Obstetrics and gynecology最新文献

{"title":"Blood Pressure in Pregnancy and Hypertension 10-14 Years After Delivery.","authors":"Kartik K Venkatesh, William A Grobman, Jiqiang Wu, Maged M Costantine, Mark B Landon, Denise Scholtens, William Lowe, Nilay S Shah, Natalie A Cameron, Sadiya S Khan","doi":"10.1097/AOG.0000000000005803","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005803","url":null,"abstract":"<p><p>We examined the association between blood pressure (BP) in the early third trimester and hypertension 10-14 years after delivery per American College of Cardiology and American Heart Association recommendations. We conducted a secondary analysis using the prospective HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study) in patients without a chronic hypertension diagnosis. The exposure and outcome were systolic and diastolic BP measured in the early third trimester and 10-14 years after delivery, respectively. Among 4,697 participants in the HAPO FUS, at 10-14 years after delivery (median age 41.6 years), 8.3% had elevated BP, 14.1% had stage 1 hypertension, and 6.1% had stage 2 hypertension. Compared with normal BP, elevated BP in the early third trimester was associated with an increased risk of stage 1 hypertension (adjusted odds ratio [aOR] 2.76; 95% CI, 1.91-4.00) and stage 2 hypertension (aOR 3.76; 95% CI, 2.28-6.19). Stage 1 hypertension was associated with an increased risk of stage 2 hypertension (aOR 6.16; 4.24, 8.94). Pregnant individuals with high BP in the third trimester were at increased risk of developing hypertension 10-14 years after delivery.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Area Poverty and Adverse Birth Outcomes: An Opportunity for Quality Improvement.","authors":"Nigel Madden, Samanvi Kanugula, Lynn M Yee, Kelsey Rydland, Joe Feinglass","doi":"10.1097/AOG.0000000000005809","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005809","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between area poverty and adverse birth outcomes in the diverse birthing population of a large health system.</p><p><strong>Methods: </strong>This was a retrospective cohort study using electronic health record and hospital administrative data for pregnant people at nine hospitals within a large health system in the Chicago metropolitan area from 2018 to 2023. Patient addresses were geocoded and categorized by Census tract area percent poor households. Unadjusted and adjusted Poisson regression models, controlling for individual-level risk factors, evaluated the independent association between area poverty and birth outcomes to determine the degree to which this association is attenuated by the inclusion of individual-level factors in the model.</p><p><strong>Results: </strong>The study included 85,025 pregnant people. Area poverty was associated with sociodemographic factors, including young age, non-Hispanic Black race, Hispanic ethnicity, Medicaid insurance coverage, higher parity, and several comorbid conditions. Area poverty was associated with adverse birth outcomes and demonstrated a gradient effect with increasing area poverty in bivariable analyses. In unadjusted regression analyses, residence in areas with 5.0% or more poverty was associated with severe maternal morbidity, preterm birth, and low birth weight, and residence in areas with 8.0% or higher poverty was associated with neonatal intensive care unit admission. Although these associations persisted in multivariable analysis for severe maternal morbidity and neonatal intensive care unit admission, the associations with preterm birth and low birth weight persisted only for individuals residing in areas of 12.0% or higher poverty when controlling for individual-level risk factors.</p><p><strong>Conclusion: </strong>Area poverty was associated with adverse birth outcomes in this birthing population even when controlling for individual-level risk factors, highlighting the need for system- and community-level quality-improvement interventions.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Utilization After Immediate Compared With Delayed Postpartum Intrauterine Device Placement.","authors":"Talis M Swisher, Amy Alabaster, Margaret C Howe","doi":"10.1097/AOG.0000000000005807","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005807","url":null,"abstract":"<p><strong>Objective: </strong>To investigate differences in health care utilization between immediate (within 10 minutes of placental delivery) and delayed (after 24 hours) intrauterine device (IUD) placement.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted with data from Kaiser Permanente Northern California from 2017 to 2019 and included patients with an IUD placed between 0 and 63 days postpartum. The primary outcome for health care utilization was the number of obstetrician-gynecologist (ob-gyn) or women's health office visits within 1 year. Secondary outcomes included formal imaging studies, surgical intervention, and hospitalizations related to IUD complications within 1 year. An additional secondary outcome was live births at 120 days and 1 year.