{"title":"Effectiveness of Biker Shorts-Style Compression Garments for the Treatment of Secondary Lower Limb Lymphedema.","authors":"Kazuyo Kamiyama, Akira Shinaoka, Yoshihiro Kimata","doi":"10.1177/15578585251378442","DOIUrl":"https://doi.org/10.1177/15578585251378442","url":null,"abstract":"<p><p><b><i>Background:</i></b> Gradient compression garments are a standard treatment for lower limb lymphedema. However, few reports exist on the indications, effectiveness, and limitations of a biker shorts-style compression garment providing only proximal local compression of the thigh and lower abdomen for lymphedema treatment. This pilot study aimed to investigate the therapeutic effects of using biker shorts-style compression garments for lower limb lymphedema treatment. <b><i>Methods and Results:</i></b> We retrospectively analyzed 40 limbs that received treatment using biker shorts-style compression garments. The primary endpoint was the volume change in the thigh (compression region) and the lower leg (non-compression region) after 6 months of using biker shorts-style compression garments. The control was the volume change in the same patients during an equivalent time period when gradient compression garments were worn. Changes in lymphedema-related symptoms and patients' subjective comments were secondary endpoints. Of the 40 limbs analyzed, 33 limbs were early-stage cases classified as stage 1 or lower by the International Society of Lymphology. Twenty-one limbs had pain and heaviness associated with lymphedema in the thigh or groin. After 6 months of using biker shorts-style compression garments, there was a significant reduction in thigh volume compared to that after using gradient compression garments during the same period. Lymph-related pain improved in all limbs. Significantly poorer thigh volume improvement was observed in patients with a missing posterolateral pathway on lymphangiography and a history of radiation therapy. <b><i>Conclusion:</i></b> Compared to gradient compression garments, biker shorts-style compression garments may improve thigh volume and symptoms in lower limb secondary lymphedema.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138053","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}
Johanna Mahler, Vaughan Keeley, Doha Obed, Alperen Bingöl, Peter M Vogt, Catarina Hadamitzky
{"title":"Validation of the Lymphedema Quality of Life Questionnaire for German Patients with Lipedema.","authors":"Johanna Mahler, Vaughan Keeley, Doha Obed, Alperen Bingöl, Peter M Vogt, Catarina Hadamitzky","doi":"10.1177/15578585251382110","DOIUrl":"https://doi.org/10.1177/15578585251382110","url":null,"abstract":"<p><p><b><i>Background:</i></b> Lipedema, a chronic condition affecting mostly women, involves painful bilateral increase of subcutaneous adipose tissue. The societal impact of this disease is still poorly understood. This study aimed to validate the Lymphedema Quality-of-Life Questionnaire (LYMQOL) for lipedema patients in Germany, assessing its feasibility, reliability, and validity. <b><i>Methods and Results:</i></b> A total of 81 German-speaking stage II lipedema patients were asked to complete both the LYMQOL (arm and leg versions) and the Short Form Health Survey (SF-36) questionnaires twice, and this was 2 weeks apart. Feasibility was evaluated through response rates, scale structure via factor analysis, validity through SF-36 correlations, and reliability through internal consistency and test-retest reliability analysis. A valid 68% response rate was achieved. Both arm and leg versions demonstrated construct validity with significant correlations to SF-36 subscales. Internal consistency for the leg version was acceptable to excellent, and good to excellent for the arm version. Test-retest reliability was very good for both versions. <b><i>Conclusions:</i></b> This study validates the LYMQOL as a robust tool for assessing lipedema patients' quality of life, and also validates the German translation contained in this article. We hope to fill a critical research gap and support future clinical studies aiming at enhancing patient care.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138028","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":"Changes in the Diameter of Lymphatic Vessels and Veins Due to Body Position, Evaluated by Ultrasound.","authors":"Hisako Hara, Makoto Mihara","doi":"10.1177/15578585251382108","DOIUrl":"https://doi.org/10.1177/15578585251382108","url":null,"abstract":"<p><p><b><i>Background:</i></b> The purpose of this study was to clarify how lymphatic vessels and veins change when body position is changed in lower limbs affected by lymphedema. <b><i>Methods:</i></b> We performed a retrospective study of 18 consecutive patients (33 limbs) who underwent lymphaticovenous anastomosis (LVA) for lower limb lymphedema. We performed ultrasound to detect the suitable lymphatic vessels and veins preoperatively, applying the index of D-CUPS (Doppler, Crossing, Uncollapsible, Parallel, and Superficial fascia) to identify lymphatic vessels. We measured the vertical diameter of the lymphatic vessels