Minerva obstetrics and gynecology最新文献

{"title":"A case report of uterine leiomyosarcoma: unusual clinical presentation with unilateral hydronephrosis and importance of an appropriate diagnosis.","authors":"S. Restaino, Annalisa Graziano, C. Ronsini, Federico Paparcura, Margherita Bagolin, Marianna C Cinti, Arianna Castenetto, F. Titone, Marco Rensi, L. Driul, Giuseppe Vizzielli","doi":"10.23736/S2724-606X.22.05131-4","DOIUrl":"https://doi.org/10.23736/S2724-606X.22.05131-4","url":null,"abstract":"Uterine leiomyosarcoma is a rare malignant gynecologic tumor that arises from the myometrial or endometrial stromal precursor cells. This tumor has the highest prevalence in the pre- and post-is more frequent between 40 and 60 years old. It has a very unfavorable prognosis: only early-stage tumors have an acceptable prognosis; unfortunately, it is often diagnosed accidentally, typically on an advanced stage, when hematological metastases have already spread. Surgery is the main treatment strategy, while systemic treatment and radiotherapy are not recommended due to the lack of results. Since metastatization is mainly hematological, lymphadenectomy is not recommended. Recent progresses have been achieved in advanced and recurrent disease, often inoperable, thanks to new chemotherapies, target therapies and immunotherapies. We reported the case of a 51-year-old woman evaluated for lumbar pain in the right region compatible with renal colic. The ultrasound evaluation revealed right hydronephrosis and the presence of a paraovarian or intraligamentary mass compatible with fibroma. The abdominal CT confirmed the presence of a mass with heterogeneous vascularization. Therefore, the patient underwent laparoscopic surgery to remove the lesion which resulted to be a leiomyosarcoma G2. During the following week the patient underwent a laparoscopic hysterectomy. The first step for differential diagnosis consists in the evaluation of clinicopathological features, followed by the analysis of preoperative imaging. Pelvic MRI represents the gold standard, while CT is used to detect metastases. The main issue is that imaging shows limited ability in differential diagnosis between benign and malign smooth muscle tumor. The definitive diagnosis is confirmed by histological analysis; this implies the necessity of improved attentions on the surgical procedure, which is often performed by steps with prolongation of the treatment pathway. To distinguish which fibroids presents a major risk to be misdiagnosed, some risk scores were developed (rPRESS in 2014 and pLMS in 2019), though actually they are not applied in clinical practice. Uterine leiomyosarcoma (uLMS) is rare but causes several deaths in perimenopausal women due to lack of effective treatments, although target therapies represent a future hope. Furthermore, clinical practice needs support through the development and improvement of diagnostic risk scores and their integration into guidelines.","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796302","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":"Intrauterine fetal death in a COVID positive pregnant woman.","authors":"Valentina Zanin, Lorenza Driul, Silvia Zoletto, Stefano Restaino, Angelica Tulisso, Michela Bulfoni, Maria Orsaria","doi":"10.23736/S2724-606X.22.05149-1","DOIUrl":"10.23736/S2724-606X.22.05149-1","url":null,"abstract":"<p><p>SARS-CoV-2 disease mechanisms are not yet fully understood, especially in cases affecting pregnant women. In fact, although they suffer from the same symptoms as non-pregnant women, they are more susceptible to-adverse outcomes of COVID-19 as well as pregnancy complications leading to stillbirth, premature rupture of membrane, or intrauterine fetal demise (IUFD). The consequences on pregnancy are not clearly correlated with the severity of the infection. We present a case of fetal death in a 30-year-old woman with a confirmed SARS-CoV-2 infection without any other significant clinical or obstetric disorders. A histopathological examination of the placenta indicated massive and diffuse intervillar fibrinoid deposits associated with chronic histiocytic intervillositis that can be associated with SARS-CoV-2 placentitis. Given the high rates of SARS-CoV-2 infections in pregnancy, it is important to understand the factors that determine negative pregnancy outcomes, regardless of the severity of the patient's symptoms.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40338891","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":"Intravenous lidocaine on postoperative pain and opioid consumption during gynecological surgery: a meta-analysis of randomized controlled trials.","authors":"Guan-Chao Qin, Yang Hu, Ning-Hui Cha, Qing-Yun Zhang, Yuan Gong","doi":"10.23736/S2724-606X.22.05209-5","DOIUrl":"10.23736/S2724-606X.22.05209-5","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the role of intravenous lidocaine as a adjuvant anesthetics in patients undergoing gynecological surgery.