Modern Rheumatology最新文献

{"title":"Characteristics of patients with polymyalgia rheumatica based on glucocorticoid dose in Japan: A cohort study using routinely collected health data.","authors":"Yoshiya Tanaka, Toshiya Takahashi, Shoichiro Inokuchi, Hidetoshi Uenaka, Akiko Fujita, Kazuhito Sakamoto","doi":"10.1093/mr/roaf001","DOIUrl":"10.1093/mr/roaf001","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to describe the characteristics, inflammatory markers as surrogates for disease activity, and treatment of patients with polymyalgia rheumatica (PMR) in Japan.</p><p><strong>Methods: </strong>This cohort study analysed the data of 373 patients with PMR retrieved from an electronic medical record database in Japan. Patients were classified into quartiles, based on the daily glucocorticoid (GC) dose over the initial 90 days of treatment (Q1-Q4).</p><p><strong>Results: </strong>The low GC dose group (Q1) had more patients aged ≥90 years (11.7%) and a higher prevalence of comorbidities. At 52 weeks, GC-free remission was achieved in 10% of patients and higher C-reactive protein levels were observed during the follow-up period. In contrast, the high GC dose group (Q4) exhibited a slower decline in C-reactive protein levels and more events of increased GC dose compared to Q1-Q3. The introduction of methotrexate was low, with 4.3-7.3% of patients. The incidence of osteoporosis and diabetes was higher in patients <75 years, whereas the incidence of hypertension was higher in patients ≥75 years.</p><p><strong>Conclusions: </strong>Patients refractory to high GC doses were identified. Patients receiving inadequately low doses of GCs were older with more comorbidities. This study highlights the unmet medical needs for PMR.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"722-730"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008487","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":"Differences in the autoantibody phenotypes and long-term outcomes between juvenile- and adult-onset systemic sclerosis.","authors":"Hideaki Tsuji, Mirei Shirakashi, Ryosuke Hiwa, Shuji Akizuki, Ran Nakashima, Akira Onishi, Hajime Yoshifuji, Masao Tanaka, Akio Morinobu","doi":"10.1093/mr/roaf005","DOIUrl":"10.1093/mr/roaf005","url":null,"abstract":"<p><strong>Objective: </strong>To investigate differences in autoantibodies, clinical features, and long-term outcomes between juvenile- and adult-onset systemic sclerosis (SSc).</p><p><strong>Methods: </strong>Autoantibodies and survival rates over a maximum of 20 years were retrospectively analysed in 504 Japanese patients with SSc (juvenile-onset SSc, n = 17; adult-onset SSc, n = 487) using data from Kyoto University Registry.</p><p><strong>Results: </strong>: The autoantibodies observed were anti-topoisomerase-I (71% vs. 26%), anti-centromere (24% vs. 54%), and anti-RNA-polymerase-III (0% vs. 12%). A diffuse type and multiorgan involvement were observed in patients with anti-topoisomerase-I in both juvenile- and adult-onset SSc. In patients with anti-centromere, a diffuse type (juvenile-onset SSc vs. adult-onset SSc, 75% vs. 28%) and pulmonary fibrosis (50% vs. 17%) were more frequently observed in juvenile-onset SSc than in adult-onset SSc. Cox proportional hazard analyses showed that older onset (hazard ratio: 1.06, 95% confidence interval: 1.03-1.09) was associated with death, while autoantibodies were not significantly associated with death. Cumulative survival rates for 20 years were similar between juvenile- and adult-onset SSc when classified based on the presence of anti-centromere (100% vs. 89%, P = .20) and anti-topoisomerase-I (90% vs. 90%, P = .70).</p><p><strong>Conclusions: </strong>: Juvenile-onset SSc had more frequent diffuse-type and anti-topoisomerase-I. An older onset was slightly associated with mortality, whereas autoantibodies were not associated with mortality.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"683-690"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008489","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":"MRI-based predictors of spinal ankylosis progression: ESSR framework for axial spondyloarthritis.","authors":"Yu Mori, Naoko Mori, Takuya Izumiyama, Ryuichi Kanabuchi, Hiroshi Hatakeyama, Toshimi Aizawa","doi":"10.1093/mr/roaf015","DOIUrl":"10.1093/mr/roaf015","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance imaging (MRI), utilizing fat-saturated T2-weighted and short-tau inversion recovery sequences, is essential for the early diagnosis and monitoring of axial spondyloarthritis (axSpA). Recently, the European Society of Musculoskeletal Radiology proposed recommendations for the standardization of MRI findings for axSpA. However, the predictive value of specific MRI findings for spinal ankylosis progression remains unclear. This study investigates whether baseline MRI findings correlate with the progression of spinal ankylosis observed on radiographs over a 2-year period.