Neurology. Clinical practice最新文献

{"title":"Approach to Managing the Initial Presentation of Multiple Sclerosis: A Worldwide Practice Survey.","authors":"Jodie I Roberts, Aravind Ganesh, Luca Bartolini, Tomas Kalincik","doi":"10.1212/CPJ.0000000000200376","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200376","url":null,"abstract":"<p><strong>Background and objectives: </strong>Available disease-modifying therapies (DMTs) for multiple sclerosis (MS) are rapidly expanding; although escalation approaches aim to balance safety and efficacy, emerging evidence suggests superior outcomes for people with MS who are exposed to early high-efficacy therapies. We aimed to explore practice differences in prevailing management strategies for relapsing-remitting MS.</p><p><strong>Methods: </strong>We used a worldwide electronic survey launched by the Practice Current section of <i>Neurology® Clinical Practice</i>. Questions pertained to a case of a 37-year-old woman presenting with optic neuritis. Respondents were asked to indicate their initial investigations, relapse management strategy, choice of disease-modifying therapy, and plan for follow-up imaging (contrast/noncontrast). Survey responses were stratified by key demographic variables along with 95% confidence intervals (95% CIs).</p><p><strong>Results: </strong>We received 153 responses from 42 countries; 32.3% responders identified as MS specialists. There was a strong preference for intravenous delivery of high-dose corticosteroids (87.7%, 95% CI 80.7-92.5), and most of the responders (61.3%, 95% CI 52.6-69.4) indicated they would treat a nondisabling (mild sensory) MS relapse. When asked to select a single initial DMT, 56.6% (95% CI 47.6-65.1) selected a high-efficacy therapy (67.5% MS specialists vs 53.7% non-MS specialists). The most selected agents overall were fingolimod (14.7%), natalizumab (15.5%), and dimethyl fumarate (20.9%). Two-thirds of respondents indicated they would request contrast-enhanced surveillance MRI.</p><p><strong>Discussion: </strong>Although there is a slight preference for initiating high-efficacy DMT at the time of initial MS diagnosis, opinions regarding the most appropriate treatment paradigm remain divided.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200376"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coprophenomena Associated With Worse Individual and Family Function for Youth With Tourette Syndrome: A Cross-Sectional Study.","authors":"Samantha P Myers, Kathleen D Meeks, Heather Adams, Amy E Vierhile, Erika Augustine, Alyssa Collins, Adam B Lewin, Tanya K Murphy, Jonathan W Mink, Jennifer Vermilion","doi":"10.1212/CPJ.0000000000200369","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200369","url":null,"abstract":"<p><strong>Background and objectives: </strong>Tourette syndrome (TS) is defined by multiple motor tics and one or more phonic tics with a symptom duration of >1 year. Coprophenomena are uncommon tics characterized by obscene sounds, words, or gestures. Youth with TS commonly have psychiatric co-occurring conditions such as attention-deficit hyperactivity disorder or obsessive-compulsive disorder and have reported lower scores on measures of individual and family functioning than youth without TS. This study aimed to determine associations among co-occurring condition symptoms, tic severity, and function in youth with TS and coprophenomena compared with those with TS without coprophenomena.</p><p><strong>Methods: </strong>Data were collected through a multicenter, cross-sectional study. Youth with TS were recruited from 2 referral centers, and data were collected from youth and their parents or caregivers. Tic severity was assessed using the Yale Global Tic Severity Scale, and individual function was measured with the Children's Global Assessment Scale. Family impact was measured using the Family Impact Module in domains of parent health-related quality of life (HRQOL), family functioning, and total family impact. We compared individual and family function in youth with TS with coprophenomena (TS+copro) and without coprophenomena (TS-copro). Wilcoxon rank-sum tests were used to compare scores on individual function and family function measures.</p><p><strong>Results: </strong>Of 169 participants, 17 (10.1%) reported coprophenomena. Participants with TS and coprophenomena had higher tic severity scores than those without coprophenomena (TS+copro mean = 36.9, TS-copro = 20.8). Youth with coprophenomena had lower scores for global function (TS+copro median = 51, TS-copro = 60), family functioning (TS+copro = 43.8, TS-copro = 59.4), parent HRQOL (TS+copro = 57, TS-copro = 72), and total family QOL (TS+copro = 50.7, TS-copro = 65.3).