</p><p><strong>Evidence acquisition: </strong>We conducted a meta-analysis of randomized controlled trials (RCTs) from PubMed/Medline, Embase and clinic trails.gov involving the use of intravenous lidocaine in gynecological surgery. We used a more comprehensive search strategy to adequately screen for randomized controlled trials involving intravenous lidocaine infusion in gynecological surgery. First outcomes were postoperative pain scores. And secondary outcomes included 24 h postoperative opioids consumption, time to first flatus, and incidence of postoperative nausea and vomiting.</p><p><strong>Evidence synthesis: </strong>A total of 6 RCTs comprising 375 patients were included in the meta-analysis. There were statistically significant between postoperative pain scores. The consumption of opioids and anesthetics during surgery and 24 hours after surgery was statistically significant when compared with the control group. Postoperative pain scores were similar at 2, 4, 6, 8, 10, 12, 24, 48 hours between groups. No statistical differences were found in postoperative complications including nausea, vomiting and restoration of the intestinal function.</p><p><strong>Conclusions: </strong>Our results indicated that the current literature supports the perioperative use of intravenous lidocaine as part of multimodal analgesia and beneficial to patients in early postoperative analgesia, reduced opioid consumption.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40338894","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":"Medically assisted reproduction in Italy, 2020 data from the Italian MAR Register.","authors":"Giulia Scaravelli, Roberto DE Luca, Roberta Spoletini, Lucia Speziale, Fabiola Fedele, Simone Bolli, Monica Mazzola, Anna Bertini, Cinzia DI Monte, Vincenzo Vigiliano","doi":"10.23736/S2724-606X.23.05375-7","DOIUrl":"10.23736/S2724-606X.23.05375-7","url":null,"abstract":"<p><strong>Background: </strong>The Italian Medically Assisted Reproduction (MAR) Register (ItMARR) was established by the Decree of the Minister of Health issued on October 7^th, 2005. ItMARR has a crucial role in clearly and publicly disseminating epidemiological information on the MAR activities and outcomes.</p><p><strong>Methods: </strong>ItMARR data is collected in aggregate form and is mandatory as set out in Law 40/2004. The aim of this article is to make a snapshot of the authorized centers that perform IUI and ART in Italy. Data used in this article refer to MAR treatments started between January 1^st and December 31^st, 2020.</p><p><strong>Results: </strong>MAR techniques were performed by 332 centers. In total, 67,927 ART cycles and 12,171 IUI cycles were performed in 2020. Gametes donation cycles represent 12.9% of ART activity and 4.0% of IUI. ART cycles performed per million women of childbearing age was 6525. In 2020, 2.5% of births in the general population in Italy were a result of application of ART techniques. MAR activity in 2020, has been heavily reduced by the limitations to reproductive treatment due to SARS-CoV-2 pandemic. Pregnancy rates per transfers were 26.7% with fresh techniques, 32.6% with FER, 25.7% with FO, 38.0% with OD and 39.1% with SD. There were fewer multiple deliveries than the previous year.</p><p><strong>Conclusions: </strong>The ItMARR, has become a great asset in the reproductive health scenario promoting a better MAR information dissemination. ItMARR is working on the implementation towards a \"cycle-by-cycle\" data collection system. This will bring the Italian monitoring system in line with others European countries.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139990593","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":"Vitamin D and its role in gynecology: emerging importance of checking vitamin D status in certain gynecological entities.","authors":"Mateja Legan, Naneta Legan Kokol","doi":"10.23736/S2724-606X.22.05047-3","DOIUrl":"10.23736/S2724-606X.22.05047-3","url":null,"abstract":"<p><p>Among non-bone effects of vitamin D, the three main chronological stages in gynecology ‒ menarche, reproductive stage and menopause/postmenopause - are possibly impacted by vitamin D deficiency. A large amount of emerging data show that vitamin D is a confounding factor in these parameters. Gynecology stays at the crossroads with endocrinology and, in the light of the rising knowledge about the involvement of vitamin D in many gynecological disorders, it is worth to investigate the exact role of vitamin D in this area. Especially since vitamin D is easy to substitute in case of deficiency. Authors present some emerging data on the role of vitamin D in gynecology, suggesting when it is necessary to check vitamin D status to intervene with vitamin D supplementation and raising gynecologists' awareness of the need for further clinical studies.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43627332","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":"Navigating towards precision: evaluating the clinical value of non-invasive biomarkers for the diagnosis of endometriosis.","authors":"D. Encalada Soto","doi":"10.23736/S2724-606X.23.05313-7","DOIUrl":"https://doi.org/10.23736/S2724-606X.23.05313-7","url":null,"abstract":"INTRODUCTION\u0000Endometriosis is a chronic disease that affects millions of women worldwide, causing dysmenorrhea, chronic pain, and infertility, and has a significant impact on the healthcare system. Despite efforts to understand its pathogenesis, endometriosis is a disease with heterogeneous presentations and phenotypes which is manifested in part by the lack of a non-invasive biomarker available for its diagnosis. This review aims to bridge the gap between theory and practice by summarizing the most promising areas of study for developing a reliable biomarker or combination of biomarkers for the non-invasive diagnosis of endometriosis.