</p><p><strong>Results: </strong>Among 1,543 immediate and 10,332 delayed postpartum IUD placements, the number of visits to an ob-gyn or women's health office within 1 year was slightly increased with delayed placement (mean 2.30 vs 2.47, P<.001). Imaging was increased in the immediate compared with the delayed group (10.5% vs 4.1%, P<.001). Laparoscopy was decreased in the immediate compared with the delayed group (0.0% vs 0.4%, P=.005), with no significant difference in hysteroscopy (0.2% vs 0.1%, P=.413). Hospitalizations were rare and increased in the immediate group (0.4% vs 0.02%, P<.001). Lastly, there was no difference in repeat pregnancies between groups at 120 days (both 0.2%) or at 1 year (2.9% vs 2.5%, P=.342).</p><p><strong>Conclusion: </strong>Compared with delayed placement, immediate postpartum IUD placement is not associated with increased office visits. Immediate placement is associated with an increase in imaging but a decrease in laparoscopic surgery to manage IUD-related complications. There was no difference in live birth rates at 6 months or 1 year between groups.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity of a Classification System for the Levels of Maternal Care.","authors":"Jennifer Vanderlaan, Jay Shen, Ian K McDonough","doi":"10.1097/AOG.0000000000005806","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005806","url":null,"abstract":"<p><strong>Objective: </strong>To assess the content validity of the classification of maternal level of care of the American Hospital Association Database for research use.</p><p><strong>Methods: </strong>This was a secondary data analysis where we classified the maternal level of care in the 2018 American Hospital Association Database and linked this to birth hospitalizations from five states in the 2016 and 2017 State Inpatient Databases: Delaware, Florida, Kentucky, Maryland, and Washington. We compared maternal level of care classification with birth volume quartiles, hospital size quartiles, and teaching status to predict the birth hospital for women with high OCI (Obstetric Comorbidity Index) scores and hospital-to-hospital transfers. We calculated the odds of birth at the highest-level hospital, controlling for maternal race, rural residence, primary payer, and state.</p><p><strong>Results: </strong>People with high OCI scores and hospital-to-hospital transfer had increased odds of birth at hospitals classified as maternal level III or IV, large hospitals, and teaching hospitals. The probability of birth at the highest-level hospital for people with high OCI scores was increased 4.9% for a level III or IV hospital, 2.6% for a large hospital, and 1.2% for a teaching hospital. The probability of birth at the highest-level hospital for people with hospital transfer was increased 5.2% for a level III or IV hospital, 1.4% for a large hospital, and 14.4% for a teaching hospital.</p><p><strong>Conclusion: </strong>Researchers can classify the maternal level of care using the American Hospital Association Database to study maternal risk-appropriate care.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acetaminophen in Pregnancy and Attention-Deficit and Hyperactivity Disorder and Autistic Spectrum Disorder.","authors":"Per Damkier, Erika B Gram, Michael Ceulemans, Alice Panchaud, Brian Cleary, Christina Chambers, Corinna Weber-Schoendorfer, Debra Kennedy, Ken Hodson, Kimberly S Grant, Orna Diav-Citrin, Sarah G Običan, Svetlana Shechtman, Sura Alwan","doi":"10.1097/AOG.0000000000005802","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005802","url":null,"abstract":"<p><p>Acetaminophen is a common over-the-counter medication that recently gained substantial media attention regarding its use by pregnant individuals. In this clinical perspective, we discuss the strengths and limitations of the published literature on the effect of maternal acetaminophen use in pregnancy on the child's risk of developing attention-deficit and hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). Studies included were specifically selected on the basis of the quality and validity of ADHD or ASD outcome definitions. From a total of 56 identified studies, commentaries, and editorials of relevance, we critically reviewed nine studies with original data that satisfied our inclusion criteria and three meta-analyses. Most studies that have reported positive findings are difficult to interpret because they have important biases, notably a high degree of selection bias, variability in selection and adjustment for various potential confounders, and unmeasured familial confounding. When unobserved familial confounding through sibling analysis was controlled for, associations weakened substantially. This suggests that residual confounding from shared genetic and environmental factors may have caused an upward bias in the original observations. According to the current scientific evidence, in utero exposure to acetaminophen is unlikely to confer a clinically important increased risk of childhood ADHD or ASD. The current level of evidence does not warrant changes to clinical guidelines on the treatment of fever or pain in pregnancy. Prospective research designed to account for familial and psychosocial environmental factors related to both maternal use of acetaminophen and children's neurodevelopment should be undertaken.