and veins in each incision site for LVA using ultrasound with the patients lying, sitting, and standing, and a Student's <i>t test</i> was performed. <b><i>Results:</i></b> The mean age of the participants was 61.8 years old, and the mean body mass index was 21.7 (range: 18.3-28.1). Thirty-eight sites on the 30 thighs and 21 sites on the 18 calves were evaluated. The diameter of veins increased significantly when changing from a lying to a sitting or a standing position (thigh: <i>p</i> < 0.01, calf: <i>p</i> = 0.016 and 0.015, respectively), but lymphatic vessels did not (thigh: <i>p</i> = 0.65, calf: <i>p</i> = 0.60 and 0.36, respectively). A weak correlation was found between dilatation rates of veins and lymphatic vessels in the calf (r = 0.39, <i>p</i> = 0.030). <b><i>Conclusion:</i></b> The veins dilated significantly when the body changed from the supine to standing position, but the lymphatic vessels did not. Similar studies with a larger number of cases are desirable in the future.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131186","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":"Time-Dependent Changes in the Skin Hardness in Taxane-Induced Swollen Arms.","authors":"Kotaro Suehiro, Saiko Honda, Takasuke Harada, Yuriko Takeuchi, Takahiro Mizoguchi, Ryunosuke Sakamoto, Ryo Suzuki, Hiroshi Kurazumi, Kimikazu Hamano","doi":"10.1177/15578585251378108","DOIUrl":"https://doi.org/10.1177/15578585251378108","url":null,"abstract":"<p><p><b><i>Background:</i></b> We aimed to clarify the time-dependent changes in skin hardness in taxane-induced arm swelling. <b><i>Methods and Results:</i></b> Fifteen patients with unilateral arm swelling that developed during or within 3 months from the termination of postoperative taxane-containing chemotherapy were studied. The patients were followed up every 3-6 months for 24 months from the initial visit. During each visit, arm circumference and skin hardness were assessed using a scale ranging from 1 (softest) to 7 (hardest). Ultrasonography of the skin and subcutaneous tissues was performed at 0, 6, 12, and 24 months from the initial visit. In the initial visit, the mean skin hardness in the affected and contralateral arms was 3.8 versus 2.8 (<i>p</i> < 0.05) in the medial/lateral upper arm, 5.0 versus 2.8 (<i>p</i> < 0.01) in the medial forearm, and 4.3 versus 2.8 (<i>p</i> < 0.05) in the lateral forearm. In 12 patients whose arm swelling resolved, the difference in skin hardness between the arms disappeared in 9 patients until 9 months from the initial visit, whereas a mild difference in skin hardness persisted in the remaining 3 patients. Even in three patients whose arm swelling persisted, a certain improvement was observed until 9-12 months from the initial visit. <b><i>Conclusions:</i></b> We found that the majority of skin hardening associated with taxane-induced arm swelling improved until approximately 9-12 months from the initial visit, including complete resolution in 60% of patients.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040669","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}
Joyce Teng, Jeff Martini, Michael Kelly, Megha Tollefson, Alexander Greer
{"title":"Sirolimus for Venous Malformations: A Systematic Review of Efficacy and Safety.","authors":"Joyce Teng, Jeff Martini, Michael Kelly, Megha Tollefson, Alexander Greer","doi":"10.1177/15578585251377562","DOIUrl":"https://doi.org/10.1177/15578585251377562","url":null,"abstract":"<p><p><b><i>Background:</i></b> Venous malformations can cause substantial morbidity and long-term complications. There are no Food and Drug Administration (FDA)-approved therapies for the treatment of venous malformations. However, off-label use of sirolimus has demonstrated clinical benefit in these patients. This systematic review evaluates the efficacy and safety of sirolimus in the management of venous malformations. <b><i>Methods and Results:</i></b> A systematic literature search identified 26 studies comprising 98 patients treated with sirolimus for venous malformations. Most studies were case reports or case series (77%), with 15% prospective trials and 8% retrospective analyses. Sirolimus, primarily administered orally, yielded some level of clinical improvement in 72% of reported patients, with consistent symptomatic relief observed in coagulopathy, bleeding, anemia, pain, and improved function. However, reduction in the size of the malformation varied and treatment-limiting side effects were observed. <b><i>Conclusions:</i></b> Oral sirolimus is a promising treatment option for venous malformations, especially for those with deep venous malformations. A direct, targeted topical treatment could provide clinical benefit for the cutaneous manifestation without the risk of off-target effects as occur with oral sirolimus. Further prospective, controlled studies are warranted to elucidate sirolimus's role in managing venous malformations.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033806","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}
Leigh C Ward, Katrina Gaitatzis, Belinda Thompson, Vincent Singh Paramanandam, Louise A Koelmeyer