</p><p><strong>Methods: </strong>Twenty-six axSpA patients who met Assessment of SpondyloArthritis International Society criteria and underwent baseline and 2-year follow-up imaging were included. MRI assessments of the lumbar spine and sacroiliac joint evaluated inflammatory and structural lesions, including Romanus and Anderson lesions. Radiographic progression was defined as a ≥2-point increase in the modified Stoke Ankylosing Spondylitis Spinal Score. Statistical analyses compared clinical and imaging parameters between progression (n = 9) and nonprogression (n = 17) groups.</p><p><strong>Results: </strong>Patients in the progression group had significantly higher baseline modified Stoke Ankylosing Spondylitis Spinal Score (P = .04) and modified-health assessment questionnaire scores (P = .04). Positive MRI findings of anterior and posterior corner inflammatory lesions and Anderson-central lesions were significantly associated with progression (P < .05). Romanus lesions, indicative of early structural changes, were more frequent in the progression group (P = .02). However, fat lesions and sacroiliac joint inflammation showed no significant predictive value.</p><p><strong>Conclusion: </strong>Baseline MRI findings, particularly inflammatory and Romanus lesions, are strong predictors of spinal ankylosis progression in axSpA. These results highlight the importance of incorporating MRI into personalized treatment strategies to mitigate disease progression. Further studies are needed to validate these findings in larger cohorts.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"738-743"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572926","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":"Association of spinal ankylosis with spinal mobility and functional impairment in radiographic axial spondyloarthritis: A computed tomography study.","authors":"Kenji Kishimoto, Shuji Asai, Mochihito Suzuki, Ryo Sato, Junya Hasegawa, Yusuke Ohno, Kenya Terabe, Shiro Imagama","doi":"10.1093/mr/roaf022","DOIUrl":"10.1093/mr/roaf022","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to examine relationships of the degree and level of spinal ankylosis with spinal mobility and functional impairment in patients with radiographic axial spondyloarthritis (r-axSpA) using computed tomography (CT).</p><p><strong>Methods: </strong>This retrospective study involving 27 patients examined the number of fused intervertebral segments in the whole, cervical, thoracic, and lumbar spine using CT as a measure of spinal ankylosis, Bath Ankylosing Spondylitis Metrology Index (BASMI) as a measure of spinal mobility, and Bath Ankylosing Spondylitis Functional Index (BASFI) as a measure of functional impairment.</p><p><strong>Results: </strong>Significant positive correlations were found between both BASMI and BASFI and the number of fused intervertebral segments in the whole, cervical, thoracic, and lumbar spine. 'Tragus to wall distance', a BASMI item, was significantly positively correlated with the number of intervertebral segments in the lumbar spine (r = 0.46, P = .02). 'Looking over your shoulder', a BASFI item, was strongly negatively correlated with the number of fused intervertebral segments in the cervical spine (r = 0.804, P < .01).</p><p><strong>Conclusions: </strong>The number of fused intervertebral segments was associated with impaired spinal mobility and functional impairment. Impaired spinal motion and functional impairment in daily living varied depending on the level of spinal ankylosis.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"744-752"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582324","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":"Consideration of useful patient-reported outcome measures to identify the unmet medical needs of children and adults with autoimmune and autoinflammatory diseases.","authors":"Shuji Sumitomo, Toru Hirano, Akinori Moriichi, Yuzaburo Inoue, Hidehiko Narazaki, Mitsuyo Inoue, Naoto Yokogawa, Naotomo Kambe, Tomoyuki Mukai, Kazushi Izawa, Dai Kishida, Hajime Yoshifuji, Ken Yamaji, Ryuta Nishikomori, Masaaki Mori, Takako Miyamae","doi":"10.1093/mr/roaf036","DOIUrl":"10.1093/mr/roaf036","url":null,"abstract":"<p><p>Patients with autoimmune and autoinflammatory diseases experience difficult physical, mental, and social situations and have various unmet medical needs. To provide appropriate solutions for these patients, an accurate understanding of their unmet medical needs is necessary. Patient-reported outcomes (PROs) reflect the problems of patients and are highly likely to be useful in understanding patient needs. This article reviews established PRO measures from the perspective of determining those appropriate for identifying the unmet medical needs of patients with autoimmune and autoinflammatory diseases. To