Otology & Neurotology最新文献

{"title":"Learning Curve and Evaluation of Robotic Assistance for Cochlear Implant Electrode Insertion.","authors":"Sarah Draut, Linda Ask, Veronika Volgger, Florian Schrötzlmair, John-Martin Hempel, Joachim Müller, Clemens Stihl","doi":"10.1097/MAO.0000000000005035","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005035","url":null,"abstract":"<p><strong>Objective: </strong>Robotic assistance has been introduced to improve precision and reduce intracochlear trauma during cochlear implant electrode insertion. This study evaluates the learning curve associated with robotic assistance systems and assesses objective and subjective performance metrics during early clinical implementation.</p><p><strong>Study design: </strong>Prospective observational cohort study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Participants: </strong>Three surgeons with varying levels of experience performing robotic-assisted cochlear implantation.</p><p><strong>Interventions: </strong>Robotic-assisted cochlear implant electrode insertion after a structured training program.</p><p><strong>Main outcome measures: </strong>Robot usage time, preparation time, insertion time, total operation time, and intraoperative workload assessed using the SURG-TLX questionnaire. Learning curves were evaluated using sequential group comparisons, CUSUM analysis, and nonlinear exponential decay modelling. Model fit was compared with linear alternatives.</p><p><strong>Results: </strong>Sixty consecutive robotic-assisted insertions were analyzed. Robot usage time decreased from 19.1 minutes (cases 1-20) to 15.0 minutes (cases 41-60) (P=0.020). Preparation time decreased from 12.5 to 9.2 minutes (P=0.012), with the largest improvement in the first 20 cases. Exponential decay modeling demonstrated a nonlinear learning pattern with an estimated asymptotic robot usage time of 16.3 minutes (τ=1.65 procedures), outperforming linear regression based on AIC/BIC model comparison. Insertion time and total operation time did not differ significantly between groups. CUSUM analysis suggested group-level stabilization of robot usage time within 20-30 cases. SURG-TLX showed a significant reduction in situational stress between cases 21-40 and 41-60 (P=0.031).</p><p><strong>Conclusion: </strong>Robot-assisted cochlear implant electrode insertion shows a distinct learning curve primarily driven by adjustment in robotic setup and handling. Procedural efficiency improves rapidly, with early stabilization at the individual level and later stabilization at the aggregated level over all surgeons. Structured training and protocolized workflow support safe clinical adoption.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Downbeat Nystagmus Induced by Neck Extension in Chiari I Malformation.","authors":"Leonardo Ariello, David Patric Werner Rastall","doi":"10.1097/MAO.0000000000005061","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005061","url":null,"abstract":"<p><strong>Objective: </strong>To describe a cervical extension-triggered form of positional downbeat nystagmus (DBN) associated with Chiari I malformation (CMI).</p><p><strong>Patient: </strong>A 44-year-old woman with recurrent episodic vertigo reproducibly triggered by neck extension.</p><p><strong>Interventions: </strong>Bedside ocular motor examination, positional testing, video-oculography, and brain magnetic resonance imaging (MRI).</p><p><strong>Main outcome measures: </strong>Characterization of positional nystagmus and identification of its provoking mechanism.</p><p><strong>Results: </strong>Conventional positional maneuvers alone failed to provoke symptoms or nystagmus. Reproducible positional DBN was observed only when additional cervical extension was superimposed during positional maneuvers. The patient could also reliably trigger symptoms and DBN through active neck extension while seated. Brain MRI demonstrated cerebellar tonsillar herniation consistent with CMI.</p><p><strong>Conclusions: </strong>Positional DBN triggered by cervical extension should prompt consideration not only of central positional nystagmus, but also of the underlying mechanism responsible for the central phenotype. In this patient, the highly stereotyped dependence on neck extension suggested a dynamic compression-related mechanism at the craniocervical junction rather than a gravity-dependent central vestibular disorder.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Patterns of Spontaneous New Encephaloceles Following Initial Lateral Skull Base Repair.","authors":"Kevin Wong, Keshav V Shah, Kim Le, Christina Jackson, John Y Lee, Tiffany P Hwa, Douglas C Bigelow, Michael J Ruckenstein","doi":"10.1097/MAO.0000000000005052","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005052","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors and developmental patterns for new spontaneous encephaloceles following an initial repair.