</p><p><strong>Discussion: </strong>Youth with TS and coprophenomena had lower individual function, family function, and parent HRQOL than youth without coprophenomena. Coprophenomena presence may indicate that youth have a more severe phenotype of TS, and youth with copropheneomena may benefit from additional caregiver or family supports.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200369"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Movement Disorders and Deep Brain Stimulation: A Review.","authors":"Alexandra Boogers, Alfonso Fasano","doi":"10.1212/CPJ.0000000000200367","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200367","url":null,"abstract":"<p><strong>Purpose of the review: </strong>The aim of this narrative review was to explore the interplay between functional movement disorders (FMDs) and deep brain stimulation (DBS).</p><p><strong>Recent findings: </strong>Patients with unrecognized FMD who are referred for DBS usually present with functional dystonia. By contrast, patients who present with FMD after DBS are mostly presenting with functional tremor, in keeping with non-DBS FMD cohorts. Comorbid presentation of FMD in established DBS indications makes the decision to opt for surgery challenging. Many contributing factors can play a role in the development of FMD, including the trauma caused by awake neurosurgery and/or extensive DBS programming.</p><p><strong>Summary: </strong>FMDs in the context of DBS are often overlooked and should be diagnosed promptly because they determine surgical outcome. The approach to DBS candidates with comorbid FMD and the risk factors of FMD after DBS should be further explored.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200367"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Post-Neurointensive Care Recovery Clinic: Design, Utilization, and Clinician Perspectives.","authors":"Julia M Carlson, Galina Gheihman, Kristi Emerson, Haitham S Alabsi, W Taylor Kimberly, Michael J Young, David J Lin","doi":"10.1212/CPJ.0000000000200364","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200364","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite increasing interest in post-intensive care unit (ICU) clinical care and management, there have been limited descriptions focused on the post-neurologic (neuro)-ICU population. Here, we describe the design of a post-neuro-ICU Neurorecovery Clinic (NRC) and present data collected regarding the clinic's population, referrals, visits, and clinician satisfaction.</p><p><strong>Methods: </strong>This is a single-institution experience with a NRC designed to provide an infrastructure for post-ICU care to patients recovering from acute neurologic disorders or systemic conditions with neurologic sequelae. The clinic offers 2 visit types with different frequencies: a weekly visit and a monthly multidisciplinary visit. This study assessed clinical utilization and clinician perspectives regarding the clinic. Data on clinic referrals, no-show frequency, visit types, and diagnoses for both weekly and monthly visits were collected. A survey was conducted to assess clinician satisfaction and perspectives. Qualitative thematic analysis was performed to identify major themes among survey free responses.</p><p><strong>Results: </strong>In a 2-year period, 225 patients were referred from the Massachusetts General Hospital neuro-ICU to the NRC. Of those, 105 (47%) were seen in clinic for at least one visit. The most common reasons for loss to follow-up were no shows (38%) and noncontracted insurance (21%). Twenty percent of visits were in-person (the rest were by telehealth). Forty-eight percent were new patients compared with return visits. The most common diagnoses were other (36%), ischemic stroke (26%), and traumatic brain injury (17%). An additional monthly multidisciplinary clinic has seen 14 patients with one no show. Clinicians found their experience in the NRC valuable. Identified benefits included interdisciplinary collaboration, being a more well-rounded and better clinician, improving effectiveness in managing post-ICU problems, and influencing ICU prognosis. Clinicians' greatest challenge was navigating resource limitations for patients.</p><p><strong>Discussion: </strong>A postneuro-ICU NRC is a feasible model of care delivery for patients after severe acute neurologic disorders. Patients with a broad variety of diagnoses were seen in a 2-year period. Providers valued their clinic time and experiences. Future studies should evaluate whether this model of care improves patients' postneuro-ICU outcomes.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200364"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The New Frontier of Adult Neurodevelopmental Care: Individual and Caregiver Values.","authors":"Jessica S Sanders, Ashley Dafoe, Chloe Glaros, Brooke Dorsey Holliman","doi":"10.1212/CPJ.0000000000200384","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200384","url":null,"abstract":"<p><strong>Background and objectives: </strong>There are few specialists that serve adults with neurodevelopmental disabilities (NDD), and most adults with NDD receive care from providers without specialty training in NDD. Care for this population is highly variable, and patient and caregiver priorities in this age group are not well known. We aimed to explore individual and caregiver values around adult neurodevelopmental care.