consider appropriate PRO measures, discussions were held by experts at the Ministry of Health, Labor and Welfare group meetings. The possibility of developing a method to collect PRO data electronically using information and communication technology was also considered. The experts proposed 28 measures, both disease-specific and non-disease-specific, as candidates. It was confirmed that linguistic validation was important and that measures obtained from adults and children could not be considered together. A migration from paper to digital PRO measures was not conducted due to the need for ensuring accuracy and the shortage of technical and financial support. Appropriate non-disease-specific PRO measures were considered to be the KINDL® and EQ-5D-Y for children and the SF-36v2® and EQ-5D™ for adults.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"599-611"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788472","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":"Three-year safety and effectiveness of tofacitinib in patients with rheumatoid arthritis in Japan: Final analysis of an all-case postmarketing surveillance study.","authors":"Masataka Kuwana, Naonobu Sugiyama, Shigeki Momohara, Tatsuya Atsumi, Syuji Takei, Naoto Tamura, Masayoshi Harigai, Takao Fujii, Hiroaki Matsuno, Kazuhiko Yamamoto, Yoshinari Takasaki, Nami Okamoto, Nobunori Takahashi, Atsuo Nakajima, Ayako Nakajima, Miki Tanigawa, Yutaka Endo, Toshitaka Hirano, Masato Hoshi, Tsuneyo Mimori, Michiaki Takagi, Sakae Tanaka, Yoshiya Tanaka, Tsutomu Takeuchi","doi":"10.1093/mr/roaf017","DOIUrl":"10.1093/mr/roaf017","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate tofacitinib real-world safety/effectiveness in patients with rheumatoid arthritis (RA) in Japan in a 3-year all-case postmarketing surveillance study.</p><p><strong>Methods: </strong>All patients with RA who initiated tofacitinib (30 July 2013-03 December 2017) were registered in Japan. Serious infections/malignancy/mortality incidences were compared in patients with active RA after >8 mg methotrexate/week for ≥3 months who received tofacitinib or other drugs (control: methotrexate/other disease-modifying antirheumatic drugs/immunosuppressants). Disease activity was assessed over 3 years.</p><p><strong>Results: </strong>The adherent comparative safety analysis set included 3731/2419 (tofacitinib/control) patients. Baseline (tofacitinib/control) biologic disease-modifying antirheumatic drug history (53.3%/12.2%), methotrexate history (81.4%/98.6%), and RA stage (I-II: 45.3%/67.1%) and class (1-2: 76.5%/90.8%) varied between groups. For tofacitinib vs control, incidence rates [patients with event/100 patient-years (95% confidence interval)] were 6.86 (5.96-7.86) vs 1.42 (0.97-2.00) for serious infections (adjusted hazard ratios 3.25-3.80); 1.40 (1.18-1.66) vs 0.88 (0.66-1.15) for malignancies (adjusted hazard ratios 1.37-1.53); 0.89 (0.72-1.10) vs 0.26 (0.15-0.43) for mortality (unadjusted hazard ratio 3.29). Remission/low disease activity rates with tofacitinib increased over 3 years.</p><p><strong>Conclusions: </strong>Serious infection rates were higher, and malignancy rates were numerically higher with tofacitinib vs control. Results should be interpreted cautiously due to imbalanced groups and unmeasured confounders.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"637-649"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575771","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":"Association between the timing of intravenous immunoglobulin treatment and severity of Kawasaki disease.","authors":"Mitsuji Iwasa, Gaku Aoki, Sachiko Inukai","doi":"10.1093/mr/roaf003","DOIUrl":"10.1093/mr/roaf003","url":null,"abstract":"<p><strong>Objectives: </strong>The early administration of immunoglobulin in Kawasaki disease occasionally results in treatment failure. However, whether this is because severe cases are diagnosed and treated early or due to other factors remains unclear. In this study, we examined the timing of initial immunoglobulin administration and immunoglobulin resistance in cases classified by severity of illness.</p><p><strong>Methods: </strong>This study was a single-hospital, retrospective cohort study of 608 patients who received immunoglobulin within 4 (Early-treatment group, n = 225) or between 5 and 7 days (Late-treatment group, n = 383) following treatment onset. Cases were classified into four groups: high (n = 55), moderate (n = 96), low (n = 197), and very-low (n = 260) risk, based on the Kobayashi score, modified to exclude the day of illness factor. Within each risk group, immunoglobulin resistance was compared between the early- and late-treatment groups.