</p><p><strong>Study design: </strong>Retrospective.</p><p><strong>Setting: </strong>Tertiary academic medical center.</p><p><strong>Patients: </strong>Consecutive patients with spontaneous encephaloceles treated at the University of Pennsylvania Health System between October 2012 and October 2024.</p><p><strong>Main outcome measures: </strong>Risk factors for, median time to, and location of new, spontaneous CSF leaks following a prior repair.</p><p><strong>Results: </strong>One hundred seventy-six adults met inclusion criteria. Mean age was 56.8 years (SD: 12.4 y), average BMI was 35.2 kg/m2 (SD: 8.5 kg/m2), and 110 (62.5%) patients were females. Thirty-two (18%) patients developed new encephaloceles after initial repair, with a median time to recurrence of 1.6 years (IQR: 0.3, 2.9). Of these newly developed skull base encephaloceles, 22 (69%) were ipsilateral, 7 (22%) were anterior, and 3 (9%) were contralateral.</p><p><strong>Conclusions: </strong>Wide exposure and repair of the entire skull base is recommended in patients undergoing lateral encephalocele repair. The existence of new, spontaneous encephaloceles at sites distant from the original repair warrants further investigation into additional physiological risk factors.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Value of Electrocochleography and Gadolinium-Enhanced Inner Ear MRI for Patients With Meniere Disease.","authors":"Wenbin Wang, Fei Zhao, Yafeng Lv, Shuo Liang, Na Hu, Xugang Zhuang, Shanshan Tian, Mingyue Li, Zhaomin Fan, Haibo Wang, Yu Ai","doi":"10.1097/MAO.0000000000005049","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005049","url":null,"abstract":"<p><strong>Objective: </strong>To compare the diagnostic performance of electrocochleography (EcochG) and gadolinium-enhanced inner ear MRI in patients with definite and probable Menière disease (MD) and to evaluate their clinical applicability.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>A total of 694 patients with MD (765 ears) were included. Ears were categorized into the definite group (704 ears), the probable group (61 ears), and the non-MD group (asymptomatic contralateral ears, 574 ears). In addition, 100 normal ears served as the control group.</p><p><strong>Interventions: </strong>Extratympanic EcochG recordings and gadolinium-enhanced inner ear MRI.</p><p><strong>Main outcome measures: </strong>Diagnostic accuracy of EcochG parameters (amplitude ratio, area1 ratio, area2 ratio) and gadolinium-enhanced MRI, evaluated using receiver operating characteristic analysis.</p><p><strong>Results: </strong>MRI demonstrated the highest diagnostic accuracy in distinguishing the definite group from the non-MD group (sensitivity 79%, specificity 99%). In contrast, EcochG parameters, particularly the area2 ratio, showed superior performance in differentiating the probable group from the non-MD group, with significantly higher area under the curve values than MRI (P<0.05). A stepwise gradient was observed across groups for both MRI and EcochG parameters. However, area ratios did not significantly differ between the definite group and the probable group. There were weak correlations between MRI findings and EcochG parameters.</p><p><strong>Conclusions: </strong>MRI exhibits high diagnostic value and reflects structural disease burden in definite MD, but its sensitivity in early-stage or probable MD remains limited. Area ratio-based EcochG, especially the area2 ratio, appears more sensitive to early functional alterations associated with endolymphatic hydrops. EcochG might serve as a valuable complementary tool for early detection, whereas MRI remains essential for assessing structural involvement.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Theodore Hieronymus Bast (1890-1959): His Contributions to Ear Anatomy.","authors":"Hadice Uçar, Mert Çetin, Orhan Beger, R Shane Tubbs","doi":"10.1097/MAO.0000000000005071","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005071","url":null,"abstract":"<p><strong>Objective: </strong>To review the life, scientific achievements, and enduring contributions of Theodore Hieronymus Bast (1890-1959) to ear anatomy, embryology, and otology.</p><p><strong>Study design: </strong>Historical review.</p><p><strong>Methods: </strong>Published scientific articles related to Theodore H. Bast's academic career and anatomic investigations of the inner ear were reviewed.