</p><p><strong>Methods: </strong>In this qualitative study, a qualitative analyst conducted 22 semistructured virtual interviews from September 2021 to February 2022 with randomly selected adults with NDD and/or their caregivers. Each individual with NDD had at least one appointment in the adult NDD clinic, which started in October 2020. Interviews were recorded and professionally transcribed. An inductive codebook was developed and reconciled through an iterative process; transcripts were coded in Atlas.ti with 20% double-coding. Major themes were developed through team discussion.</p><p><strong>Results: </strong>Most interviewees were caregivers of patients with NDD (12); 9 interviews were with patient/caregiver dyads; 1 interview was with a patient alone. Three main themes emerged from the interviews. (1) Value in providers who are curious, engaged, and knowledgeable about NDD-related conditions, which individuals and caregivers referred to as \"Unicorn Providers.\" (2) Value in a connected and coordinated web of care. (3) Value in comfortable and adaptable clinic spaces. They value clinical environments that foster patient success during visits.</p><p><strong>Discussion: </strong>The need for adult neurodevelopmental care is growing as more individuals with NDD are living into adulthood. Better understanding of patient and caregiver values can help shape this emerging field to meet the needs of this unique, often overlooked and underserved, population.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200384"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Design and Write Your Quality Improvement Study for Publication: Pearls and Pitfalls.","authors":"Anup D Patel, Laurice Yang, Kathryn Kvam, Christine Baca, Lyell K Jones","doi":"10.1212/CPJ.0000000000200419","DOIUrl":"10.1212/CPJ.0000000000200419","url":null,"abstract":"<p><strong>Objective: </strong>To describe a pragmatic process for translating quality improvement (QI) projects into published manuscripts.</p><p><strong>Scope: </strong>Types of QI work that are generalizable and have broad relevance (to journals and readers), design principles that are important for publishable QI work, how QI manuscript organization might differ from biomedical manuscripts, how to use and not to use Standards for Quality Improvement Reporting Excellence and other guidelines, pitfalls, and how to avoid/repair them.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200419"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Cavum Septum Pellucidum in Former American Football Players: Findings From the DIAGNOSE CTE Research Project.","authors":"","doi":"10.1212/CPJ.0000000000200414","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200414","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/CPJ.0000000000200324.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200414"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referral to a Functional Seizures Clinic Reduces Inpatient and Emergency Department Health Care Utilization and Costs.","authors":"Meagan R Bean, Meagan M Watson, Mackenzi L Moore, Laura A Strom","doi":"10.1212/CPJ.0000000000200393","DOIUrl":"10.1212/CPJ.0000000000200393","url":null,"abstract":"<p><strong>Background and objectives: </strong>People with functional seizures (FSs) experience high health care utilization and costs revolving around the emergency department (ED). Overall, appropriate treatment of FS is underused, and better care pathways are associated with lower ED reattendance. Our objective was to assess changes in total ED and inpatient visits and costs before and after referral to a specialized, comprehensive FS treatment clinic.</p><p><strong>Methods: </strong>We collected data from 100 consecutive patients referred to the University of Colorado (CU) FS Clinic between July 2019 and December 2021. Hospital account data were obtained directly from the electronic health record. Total ED and inpatient visits, charges, and payments 1 year before and 1 year after referral were collected and analyzed using the Wilcoxon signed-rank test.</p><p><strong>Results: </strong>Ninety-four patients were included for analysis. 79% were female, 52% were on Medicaid, and the mean age was 41 (SD 13) years. Total visits after referral (ED and inpatient) were significantly reduced compared with total visits before referral (mean = 1.44 (SD 3.52) vs 1.83 (SD 3.52), <i>p</i> = 0.045). The same test was performed for total charges after and before referral ($15,551 (SD $38,712) vs $30,257 (SD $81,589), <i>p</i> = 0.03) and for total payments after and before referral ($2,469 (SD $6,682) vs $5,199 (SD $15,084), <i>p</i> = 0.02).