustained comfort with push and pull techniques, but comfort with Patwardhan waned (<em>P</em> = 0.03). Faculty comfort was unchanged for push and pull techniques but significantly improved for Patwardhan (<em>P</em> = 0.01). The adjusted relative risk of composite maternal/neonatal morbidity following implementation was unchanged (relative risk 1.03; 95% CI 0.75–1.42). However, neonatal intensive care unit admissions were reduced (<em>P</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>An IFH simulation session was associated with improvement in trainee knowledge and faculty and trainee comfort with the Patwardhan technique. Simulation may be an effective tool to improve obstetrician comfort with novel recommendations.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103037"},"PeriodicalIF":2.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621688","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":"Effectiveness of Pelvic Floor Muscle Strength Training to Prevent and Treat Urinary Incontinence in Postpartum Primiparous Women: A Systematic Review","authors":"Alfonso Javier Ibáñez-Vera PhD ,&nbsp;María Cano-Castilla PT ,&nbsp;Victoria Carazo-Carrascosa PT ,&nbsp;Esther Díaz-Mohedo PhD","doi":"10.1016/j.jogc.2025.103023","DOIUrl":"10.1016/j.jogc.2025.103023","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the effectiveness of active physiotherapy of the pelvic floor as a method of prevention and treatment in primiparous postpartum women.</div></div><div><h3>Methods</h3><div>PubMed (MEDLINE), SCOPUS, Web of Science, CINAHL Complete, and PEDro databases were searched to identify clinical trials that included primiparous postpartum women that compared the effects of active physiotherapy of the pelvic floor during postpartum, and the degree of urinary incontinence was measured. Data extraction was conducted by 2 authors using a Microsoft Excel sheet, with a third author involved in case of discrepancy or doubt.</div></div><div><h3>Results</h3><div>A total of 5 studies were selected, including 444 primiparous postpartum women, 222 of whom received active physiotherapy of the pelvic floor. The results were very heterogeneous; 2 of the studies did not find significant differences between the groups, one study showed a clear improvement in the intervention group, and in the other studies, a significant intragroup improvement was found post-intervention. There was no significant difference in muscle resistance and strength (<em>P</em> &lt; 0.05), but if applied combined with biofeedback, there was a clear improvement (<em>P</em> = 0.001). Regarding urinary symptoms, there was an improvement in the intervention group (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>This systematic review indicates that pelvic floor muscle training is an effective intervention to prevent and treat urinary incontinence in postpartum women. Pelvic floor muscle training is effective in improving pelvic floor strength and reducing urinary incontinence symptoms.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103023"},"PeriodicalIF":2.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565538","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":"Feasibility of Same-Day Discharge in Patients Undergoing Laparoscopic Gynaecologic Oncology Surgery","authors":"Mandy Litt MD ,&nbsp;Jack Thorburn MD ,&nbsp;Joannie Neveu MD","doi":"10.1016/j.jogc.2025.103025","DOIUrl":"10.1016/j.jogc.2025.103025","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the safety and feasibility of same-day discharge (SDD) of oncology patients undergoing complex laparoscopic gynaecologic oncology surgery.</div></div><div><h3>Methods</h3><div>A retrospective review including patients from October 2019 to July 2023 undergoing surgical staging for endometrial, tubal, or cervical cancer, treatment for endometrial hyperplasia or pelvic masses. Surgeries included a total laparoscopic hysterectomy. Patients accomplishing SDD were compared with those requiring admission. Data collection included clinical, demographic, and perioperative variables up to 6 weeks after surgery. Univariate and multivariate analyses were conducted.</div></div><div><h3>Results</h3><div>A total of 152 patients were included. On multivariate analysis, variables that significantly predicted admission were age ≥61 (OR 0.256; 95% CI 0.102–0.642, <em>P</em> = 0.004), BMI ≥30–34.9 kg/m² (OR 0.291; 95% CI 0.094–0.905), BMI ≥35 kg/m² (OR 0.207; 95% CI 0.075–0.569, <em>P</em> = 0.002), operative time ≥181 minutes (OR 0.143; 95% CI 0.057–0.361, <em>P</em> &lt; 0.001), and an operative start time after 2:00 PM or later (OR .135; 95% CI 0.036–0.503, <em>P</em> = 0.003). Patient’s location &lt;1 hour away from the centre significantly increased the odds of SDD (OR 2.50; 95% CI 1.068–5.863, <em>P</em> = 0.035). Of 51 patients who accomplished SDD, there was a &lt;4% failure rate, with those who were discharged requiring admission &gt;96 hours postoperatively. The average length of stay was 1.09 days.</div></div><div><h3>Conclusions</h3><div>SDD is safe and feasible for patients. There are few complications, re-admissions, or unscheduled patient contacts postoperatively. Its success can be increased by refining patient selection using predictive variables.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"47 9","pages":"Article 103025"},"PeriodicalIF":2.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565540","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}