</p><p><strong>Results: </strong>Advances in otological anatomy have deepened understanding of the intricate structures of the inner ear and their physiological functions. Theodore H. Bast made significant contributions to this area through his studies of the labyrinth's microscopic structure, the neural organization of the vestibular system, and the developmental anatomy of the temporal bone. In particular, his description of the utriculo-endolymphatic valve (Bast's valve) provided important insights into the regulation of endolymph dynamics and inner ear pressure balance. Through his extensive anatomic studies, Bast helped inform subsequent research on vestibular physiology and related disorders.</p><p><strong>Conclusion: </strong>Theodore H. Bast was an anatomist who made significant contributions to otology. Through his investigations of the inner ear, temporal bone, and vestibular system, he helped advance knowledge in both embryologic and clinical otology.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative Technique to Improve Visibility and Success With Robotic-Assisted Cochlear Implantation.","authors":"Elena Quinonez Del Cid, Nicholas J Thompson","doi":"10.1097/MAO.0000000000005067","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005067","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring Hearing Function in Patients With Sporadic Vestibular Schwannoma: A Feasibility Study to Inform a Future Randomized Controlled Trial.","authors":"Daniel Lewis, Rebecca E Millman, Helen Whiston, Cathal J Hannan, Andrea Wadeson, Christopher Partlett, Gillian Whitfield, Omar N Pathmanaban, Kevin J Munro","doi":"10.1097/MAO.0000000000005033","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005033","url":null,"abstract":"<p><strong>Objective: </strong>There is a need for a definitive RCT comparing upfront stereotactic radiosurgery (SRS) versus watch-and-wait (WW) for long-term hearing preservation in vestibular schwannoma (VS). Specific objectives of this feasibility study were to: (1) assess patient eligibility and recruitment/ retention rates, (2) determine completion rates/ times, and (3) estimate the variance in key proposed outcome measures to inform sample-size estimation for an RCT.</p><p><strong>Study design: </strong>Nonrandomized, single-centre, prospective study.</p><p><strong>Setting: </strong>Tertiary-referral centre.</p><p><strong>Patients: </strong>Thirty-one patients with sporadic VS undergoing WW (n = 22) or SRS (n = 9).</p><p><strong>Interventions: </strong>Four-frequency average pure-tone audiometry (4FAPTA) thresholds, Word Recognition Scores (WRS), monaural/antiphasic Digits-in-Noise speech reception thresholds (DiN SRT50), and self-reported outcomes including the Speech, Spatial and Qualities of Hearing Scale (SSQ) and Tinnitus Functional Index (TFI).</p><p><strong>Main outcome measures: </strong>Feasibility metrics (recruitment, completion rates, testing times). Variance of outcome measures (hearing-related: 4FAPTA, monoaural/ antiphasic DiN-SRT50, WRS. Patient-reported outcomes: SSQ, TFI.</p><p><strong>Results: </strong>Forty-four patients were recruited over 7 months. Thirty-one (70.5%) met inclusion criteria, and 25 (80%) completed all tests. Average time to complete the assessments was 1 hour 42 minutes. Mean 4FAPTA (±SD) in VS-affected ears was 42 ± 14 dB HL (WW) and 55 ± 9.4 dB HL (SRS). Antiphasic DiN-SRT50 thresholds were WW: -14.2 dB SNR ± 4.1; SRS: -11.6 dB SNR ± 1.9, and 4FAPTA and antiphasic DiN-SRT50 were correlated (P < 0.001) in VS-affected ears.</p><p><strong>Conclusions: </strong>This study has demonstrated sufficient eligibility and recruitment/retention rates for the proposed RCT and high-test completion rates with acceptable duration. Variability estimates of key outcome measures (DiN-SRT50, 4FAPTA) have also been provided to determine the sample size for the RCT.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Clinical Performance of a Wide-Diameter Bone-Anchored Hearing Implant: Over 10 Years of Follow-up.","authors":"Carine Hajema, Emma M Teunissen, Coosje J I Caspers, Emmanuel A M Mylanus, Myrthe K S Hol","doi":"10.1097/MAO.0000000000005058","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005058","url":null,"abstract":"<p><strong>Objective: </strong>To investigate long-term survival and stability of a wide-diameter bone-anchored hearing implant, soft tissue reactions, and quality of life at least 10 years after implantation.</p><p><strong>Study design: </strong>This study is a continuation of previously published single-center trials with 6-month, 3-year, and 5-year results, adding one follow-up visit at least 10 years postimplantation.