Pediatric Hematology and Oncology最新文献

{"title":"Clofarabine monotherapy in refractory multisystem LCH with gastrointestinal involvement.","authors":"Stephanie Aronson, Vivian Tang, Klaudia Cios, Meredith Pittman, Mahmut Y Çeliker","doi":"10.1080/08880018.2025.2563535","DOIUrl":"https://doi.org/10.1080/08880018.2025.2563535","url":null,"abstract":"<p><p>Langerhans Cell Histiocytosis (LCH) is a rare histiocytic disorder that involves various organ systems. Recognizing gastrointestinal (GI) tract involvement in LCH is crucial, as GI cases, even without high-risk organ involvement, may be refractory to initial as well as second line therapy. Here, we report two cases of LCH with GI involvement, that were refractory to vinblastine, prednisone and cytarabine, and ultimately required clofarabine to reach clinical remission. We propose that clofarabine should be further studied as a first choice for second line treatment for GI-LCH cases and that GI involvement should be considered as high risk in the LCH risk stratification algorithm.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"1-6"},"PeriodicalIF":1.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131644","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":"Barriers and opportunities for a complementary medicine advisory network in pediatric oncology: perspectives from german experts.","authors":"Lara Nowak, Daniela Reis, David D Martin, Alfred Längler, Tycho Zuzak","doi":"10.1080/08880018.2025.2553618","DOIUrl":"https://doi.org/10.1080/08880018.2025.2553618","url":null,"abstract":"<p><p>Complementary medicine (CM) is commonly used by parents of pediatric cancer patients alongside conventional treatment, yet pediatric oncologists often feel inadequately trained to advise on CM. A collaborative project led by Gemeinschaftskrankenhaus Herdecke, integrated into inpatient pediatric cancer care in four centers in Germany in the Rhine-Ruhr Region, provides CM consultations and training for pediatric oncology teams. This study aimed to identify barriers perceived by healthcare professionals regarding the implementation of a CM advisory network for parents and assess their training needs. Eleven semi-structured interviews, lasting an average of 17.6 min, were conducted at four locations, including in-person (<i>n</i> = 7) and digital (<i>n</i> = 5) formats. Participants included physicians, senior physicians, residents and nurses. The interviews were analyzed using qualitative thematic analysis to inform targeted training for healthcare professionals to promote safe use of CM. The results highlighted the relevance of CM as perceived by healthcare professionals, as parents expect it to support their child's therapy. There was a notable interplay between parents' desire to explore options beyond conventional treatment and the stress they experience due to their child's diagnosis. The study identified necessary features for implementing a counseling service, emphasizing further training options, consistency, and identifying additional options. For team training, the interviewees stressed the importance of practical orientation and self-exploration. The key barriers identified were the scarcity of resources, including personnel, time, costs, and logistics. The study's findings will inform the development of future educational interventions for healthcare professionals.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"1-11"},"PeriodicalIF":1.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030240","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":"Intracardiac thrombi in children: A decade of experience at a tertiary care hospital.","authors":"Tzofnat Farbstein-Aljanati, Tal Tirosh-Wagner, Ivan Budnik, Uriel Katz, Sharon Borik, Assaf A Barg, Gili Kenet, Sarina Levy-Mendelovich","doi":"10.1080/08880018.2025.2531011","DOIUrl":"10.1080/08880018.2025.2531011","url":null,"abstract":"<p><p>Intracardiac thrombus (ICT) in children is a serious and potentially life-threatening condition, particularly among hospitalized patients. Pediatric-specific data on ICT remain scarce, posing challenges for optimal, evidence-based management. This study aimed to analyze pediatric ICT cases over a decade to identify clinical characteristics, management strategies, and outcomes.</p><p><p>This retrospective study was conducted at a tertiary referral center and included all pediatric patients (ages 0-18) diagnosed with ICT between 2012 and 2023. Clinical and demographic data were extracted from electronic medical records, following IRB approval.</p><p><p>Twenty-three children were identified (median age: 39 months; 52% female). Major risk factors included central venous catheters (60.9%), congenital or acquired heart disease (52.2%), and malignancy (34.8%). Most thrombi (78.3%) were right-sided. ICT was incidentally diagnosed in 56.5% of cases; in others, symptoms led to imaging <i>via</i> echocardiography, CT, or cardiac catheterization.</p><p><p>Anticoagulation therapy was initiated in 87% of patients. Eight required indefinite treatment due to persistent thrombi or ongoing risk factors, while others received a median therapy duration of four months. Three patients did not receive anticoagulation due to clinical considerations. Surgical thrombectomy was performed in four cases (17.4%), and one patient underwent catheter-based thrombolysis. There were no major bleeding events. Complete thrombus resolution was achieved in 60.9% of cases, with partial improvement in 26.1%.