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online Screening and Virtual Patient Education for Hereditary Cancer Risk Assessment and Testing.","authors":"Richard N Waldman, Mark S DeFrancesco, John P Feltz, Daniel S Welling, Wade A Neiman, Melissa M Pearlstone, Christine A Marraccini, Dana Karanik, Elaine Mielcarski, Logan Schneider, Lauren Lenz, Edith C Smith, Katherine Johansen Taber, Royce T Adkins","doi":"10.1097/AOG.0000000000005799","DOIUrl":"10.1097/AOG.0000000000005799","url":null,"abstract":"<p><strong>Objective: </strong>To use online screening and virtual patient education tools to improve the provision of hereditary cancer risk assessment.</p><p><strong>Methods: </strong>We conducted a prospective, single-arm study in which clinicians at five U.S. community obstetrics and gynecology practices underwent an 8-week observation followed by 3-4 weeks of training on online patient screening and virtual patient education (prerecorded video with or without a genetic counselor phone call) for genetic testing-eligible patients. After a 4-week practice period, hereditary cancer risk assessment and patient education metrics were collected at 8 weeks and compared with preintervention metrics using univariate conditional logistic regression models stratified by site. The primary outcome was the change in genetic testing completion rate. Clinicians and patients were invited to complete a satisfaction survey.</p><p><strong>Results: </strong>A total of 5,795 and 5,135 patients were seen before and after the intervention, respectively. The proportion of screened patients meeting testing guidelines increased from 21.6% before the intervention to 28.2% after the intervention (odds ratio [OR] 1.36, 95% CI, 1.26-1.47, P<.001). Guideline-eligible patients were significantly more likely to be offered genetic testing (59.1% vs 89.1%, OR 2.06, 95% CI, 1.87-2.27, P<.001), to submit a sample (32.9% vs 45.0%, OR 1.49, 95% CI, 1.27-1.74, P<.001), and to complete testing (16.0% vs 34.2%, OR 2.38, 95% CI, 2.00-2.83, P<.001). Most clinicians agreed or strongly agreed that the screening tool improved the identification of patients meeting hereditary cancer risk assessment guidelines (92.1%), saved time (64.9%), and was easy to incorporate (68.4%) and that patient education improved their ability to deliver hereditary cancer risk assessment standard of care (84.2%). Most patients agreed or strongly agreed that virtual education helped them understand the purpose (91.7%) and implications (92.6%) of genetic testing.</p><p><strong>Conclusion: </strong>A guideline-based online patient screening tool and virtual patient education were well received. The online tool enabled identification of significantly more guideline-eligible candidates for hereditary cancer risk assessment, and education improved patients' genetic literacy. Together, these tools ultimately improved the genetic testing completion rate.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Maryland Infertility Mandates: Firsts Across the Board.","authors":"Eli Y Adashi, Howard Haft","doi":"10.1097/AOG.0000000000005789","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005789","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Early Pregnancy Loss With Mifepristone and Misoprostol Compared With Misoprostol Only.","authors":"Matan Friedman, Liat Mor, Rotem Shazar, Natalie Paul, Ram Kerner, Ran Keidar, Ron Sagiv, Ohad Gluck","doi":"10.1097/AOG.0000000000005800","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005800","url":null,"abstract":"<p><strong>Objective: </strong>To compare the rates of treatment failure in cases of early pregnancy loss between mifepristone-misoprostol and misoprostol only.</p><p><strong>Methods: </strong>This retrospective cohort study included patients who received medical treatment for early pregnancy loss between 2016 and 2023 at a single medical center. Patients returned for a follow-up ultrasonogram after 1 week and were treated again with misoprostol if needed. Finally, they were instructed to obtain an ultrasonogram after menstruation and to return for evaluation in case retained product of conception was suspected. We defined treatment failure as needing any surgical intervention because of retained product of conception, including cases when retained product of conception was diagnosed and treated after menstruation. In May 2022, we changed our protocol for treating early pregnancy loss from misoprostol to mifepristone and misoprostol. We compared the failure rate between patients who received mifepristone-misoprostol and those treated with misoprostol only.