</p><p><strong>Patients and main outcome measures: </strong>A total of 48 patients (49 implants) from 63 participants in previous trials, all of whom received the Ponto Wide implant, were included. Implant survival was evaluated for all 63 patients (65 implants). Most patients attended the outpatient clinic, where implant stability was measured and soft tissue reactions around the abutment were assessed using the Holgers classification and IPS scale. In addition, quality of life was evaluated using the International Outcome Inventory for Hearing Aids (IOI-HA) and the Glasgow Benefit Inventory (GBI) questionnaires.</p><p><strong>Results: </strong>The 10-year implant survival rate was 95.4%, including explantations. At the ≥10-year follow-up visit, ISQ values were higher compared to baseline at surgery, and minor skin reactions were observed in only 3 patients. No adverse skin reactions occurred. Hearing-related quality of life improved in 92.1% of patients (GBI) compared to before the intervention, and the median IOI-HA score was 4.3 (IQR: 3.7-4.6), indicating a high level of satisfaction.</p><p><strong>Conclusion: </strong>The Ponto Wide implant shows excellent long-term outcomes with high implant survival, sustained stability, very low soft tissue complications, and high patient-reported satisfaction. These results confirm that the early advantages of this wide implant persist over time.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the Role of Pressure Dressing After Otologic Surgery: A Systematic Review and Meta-Analysis.","authors":"Pey-Yu Chen, Che-Yi Lin, Harrison W Lin, Mehdi Abouzari","doi":"10.1097/MAO.0000000000005068","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005068","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of pressure dressing after otologic surgery for evidence-based postoperative care.</p><p><strong>Databases reviewed: </strong>PubMed, Embase, Cochrane Library, EBSCOhost, and Airiti Library.</p><p><strong>Methods: </strong>Abstracts compared patients with and without pressure dressing after otologic surgery and reported postoperative surgical site outcomes. The number of operated ears and complication events in each group [pressure dressing (PD) vs. nonpressure dressing (NPD)] was extracted. The selected effect measure for complications was the Peto odds ratio (OR). Effect estimates from individual studies were pooled using the DerSimonian and Laird random-effects model. Subgroup analyses were performed using a mixed-effects model.</p><p><strong>Results: </strong>A total of 1358 operated ears from 11 studies were included, including 9 complications eligible for meta-analysis. The odds of hematoma/seroma did not differ between groups. The PD group had significantly higher odds of 3 complications: auricular bruising (1.8% [4/227] vs. 0% [0/223]; odds ratio [OR]: 7.34, 95% CI: 1.03-52.28; I2=0%), dress-related headache (31.3% [25/80] vs. 9.0% [8/89]; OR: 5.61, 95% CI: 2.44-12.92; I2=0%), and skin erythema (20.9% [76/363] vs. 0.6% [2/336]; OR: 8.44, 95% CI: 4.54-15.69; I2=4.6%).</p><p><strong>Conclusions: </strong>PD was associated with increased odds of minor complications (skin erythema, auricular bruising, and pain) without reducing hematoma/seroma, suggesting that routine use of PD after otologic surgery may be unnecessary with adequate hemostasis.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted Surgical Decompression Reduces the Morbidity of Recurrent Inflammatory Facial Nerve Palsy.","authors":"Katherine Pollaers, Peter Monksfield, Richard Irving","doi":"10.1097/MAO.0000000000005037","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005037","url":null,"abstract":"<p><strong>Objective: </strong>To describe the clinical outcomes following facial nerve decompression for recurrent facial nerve weakness.</p><p><strong>Study design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Quaternary referral centre.</p><p><strong>Patients: </strong>Patients who underwent elective surgical decompression of the facial nerve for recurrent paralysis.</p><p><strong>Interventions: </strong>Retrospective observational study.</p><p><strong>Main outcome measures: </strong>Days per year with facial nerve weakness.</p><p><strong>Results: </strong>Sixteen of 17 decompressed nerves derived benefit, with mean facial nerve weakness reduced from 56 days/year to 4 days/year.</p><p><strong>Conclusions: </strong>Surgery is a reasonable option, with high success rates, for selected cases with evidence of facial motor dysfunction and 3 or more episodes of ipsilateral facial nerve weakness secondary to recurrent idiopathic Bell's palsy or Melkersson Rosenthal syndrome.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}