{"title":"Improving Precision of Bioimpedance Spectroscopic Analysis for Lymphedema and Lipedema Assessment.","authors":"Leigh C Ward, Katrina Gaitatzis, Belinda Thompson, Vincent Singh Paramanandam, Louise A Koelmeyer","doi":"10.1089/lrb.2024.0086","DOIUrl":"10.1089/lrb.2024.0086","url":null,"abstract":"<p><p><b><i>Background:</i></b> Bioimpedance spectroscopy (BIS) is commonly used for the detection and monitoring of lymphedema and potentially lipedema. BIS measures limb electrical resistance, which decreases with fluid accumulation in these conditions. R0, the index of extracellular fluid and lymph accumulation, is typically estimated using Cole modeling, but technical and biological factors can affect accuracy. <b><i>Methods:</i></b> Participants with clinically affirmed bilateral leg lymphedema, lipedema, self-ascribed swelling, and healthy controls were included in this study. Impedance measurements were taken using a stand-on BIS device, and R0 was estimated using both the Cole modeling method and a regression approach. Quality of data fitting was assessed visually and statistically. <b><i>Results:</i></b> Control participants were younger and lighter compared with the clinical groups. The regression method was able to analyze 100% of participant data, whereas the Cole method was successful in only 80%-88% of cases in the lymphedema and lipedema groups. Additionally, the regression approach provided better curve fitting accuracy for all participants. <b><i>Conclusion:</i></b> The regression method offers a robust alternative for estimating R0 values in BIS data, especially in lower limb assessments where data analysis is challenging. The small difference between methods in absolute R0 values (2.5%) has minimal practical implications, suggesting interchangeability in data analysis. The Cole method showed poorer performance, particularly in participants with lymphedema, possibly due to differences in water proportions and limb size. Overall, the regression method can be effectively used in clinical practice for estimating R0 values in BIS data, offering a more accurate and reliable approach than traditional Cole plotting methods.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"229-238"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017331","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":"Effects of Forearm Bandaging Technique, Muscle Contraction, and Additional Compression Pad Use on Sub-Bandage Pressure.","authors":"Elif Sakizli Erdal, Miray Haspolat, Burak Erturk, Ilke Keser","doi":"10.1089/lrb.2025.0026","DOIUrl":"10.1089/lrb.2025.0026","url":null,"abstract":"<p><p><b><i>Background:</i></b> This study aimed to evaluate the effects of forearm bandaging techniques, muscle contraction, and additional compression pad use on sub-bandage pressure. <b><i>Methods and Results:</i></b> Thirty-one individuals (26 females, 5 males) with no chronic or lymphatic-related conditions participated in the study. Sub-bandage pressure was measured using the Kikuhime device, with a standardized protocol applied to the wrist extensor muscle belly. Participants were evaluated under rest and wrist extension conditions using two bandaging techniques: spiral and figure-of-eight. Variations included single and double layers, 1/2 and 1/3 overlaps, and the presence or absence of additional compression pads. Certified physiotherapists trained performed all bandaging applications using short-stretch compression materials. The figure-of-eight wrapping technique consistently produced significantly higher sub-bandage pressures compared to the spiral technique in all conditions. Double bandaging generated 1.4 times more pressure than single-layer applications, while 1/3 overlap resulted in greater pressure than 1/2 overlap. The addition of compression pads increased resting pressure by approximately 5 mmHg, and wrist extension further augmented pressure by 4-8 mmHg. The highest pressures were observed with the figure-of-eight technique, double bandaging, and 1/3 overlap combined (<i>p</i> < 0.05). <b><i>Conclusions:</i></b> These findings highlight the critical role of forearm bandaging technique, layering, and additional materials in determining sub-bandage pressure.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"239-243"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008940","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 Comparative Evaluation of Depression, Life Satisfaction, and Quality of Life Between Female Patients with Lipedema and Lymphedema.","authors":"Ayşegül Yaman, Pınar Borman, Esra Gizem Koyuncu, Ayşegül Balcan Aslan, Ayça Utkan Karasu, Cansu Şahbaz Pirinççi","doi":"10.1089/lrb.2024.0117","DOIUrl":"10.1089/lrb.2024.0117","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Lymphedema and lipedema are chronic conditions significantly impacting psychosocial status and quality of life (QOL). However, comparative studies on depression, life satisfaction, functional status, and QoL in these conditions are lacking. This study aims to fill this gap by providing a comparative evaluation of functional