</p><p><strong>Results: </strong>A total of 999 patients were included: 224 in the mifepristone-misoprostol group and 775 in the misoprostol-only group. The rate of treatment failure was significantly lower in the mifepristone-misoprostol group compared with the misoprostol-only group (17.8% vs 25.1%, P=.002). After multivariant analysis was performed, the use of mifepristone and misoprostol was associated with a reduction of 34% in the odds ratio for treatment failure compared with misoprostol alone (adjusted odds ratio 0.661, 95% CI, 0.44-0.97, P=.038). In addition, prior vaginal delivery was associated with a lower risk for treatment failure, and increasing gestational age (according to ultrasonogram) was correlated with a higher risk for treatment failure.</p><p><strong>Conclusion: </strong>The addition of mifepristone to misoprostol was associated with a significantly lower rate of treatment failure, including late surgical intervention for early pregnancy loss, compared with misoprostol alone.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the Menopause Health Needs of Military Service Members: A Call to Action.","authors":"Jill Brown, Katerina Shvartsman, Jezreelyn Bulaklak, Catherine Witkop, Monica Lutgendorf","doi":"10.1097/AOG.0000000000005801","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005801","url":null,"abstract":"<p><p>The menopause transition represents a significant life phase for people assigned female at birth marked by various physical and psychological changes. For military service members and veterans, this transition can be even more complex because of unique factors related to military service. A tradition of excluding women from service before reaching the age of the menopause transition has left the Military Health System unprepared to address the specific health needs of this population. The lack of attention to menopause needs of military service members is evidenced by the absence of menopause-related research in the active-duty population and a dearth of menopause-specific research in the veteran population. White House Executive Order 14120 on Advancing Women's Health Research and Innovation has highlighted the urgent need for focused research and improved health care delivery tailored to the menopause needs of military individuals and veterans. By addressing these gaps, we can better support the health and well-being of military service members in the menopause transition, ultimately improving operational readiness and retention. Because military service members and veterans often rely on the private sector for health care, it is incumbent on all health care professionals and systems to consider their unique health care needs related to midlife and menopause.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining Ultrasonography and Endometrial Aspiration as a One-Stop Screening for Endometrial Neoplasia.","authors":"Ohad Rotenberg, Georgios Doulaveris, Gary L Goldberg, Malte Renz, Kathleen Whitney, Leeann Dar, Noam Rotenberg, Haotian Wu, Thierry Van den Bosch, Pe'er Dar","doi":"10.1097/AOG.0000000000005752","DOIUrl":"10.1097/AOG.0000000000005752","url":null,"abstract":"<p><strong>Objective: </strong>To assess the performance of simultaneous endometrial aspiration and sonohysterography to screen for endometrial cancer or hyperplasia in women aged 50 years or older.</p><p><strong>Methods: </strong>We conducted a prospective study from February 2014 to October 2020 at the ultrasound unit of a large urban academic medical center. The study included 1,635 women aged 50 years or older referred for endometrial evaluation, with follow-up through January 2021. Participants underwent saline infusion sonohysterography combined with ultrasound-guided endometrial aspiration. The primary outcome measured was a diagnosis of endometrial cancer or hyperplasia within 1 year from screening. The diagnostic accuracy of the combined evaluation method, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), was assessed.</p><p><strong>Results: </strong>Of 1,170 women who completed the study protocol, 82 (7.0%) had endometrial cancer and 42 (3.6%) had endometrial hyperplasia. Of all patients who developed cancer during the follow-up period, 85.5% were diagnosed within 1 year after evaluation. The application of simultaneous endometrial aspiration and sonohysterography together demonstrated a sensitivity of 99.1%, specificity of 24.9%, PPV of 11.8%, and NPV of 99.6%. Using a theoretical sequential approach, assuming an endometrial aspiration is performed only in patients determined to be high risk by sonohysterography, demonstrated a sensitivity of 93.4%, specificity of 99.9%, PPV of 99.0%, and NPV of 99.3%.</p><p><strong>Conclusion: </strong>Simultaneous endometrial aspiration and sonohysterography is an effective one-stop outpatient screening tool for detecting endometrial cancer and hyperplasia in women aged 50 years or older. With the integration of two screening modalities into a single procedure, simultaneous endometrial aspiration and sonohysterography may overcome the limitations inherent in each of the currently recommended methods individually, potentially improving patient prognosis and streamlining the diagnostic process.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"801-809"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}