</p><p><strong>Results: </strong>The early-treatment group showed greater immunoglobulin resistance than the late-treatment group. After severity classification, the cases of high-risk and moderate-risk in the early-treatment group were more immunoglobulin-resistant than those in late-treatment group, with odds ratios (95% confidence interval) of 6.7 (1.6-28) and 3.7 (1.6-8.5), respectively. There was no difference in the low-risk and very-low-risk groups.</p><p><strong>Conclusion: </strong>Earlier illness day was a risk factor of immunoglobulin resistance in severe cases.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"707-714"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008486","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":"Subcutaneous Administration of Methotrexate in Children with Pediatric Rheumatic Diseases.","authors":"Yuko Hayashi, Masaaki Mori, Hiroshi Takase, Masaki Shimizu","doi":"10.1093/mr/roaf058","DOIUrl":"https://doi.org/10.1093/mr/roaf058","url":null,"abstract":"","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553948","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":"Upper extremity function and strength, assessed with unsupported upper limb exercise test (UULEX), is impaired in patients with Takayasu Arteritis.","authors":"Fatma Temiz, Yeşim Ağyol, Kerem Abacar, Berdan Özdemir, Hacer Sevim, Muhammed Güner, Çagatay Çimşit, Özge Keniş Çoşkun, Fatma Alibaz-Oner, Haner Direskeneli","doi":"10.1093/mr/roaf057","DOIUrl":"https://doi.org/10.1093/mr/roaf057","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to assess the upper extremity (UE) muscle function/strength of TAK patients compared to healthy controls (HC) and the factors affecting functional outcomes.</p><p><strong>Methods: </strong>Patients with TAK (n=51, F/M: 42/9, mean age: 44 (13.3) years) were compared cross-sectionally with HC (n=51), 24 patients also had a follow-up. Muscle outcomes were assessed by Unsupported Upper Limb Exercise Test (UULEX), handgrip strength (HS), and QuickDASH.</p><p><strong>Results: </strong>UULEX completion time was 171.1 (103.5) seconds in TAK patients, and 432 (44.7) seconds in the HC group (p<0.001). Both right HS (TAK: 22.9 (7.25) vs HC: 27.3 (2.7) kg, p=0.002) and left HS (TAK: 21.9 (6.8) vs HC: 25.4 (7.5) kg, p=0.014) were reduced in TAK patients. UULEX was significantly decreased in patients with active disease (104.4 (62.1) sec. vs. 183.5 (105.3) sec., p=0.023). In follow-up measurements, HS and QuickDASH scores were similar, while UULEX completion time increased significantly. UULEX completion time decreased significantly in patients who had a relapse during the follow-up (-37.6 (62.9) sec. vs 73.2 (87.5) sec., p=0.001).</p><p><strong>Conclusion: </strong>UE muscle function/strength is impaired in TAK patients, associated with disease relapses. UULEX appears to be a promising functional test that shows an association with clinical and radiological parameters and may have potential for monitoring disease activity or progression.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540869","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":"A comparison of coronal plane and rotational alignments of the knees between rheumatoid arthritis and osteoarthritis: a retrospective cohort study.","authors":"Kunihito Hirotomi, Shu Takagawa, Yohei Yukizawa, Kengo Harigane, Ken Kumagai, Yuichi Mochida, Yutaka Inaba, Naomi Kobayashi","doi":"10.1093/mr/roaf056","DOIUrl":"https://doi.org/10.1093/mr/roaf056","url":null,"abstract":"<p><strong>Objectives: </strong>Kinematic alignment (KA) in total knee arthroplasty (TKA) has been extensively studied in osteoarthritis (OA) knees but remains unexplored in rheumatoid arthritis (RA) knees. We compared the coronal and rotational alignments in knees with RA and OA.</p><p><strong>Methods: </strong>In total, 433 patients (69 with RA and 364 with OA) who underwent TKA were included. The hip-knee-ankle angle HKA), lateral distal femoral angle LDFA), medial proximal tibia angle (MPTA), and coronal plane alignment of the knee (CPAK) classification were measured using full length anteroposterior radiographs. The difference between the posterior condylar axis (PCA) and surgical epicondylar axis (SEA) angle was measured with computed tomography.</p><p><strong>Results: </strong>Patients with RA exhibited different CPAK classifications compared to those with OA. The mean PCA-SEA was significantly different between the RA and OA groups. Furthermore, the RA group had significantly larger HKA, smaller LDFA, and larger MPTA compared to the OA group.</p><p><strong>Conclusions: </strong>CPAK classification distribution between patients with RA and OA were different. The average PCA-SEA for RA is larger than that for OA, warranting caution of the complications associated with internal rotation placement. Understanding these differences allows for the consideration of RA knee characteristics and informs future evaluations of KA techniques.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528912","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}