</p><p><p>ICT in children is associated with identifiable risk factors and is commonly managed with anticoagulation. Surgical or interventional procedures may be needed in select cases. Early identification of high-risk patients is essential to improve outcomes.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"323-332"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760750","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":"The efficacy of oral L-arginine therapy for the treatment of vaso-occlusive pain episodes in children with sickle cell disease.","authors":"Aya Mohamed Abd Elglil, Mohamed Ramadan El-Shanshory, Hamed Mohamed Elsharkawy, Walaa Arafa Keshk, Nahed M Hablas, Lamia M Morad","doi":"10.1080/08880018.2025.2549365","DOIUrl":"10.1080/08880018.2025.2549365","url":null,"abstract":"<p><p>Pain is the clinical hallmark of sickle cell disease (SCD), with painful Vaso-occlusive episodes (VOEs) being the common medical emergencies associated with an increased mortality rate. The current study aimed to evaluate the efficacy of L-arginine as an adjuvant therapy for children with SCD and VOE, as well as its effect on Tricuspid Regurgitant Jet Velocity (TRJV) during VOE. The primary outcome was to evaluate the efficacy of L-arginine on pain intensity. This double-blind, randomized, controlled, and parallel prospective study was carried out on 40 SCD children who presented with VOE and met the inclusion criteria. The mean ± SD of age was 8.8 ± 3.2 years, and 62.5% were males. They were randomized into two groups; Group 1 included 20 patients who received L-Arginine (100 mg/kg/dose three times/day for 15 doses or until their discharge) plus standard therapy. Group 2 consisted of 20 patients who received a placebo in addition to standard therapy. Total analgesic use, daily pain score, time to crisis resolution, and length of hospital stay were recorded. Routine laboratory investigations, serum L-Arginine, asymmetric dimethyl-arginine (ADMA) levels and the Arginine/ADMA ratio were assessed. Moreover, Echocardiography was performed to assess TRJV. All these parameters were assessed at baseline (during painful crisis), at discharge, and during the clinically asymptomatic state. As regards the age, sex, consanguinity, or family history there were no statistically significant difference between all of the studied groups. L-arginine therapy significantly decreased pain score at the 3rd day of admission(<i>p</i>-value 0.036), total analgesic use (<i>p</i>-value <0.001), time to crisis resolution (<i>p</i>-value 0.011), length of hospital stays (<i>p</i>-value 0.016), and TRJV (<i>p</i>-value < 0.001). Additionally, serum L-arginine level and Arginine/ADMA ratio (<i>p</i>-value <0.001) were increased upon arginine treatment. Additionally, statistically significant differences in the serum L-arginine level, serum ADMA level, Arginine/ADMA ratio, and TRJV were reported during painful crisis compared to the asymptomatic state. L-arginine Supplementation improved painful VOE symptoms in SCD children and decreased TRJV in those children. Oral arginine could be a promising adjuvant therapy for SCD-VOE management.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"354-366"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963880","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":"Evaluation of sleep disturbances in pediatric cancer patients and sleep quality in their caregivers.","authors":"Esra Gözde Aydın, Özge Vural, Azime Şebnem Soysal Acar, Arzu Okur, Faruk Güçlü Pınarlı","doi":"10.1080/08880018.2025.2547669","DOIUrl":"10.1080/08880018.2025.2547669","url":null,"abstract":"<p><p>Cancer remains one of the leading causes of mortality among children worldwide. Both the disease itself and its treatment contribute to significant sleep-related issues. Pediatric cancer patients and survivors commonly experience sleep disturbances, including insomnia, excessive daytime sleepiness, prolonged sleep latency, reduced sleep duration, and poor overall sleep quality. The primary objective of this study was to assess the prevalence and characteristics of sleep disturbances in pediatric cancer patients and to compare these findings with those observed in children with non-oncologic conditions managed by the same pediatric oncology clinic. A secondary aim was to evaluate whether sleep disturbances in children affect the sleep quality of their caregivers. The study included 210 children aged 6 to 16 years and their caregivers. Diagnoses included lymphoma, solid tumors, Langerhans cell histiocytosis, neurofibromatosis, lymphadenopathy, and hemangioma. All participants were followed in our outpatient clinic between January 2 and May 25, 2023. Caregivers completed the Pittsburgh Sleep Quality Index (PSQI) to assess their own sleep quality and the Sleep Disturbance Scale for Children (SDSC) to evaluate their child's sleep patterns. The mean SDSC total score was 40.8 ± 8.1, indicating a high prevalence of sleep disturbances among children with cancer, particularly difficulties in initiating and maintaining sleep. The mean caregiver PSQI score was 5.02 ± 3.56. A moderate, statistically significant correlation was found between children's SDSC scores and their caregivers' PSQI scores (<i>r</i> = 0.433, <i>p</i> < 0.001). These findings underscore the importance of routine sleep assessments in pediatric oncology. Early recognition and management of sleep disturbances may enhance treatment adherence, improve therapeutic outcomes, and increase the overall quality of life for both patients and their caregivers.