status, depression, life satisfaction, and QoL in patients with lymphedema and lipedema. <b><i>Method:</i></b> Over 12 months, 73 female patients diagnosed with pure lymphedema or lipedema were recruited according to inclusion/exclusion criteria. A range of demographic variables, including age, body mass index (BMI), disease duration, stage of disease, and exercise/smoking conditions, were recorded. The lower-extremity functional scale (LEFS), life satisfaction index (LSI), patient health questionnaire (PHQ-9), and Lymphedema QOL Questionnaire for Legs were used to assess functional status, life satisfaction, depression, and QoL, respectively, in both groups. The relationship between questionnaire scores and demographic variables was carefully evaluated. <b><i>Results:</i></b> Thirty-six individuals with lymphedema (mean age: 55.1 years) and 37 patients with lipedema (mean age: 50.7 years) were included in the study. Demographical variables were statistically similar between the groups (<i>p</i> > 0.05). Duration of disease was longer (mean: 159.3 months vs. 39.6 months) in a lipedema group than in lymphedema patients. PHQ-9 (mean:11.4 vs. 10.4) and overall QoL scores (mean: 5.06 vs. 5.47) were similar between groups, while LEFS (mean: 44 vs. 62) and LSI scores (mean: 11.5 vs. 14.3) were worse in patients with lymphedema than in a lipedema group. There were correlations between age and LEFS (<i>p</i> = 0.014, <i>r</i> = -0.40) and LSI (<i>p</i> = 0.013, <i>r</i> = -0.41) in the lymphedema group; and between BMI and LEFS (<i>p</i> = 0.013, <i>r</i> = -0.041) and QoL (<i>p</i> = 0.034, <i>r</i> = 0.37) scores; and duration of disease and PHQ-9 scores (<i>p</i> = 0.028, <i>r</i> = -0.41) in the lipedema group. <b><i>Conclusions:</i></b> Patients with lipedema have similar depression and impaired QoL as lymphedema patients. However, lymphedema patients experience more functional disability and less life satisfaction. As the BMI and duration of illness are correlated with depression and QoL, early diagnosis and early management are essential to improve disability and QoL in patients suffering from lipedema.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"255-262"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625229","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}
Lucy Fry, Hayden Roys, Anne Bowlin, Gopinath Venugopal, Jordan T Bird, Alexx Weaver, Stephanie D Byrum, Tiffany Weinkopff
{"title":"Enhanced Translational Activity Is Linked to Lymphatic Endothelial Cell Activation in Cutaneous Leishmaniasis.","authors":"Lucy Fry, Hayden Roys, Anne Bowlin, Gopinath Venugopal, Jordan T Bird, Alexx Weaver, Stephanie D Byrum, Tiffany Weinkopff","doi":"10.1089/lrb.2024.0080","DOIUrl":"10.1089/lrb.2024.0080","url":null,"abstract":"<p><p><i><b>Introduction:</b></i> Cutaneous leishmaniasis (CL) is a significant public health problem leading to permanently disfiguring skin lesions caused by <i>Leishmania</i> parasites. Lesion severity stems from an excessive host inflammatory response that prevents healing. <i><b>Materials and Methods:</b></i> Here, we characterized the transcriptional and translational responses of lymphatic endothelial cells (LECs) during murine CL using single-cell RNA sequencing data combined with flow cytometry and <i>in vivo</i> puromycin incorporation to assess translational activity. <i><b>Results:</b></i> We identified upregulation of antigen presentation pathways including MHC-I, MHC-II, and immunoproteasome transcripts in dermal LECs from <i>Leishmania major</i>-infected mice compared to naive controls. LECs also exhibited increased expression of guanylate binding proteins and interferon-inducible genes, indicative of immune activation. Moreover, our findings demonstrate that LECs in leishmanial lesions displayed heightened translational activity relative to LECs from uninflamed ears, and LEC translational activity was highest in activated LECs. Furthermore, LEC translational activity exceeded that of other cell types within the lesion microenvironment. Validating the transcriptomic data, LECs in lesions expressed elevated MHC-II and programmed death-ligand 1 (PDL-1), supporting their potential role in antigen presentation. Functional assays using DQ-ovalbumin confirmed that LECs from leishmanial lesions efficiently uptake and process antigens, highlighting their capability as antigen presenting cells in the inflamed dermal microenvironment. <i><b>Conclusion:</b></i> Overall, our study reveals the activation status of LECs in leishmanial lesions, shedding light on their potential role in shaping local immunity and inflammation in a variety of skin diseases.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"244-254"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006947","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":"Research Matters.","authors":"","doi":"10.1089/lrb.2025.0074","DOIUrl":"10.1089/lrb.2025.0074","url":null,"abstract":"","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"281"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310142","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}