</p><p><strong>Discussion: </strong>Referral to a specialized FS clinic is associated with reduced health care utilization and costs. This proof-of-concept study reveals that hospitals should implement policies to support efficient care pathways to comprehensive FS treatment programs with potential for cost savings.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200393"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Epilepsy Following a First Posttraumatic Seizure: A Register-Based Study.","authors":"Markus Karlander, Samuel Håkansson, Johan Ljungqvist, Ann Sörbo, Johan Zelano","doi":"10.1212/CPJ.0000000000200409","DOIUrl":"10.1212/CPJ.0000000000200409","url":null,"abstract":"<p><strong>Background and objectives: </strong>Traumatic brain injury (TBI) is a common cause of epilepsy, and the risk increases with injury severity. Whether a first posttraumatic seizure (PTS) represents epilepsy is a common clinical problem, but often unknown. Prognostication is important for providing correct patient information and consideration of antiseizure medication. Our objective was to understand how trauma severity and latency from the injury affect the risk of epilepsy after a first PTS.</p><p><strong>Methods: </strong>The register-based cohort study including all individuals hospitalized following a TBI in Sweden 2000-2010, in addition to 3 age-matched and sex-matched controls per case. We analyzed the 10-year probability of epilepsy following a first seizure using the Kaplan-Meier estimator.</p><p><strong>Results: </strong>The risk of an epilepsy diagnosis was 41.1% (95% CI 38.6-43.7) following a PTS, higher than the risk of 33.4% (95% CI 30.3-36.5) in those without prior TBI. The risk increased with injury severity, with the highest risk following focal cerebral injuries, 62.3% (95% CI 53.7-70.9). Mild injuries and skull fractures showed a similar risk to the group without previous TBI. In addition, the risk was higher if the seizure occurred <2 years following the trauma.</p><p><strong>Discussion: </strong>Severity of the injury and latency are major modulators of epilepsy risk following a first PTS. The risk was high in the most severe types of TBI, but a substantial proportion did not develop epilepsy, highlighting the need for further research on prognostication and biomarkers, as well as caution in diagnosing epilepsy based on a first PTS.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200409"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticobasal Syndrome: Are There Central or Peripheral Triggers?","authors":"Abhishek Lenka, Joseph Jankovic","doi":"10.1212/CPJ.0000000000200365","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200365","url":null,"abstract":"<p><strong>Background and objectives: </strong>Corticobasal syndrome (CBS) is a complex of symptoms and signs comprising limb rigidity, bradykinesia, dystonia, myoclonus, apraxia, cortical sensory loss, and a variety of cognitive and language impairments. CBS is commonly seen in tauopathies. Striking asymmetry in clinical and imaging findings in CBS raises questions about potential triggers initiating neurodegeneration. The objective of this study was to investigate potential central or peripheral triggers preceding CBS symptoms.</p><p><strong>Methods: </strong>In this retrospective observational study, we reviewed medical records of patients with CBS at our Parkinson's Disease Center and Movement Disorders Clinic, focusing on evidence of possible central or peripheral \"trigger\" occurring within a year before the onset of CBS. We also reviewed records of patients with Parkinson disease (PD) for comparison.</p><p><strong>Results: </strong>Of the 72 patients with CBS, 15 (20.8%) reported potential focal triggers before the onset of CBS-related neurologic symptoms. By contrast, only 1 of 72 patients with PD (1.4%) had a documented trigger before the onset of PD-related symptoms (<i>p</i> < 0.001). Of potential triggers, 13 were peripheral (related to hand or shoulder surgeries or trauma) and 2 were central (stroke and head trauma). Patients with CBS with triggers were younger, had earlier symptom onset, comprised a higher proportion of men, and had a higher likelihood of limb onset of symptoms than those without.</p><p><strong>Discussion: </strong>Our finding of relatively high frequency of focal triggers in CBS compared with PD suggests potential central or peripheral triggers initiating neurodegeneration, possibly explaining asymmetric clinical and imaging features in CBS. Further research is necessary to validate and explore this observation's implications for CBS pathogenesis.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200365"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}