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"344-353"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963919","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":"Aberrant serum lipid levels predict clinical outcomes in patients with neuroblastoma.","authors":"Zhixia Yue, Wen Zhao, Chao Duan, Xisi Wang, Chao Gao, Xiaoli Ma, Yan Su","doi":"10.1080/08880018.2025.2522808","DOIUrl":"10.1080/08880018.2025.2522808","url":null,"abstract":"<p><p>This study aimed to explore how serum lipid levels are related to clinical features and outcomes in neuroblastoma(NB). We analyzed data from 169 patients diagnosed with NB, focusing on their serum lipid levels and how these relate to disease characteristics and prognosis. We found that older age (>18 months), high-risk disease features (e.g. elevated LDH, NSE, serum ferritin), genetic abnormalities (such as MYCN amplification, 1p36/11q23 LOH, PHOX2B expression), tumor size ≥10 cm, bone marrow metastasis, and multiple organ involvement were linked to abnormal lipid profiles, including elevated total cholesterol (TC), triglycerides (TG), LDL-C, and lipid ratios (TC/HDL-C, TG/HDL-C), along with reduced HDL-C. Interestingly, high TG and TG/HDL-C levels correlated with increased regulatory T cells (Tregs), which play a role in immune response. Patients with unfavorable lipid profiles-particularly high TC, TG, LDL-C, and lipid ratios or low HDL-C-had worse 5-year event-free survival (EFS) rates. This was especially true for high-risk patients. In statistical models, the TC/HDL-C ratio emerged as an independent predictor of poorer EFS. To assess lipid dynamics during treatment, we monitored patients at multiple time points and observed decreasing TC, TG, LDL-C, TC/HDL-C, and TG/HDL-C levels, alongside increasing HDL-C, suggesting treatment-induced improvement in lipid metabolism. In patients with disease progression or relapse, lipid levels (TC, LDL-C, HDL-C) were significantly elevated at the time of the event compared to post-chemotherapy levels.In summary, dysregulation of serum lipids is common in NB and lipid profiles are closely linked to NB progression and may serve as potential biomarkers for prognosis and treatment monitoring.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"297-311"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760749","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":"Adherence to the febrile neutropenia protocol in pediatric leukemia patients at a Brazilian Cancer Center-A retrospective audit.","authors":"Jessica Talita Mariana Wicthoff Raniero, Anita Cassoli Cortez, Cecilia Maria Lima da Costa, Luciana Mariano Palanch Piotto, Ivan Leonardo Avelino França E Silva, Viviane Sonaglio, Marjorie Vieira Batista","doi":"10.1080/08880018.2025.2525267","DOIUrl":"10.1080/08880018.2025.2525267","url":null,"abstract":"<p><p>Pediatric patients with hematologic cancers, especially those undergoing chemotherapy, are highly vulnerable to infections and febrile neutropenia (FN). Noncompliance with FN protocols often leads to excessive antibiotic use, raising the risk of multidrug-resistant bacteria and contributing to higher mortality rates. This retrospective study aimed to assess inappropriate empirical antibiotic treatment (IEAT) rates during FN episodes and identify risk factors for mortality among pediatric patients diagnosed with acute leukemia and FN at the A.C. Camargo Cancer Center between January 1, 2010, and December 31, 2020. A total of 329 FN episodes in 84 patients were analyzed, revealing an overall IEAT rate of 40%. The study identified key issues such as 2% of inadequate Gram-positive coverage, 78% of failure to de-escalate antibiotic treatment and 62% of maintenance antibiotic administration despite negative cultures Bloodstream infections were found in 77% of episodes, with age over 13 years (<i>p</i> 0.003), and bloodstream infection (<i>p</i> 0.002) being significant risk factors for mortality.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"312-322"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541812","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":"Disparities in the time and pilgrimage of families of children with cancer until arrival at a reference center for treatment in Brazil.","authors":"Denise L Q Prado, Thaissa M Faria, Adeylson G Ribeiro, Luiz Fernando Lopes","doi":"10.1080/08880018.2025.2543588","DOIUrl":"10.1080/08880018.2025.2543588","url":null,"abstract":"<p><p>This study assessed the timeline from the initial presentation of symptoms of major cancers to the arrival at and diagnosis by the reference center for pediatric oncology in Barretos, São Paulo, Brazil. The goal was to examine the flow of care within the healthcare system and identify disparities indicative of inequitable access to health services. We conducted a cross-sectional analysis of patient