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000We conducted a comprehensive literature search using the electronic databases PubMed and MEDLINE.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000This review summarizes the potential biomarkers for endometriosis, including glycoproteins, inflammatory markers, immunologic markers, angiogenic cytokines, micro RNAs and the microbiome. Each of these biomarkers' role in the development and progression of endometriosis, and their diagnostic potential are discussed in detail.\u0000\u0000\u0000CONCLUSIONS\u0000Endometriosis is a complex and underdiagnosed disease with significant health impact. The development of non-invasive biomarkers for its diagnosis would be immensely valuable, and promising research is being done in this area. While no single biomarker has yet emerged as a reliable diagnostic tool, this review highlights the potential of several biomarkers and the importance of continued research in this field. By improving the diagnosis of endometriosis, we can improve the lives of millions of women worldwide.","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140793169","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":"Effect of vasopressin injection technique on ovarian reserve during laparoscopic cystectomy of ovarian endometriomas: a systematic review and meta-analysis of randomized controlled trials.","authors":"Saeed Baradwan, M. Alshahrani, Rayan Al Sghan, H. Sabban, Khalid Khadawardi, Nabigah Alzawawi, H. H. Abduljabbar, A. M. Abdelhakim, Abdulhadi A Al Amodi, A. F. Elgamel","doi":"10.23736/S2724-606X.23.05310-1","DOIUrl":"https://doi.org/10.23736/S2724-606X.23.05310-1","url":null,"abstract":"INTRODUCTION\u0000To evaluate the effect of injecting vasopressin during laparoscopic excision of ovarian endometriomas on ovarian reserve.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000Four different databases (PubMed, Cochrane Library, Scopus, and ISI Web of Science) were searched to identify relevant studies in March 2023. We selected randomized controlled trials (RCTs) that compared vasopressin injection in the intervention group versus no injection of vasopressin in the control group among women undergoing laparoscopic cystectomy of ovarian endometriomas. The main outcomes were the amount of bleeding, number of coagulation events, and levels of serum anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH). The available data were extracted and analyzed in a meta-analysis model using RevMan software.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000Seven RCTs, involving a total number of 478 patients, were included in our study. The vasopressin group had significantly reduced blood loss amount and number of coagulation events compared to the control group (P=0.004 and P=0.005). There was a significant improvement in the AMH levels within 6 months after surgery in the vasopressin group (MD=0.52, 95% CI: 0.11, 0.93, P=0.01). In addition, the FSH levels within 6 months after laparoscopic cystectomy were significantly reduced with vasopressin injection.\u0000\u0000\u0000CONCLUSIONS\u0000Vasopressin injection during laparoscopic cystectomy of ovarian endometriomas is effective in reducing blood loss amount and frequency of coagulation, as well as protecting the ovarian reserve. More trials are encouraged to confirm our findings.","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777849","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":"Fertility preservation: knowledge, awareness, and attitude of university students and professors.","authors":"Maria E Porto, Ana L Moura, Thiago R Carvalho, Cristiano C Gonçalves, Natércia P Freitas, Edward Araujo Júnior, Marcelo B Cavalcante","doi":"10.23736/S2724-606X.22.05187-9","DOIUrl":"10.23736/S2724-606X.22.05187-9","url":null,"abstract":"<p><strong>Background: </strong>Delayed pregnancy is a worldwide trend, especially in Western countries. University students and professors are at high risk of presenting age-related reproductive difficulties due to this new reproductive profile. Thus, through this study, we aimed at exploring the knowledge, awareness, and attitude of university students and professors related to fertility and fertility preservation (FP).</p><p><strong>Methods: </strong>We adopted a prospective cross-sectional study design and included students and professors from private university located in the Northeast of Brazil. Eligible participants (male and female) were invited through an online message. The participants accessed the online questionnaire through a link.