data over eight years. Quantitative variables were examined using median values, T-tests, Kruskal-Wallis tests, ANOVA, Bonferroni adjustments, and pairwise comparisons. Categorical variables were analyzed using the Chi-square test, with a significance threshold set at 5%. A total of 508 patients with malignant cancers were studied. Patients with hematologic cancers experienced the shortest median times from initial symptom perception (2 days), to the first healthcare visit (1 day), onward referral to a specialized center (30 days), and final diagnosis (35 days). This is in contrast to patients with central nervous system cancers (2, 3, 90, and 112.5 days respectively) and bone cancers (20, 7, 60, and 90 days respectively). Families from municipalities ranked lower on the GeoSES socioeconomic scale reported longer durations before recognizing initial symptoms (p-value = 0.037). Low initial diagnostic suspicion and systemic delays are primary obstacles that need addressing to enhance the diagnosis and treatment of pediatric cancer in Brazil's most populous state.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"333-343"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794931","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":"Infectious Complications During Reinduction in Children with Relapsed Acute Lymphoblastic Leukemia: A Descriptive Analysis.","authors":"Rozalyn Chok, Amanda M Li","doi":"10.1080/08880018.2025.2550516","DOIUrl":"https://doi.org/10.1080/08880018.2025.2550516","url":null,"abstract":"<p><p>Children with relapsed acute lymphoblastic leukemia (ALL) face higher rates of infection and treatment-related mortality than at initial diagnosis. Although immunotherapy is increasingly used in the relapsed setting, combination intensive chemotherapy remains the standard approach for reinduction. Serious infections during this phase can delay or preclude curative therapy. We aimed to describe the incidence and pattern of infections during reinduction in this high-risk population. In this single-center retrospective study, we reviewed charts of patients with relapsed ALL treated with combination chemotherapy reinduction at British Columbia Children's Hospital between 2006 and 2022. Forty-three patients were included (median age 10.2 years at relapse). Most (90%) received a standard four-drug reinduction. Median duration of severe neutropenia was 20.8 days. About half (51%) experienced at least one infection, including 16% with confirmed or probable fungal infection. Infection was associated with significantly longer hospitalization (median 17 vs. 7 days; <i>p</i> = 0.006). While no predictors reached statistical significance, hyperglycemia and neutropenia ≥ 21 days were associated with higher odds of infection. Overall survival did not differ significantly by infection status (log-rank <i>p</i> = 0.43). Infectious complications remain common during reinduction chemotherapy for relapsed ALL despite advances in supportive care. While pharmacologic and clinical strategies may reduce risk, safer and more targeted reinduction approaches are urgently needed to optimize outcomes in this vulnerable group.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"1-11"},"PeriodicalIF":1.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963887","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":"Hemorrhagic complications and outcomes of children with acute promyelocytic leukemia at initial hospital admission: a multicenter cohort study.","authors":"Balagangadhar Totapally, Ariella Barhen, Guillermo De Angulo","doi":"10.1080/08880018.2025.2506414","DOIUrl":"10.1080/08880018.2025.2506414","url":null,"abstract":"<p><p>Acute promyelocytic leukemia (APL) is an uncommon subtype of acute myeloid leukemia that is associated with hemorrhagic complications and early death. Our primary objective was to describe the frequency of hemorrhagic complications and outcomes associated with APL during the initial admission using the Pediatric Health Information System (PHIS) database. We performed a retrospective cross-sectional analysis of children with APL not in remission. Demographic characteristics, resource utilization, and outcomes were compared between those with and without hemorrhagic complications. Out of 173 patients with APL, hemorrhagic complications (intracranial, gastrointestinal, or pulmonary) occurred in 32%. Children with hemorrhagic complications were more likely to have acute respiratory failure, coagulopathy, stroke, and cerebral edema. Children with hemorrhagic complications experienced more ICU admissions and mechanical ventilation, and they also received transfusions, low molecular weight heparin, hydroxyurea, and rasburicase more frequently. The median length of stay and mortality rate was not different between the groups. The median length of stay of children who died was significantly lower (<i>p</i> = 0.003) as the majority (78%) who died death occurred within 7 days. Hemorrhagic complications occurred in a 3^rd of patients with the initial admission of APL, and most deaths occurred during the first week.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":" ","pages":"265-275"},"PeriodicalIF":1.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094271","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}