</p><p><strong>Results: </strong>We performed 256 surveys (100 students and 156 professors). The overall mean age of participants was 35.8±13.1 years (from 18 to 67 years). Fertility was considered relevant by all participants, being very important among a greater number of students compared to professors, 61% versus 30.1%, P<0.001, respectively. The main reasons why participants could have postponed parenthood were reach financial stability (62.1%), career building (51.2%), health issues (37.9%), and not having a partner (33.9%). Students demonstrated a better understanding of FP and highlighted the importance of the age of females at the time of the oocyte cryopreservation. Very few students and professors already discussed reproductive planning with a health professional.</p><p><strong>Conclusions: </strong>We observed a deficiency in the knowledge of Brazilian university students and professors about female fertility and FP options. Thus, exposing the population to information related to FP should be hyped in the university environment.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33502976","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":"Therapeutic human papilloma virus vaccination in patients at risk for cervical dysplasia.","authors":"Ashley M Florence, Joshua Fogel, Makayla Mozey, Shachi Dave, Heidi O'Dell, Mary Fatehi","doi":"10.23736/S2724-606X.22.05141-7","DOIUrl":"10.23736/S2724-606X.22.05141-7","url":null,"abstract":"<p><strong>Background: </strong>Shared decision making between patients and their healthcare providers is recommended for use of the human papillomavirus (HPV) vaccine Gardasil 9 (9v-HPV) in women ages 27-45 years. We studied HPV vaccination as a treatment modality for patients undergoing colposcopy older than age 26 years who tested positive for high-risk subtypes of HPV (HR-HPV).</p><p><strong>Methods: </strong>A retrospective study (N.=155) was performed for patients that were evaluated for cervical dysplasia who tested positive for HR-HPV and received the 9v-HPV vaccine prior to repeat cervical cancer screening with co-testing. Demographic information, risk factors for cervical dysplasia, and treatment outcomes were assessed for response to vaccination as treatment.</p><p><strong>Results: </strong>Repeat co-testing was negative for HR-HPV in 76 patients (49%) and was positive in 79 patients (51%). A greater percentage of Hispanic patients cleared the virus and Black patients had a greater percentage of persistent HR-HPV on repeat co-testing (P=0.047). When comparing those who cleared the virus and those who had persistent HR-HPV, there were no differences observed for associated risk factors for dysplasia, HPV subtype, cytology or colposcopy results, vaccine dosing interval, or total number of vaccine doses received.</p><p><strong>Conclusions: </strong>While the HPV vaccine is effective for prevention of infection by high-risk strains of HPV, it remains unclear whether 9v-HPV vaccine should be recommended as a treatment option in exposed patients beyond age 26. We recommend healthcare providers discuss usefulness of 9v-HPV vaccine with their unvaccinated patients 27 years and older at risk for cervical dysplasia.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33488065","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":"Luteal phase support in assisted reproductive technology centers: Italian survey.","authors":"Antonio LA Marca, Paola Anserini, Andrea Borini, Giuseppe D'Amato, Ermanno Greco, Claudia Livi, Enrico Papaleo, Rocco Rago","doi":"10.23736/S2724-606X.22.05219-8","DOIUrl":"10.23736/S2724-606X.22.05219-8","url":null,"abstract":"<p><strong>Background: </strong>In assisted reproductive cycles (ART), the fine balance of controlling corpus luteum function is severely disrupted. To challenge this iatrogenic deficiency, clinicians aim to provide exogenous support. Several reviews have investigated progesterone route of administration, dosage and timing.</p><p><strong>Methods: </strong>A survey about luteal phase support (LPS) after ovarian stimulation was conducted among doctors in charge in Italian II-III level ART centers.</p><p><strong>Results: </strong>With regards to the general approach to LPS, 87.9% doctors declare to diversify the approach; the reasons for diversifying (69.7%) were based on the type of cycle. For all the most important administration routes (vaginal, intramuscular, subcutaneous) it appears that in frozen cycles there is a shift towards higher dosages. The 90.9% of the centers use vaginal progesterone, and when a combined approach is required, in 72.7% of cases vaginal administration is combined with injective route of administration. When Italian doctors were asked about the beginning and duration of LPS, 96% of the centers start the day of the pickup or the day after, while 80% of the centers continue LPS until week 8-12. The rate of participation of the centers confirms the low perceived importance of LPS among Italian ART centers, while may be considered quite surprising the relatively higher percentage of centers that measures P level. Tailorization to women's needs is the new objective of LPS: self-administration, good tolerability are the main aspects for Italian centers.</p><p><strong>Conclusions: </strong>In conclusion, results of Italian survey are consistent to results of main international surveys about LPS.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9299475","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}