Reumatismo最新文献

{"title":"Anifrolumab as a therapeutic option in mixed connective tissue disease with autoimmune cytopenia: a case report and narrative review of the literature.","authors":"Noemi Italiano, Fabio Massimo Perrotta, Mauro Fatica, Ennio Lubrano","doi":"10.4081/reumatismo.2026.2395","DOIUrl":"https://doi.org/10.4081/reumatismo.2026.2395","url":null,"abstract":"<p><p>Mixed connective tissue disease (MCTD) represents a complex autoimmune condition characterized by vasculopathy, fibrosis, and immune dysregulation. Autoimmune cytopenias are rare but clinically significant complications that increase morbidity and complicate management of these diseases. Current therapies, including glucocorticoids and conventional immunosuppressants, may be limited by intolerance or inadequate hematologic response. Type I interferon (IFN) signaling has emerged as a key pathogenic pathway, and its blockade represents a novel therapeutic approach. We describe a 39-year-old woman with MCTD and clinical features of systemic sclerosis, presenting with Raynaud's phenomenon, digital ischemic ulcers, esophageal involvement, and pulmonary arterial hypertension. Her disease course was complicated by progressive cytopenia, including leukopenia, severe lymphopenia, mild anemia, and thrombocytopenia. Azathioprine therapy led to worsening pancytopenia, necessitating discontinuation, while glucocorticoids provided only partial hematologic recovery. Subsequent treatment with mycophenolate was ineffective. Introduction of anifrolumab (300 mg IV every 4 weeks) resulted in hematologic improvement, with normalization of hemoglobin and stabilization of leukocyte and platelet counts, without infusion-related adverse events. The findings support type I IFN blockade as a promising therapeutic avenue in refractory hematologic manifestations of connective tissue disease, warranting further investigation in larger studies.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent herpetic hypertensive anterior uveitis and cytomegalovirus retinitis in a non-HIV patient with melanoma differentiation-associated gene-5 dermatomyositis: intravenous immunoglobulin comes to the rescue.","authors":"T Aizan Izzati Binti T Mohd Yatim, Chiew Gek Khor, Eu Ping Poh","doi":"10.4081/reumatismo.2026.1826","DOIUrl":"10.4081/reumatismo.2026.1826","url":null,"abstract":"<p><p>Melanoma differentiation-associated gene 5 dermatomyositis (MDA-5 DM) is a rare subtype of dermatomyositis. Cytomegalovirus (CMV) retinitis is an opportunistic ocular infection that has historically been linked to HIV infection. Herpes simplex virus (HSV) uveitis is caused by the reactivation of the varicella-zoster virus. We present the case of a 69-year-old woman diagnosed with aggressive MDA-5 DM associated with interstitial lung disease, who received multiple immunosuppressive therapies and subsequently developed left eye CMV retinitis and right eye acute herpetic, hypertensive, anterior uveitis with dendritic keratitis. After the diagnosis of MDA-5 DM, she was treated with glucocorticoids (GC), followed by rituximab and triple therapy (cyclosporine, cyclophosphamide, and GC); however, she did not improve and multiple adverse effects occurred. The patient then started tofacitinib (TOF) and improved. While being on TOF, she developed right eye acute herpetic, hypertensive, anterior uveitis, followed by left eye CMV retinitis. TOF was stopped, and the patient started oral acyclovir and intravenous and intravitreal ganciclovir, which was later changed to maintenance therapy with oral valganciclovir. Cyclical intravenous immunoglobulin (IVIG) administration was started, resulting in an overall improvement in disease activity associated with MDA-5 DM. This case underscores the uncommon link between CMV retinitis in a non-HIV patient and HSV anterior uveitis in a patient undergoing immunosuppressive therapy and the challenge of treating MDA-5 DM with IVIG, which led to favorable results.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed referral, socioeconomic status, and disease characteristics as factors associated with disabilities in rheumatoid arthritis patients: a multicenter observational study.","authors":"Chandrashekara S, Sapan Pandya, Padmanabha Shenoy, Uma Kumar, Alakendu Ghosh, Rajkiran Dudam, Apurva Khare, Banwari Lal Sharma, Rudra Prosad Goswami","doi":"10.4081/reumatismo.2026.1852","DOIUrl":"10.4081/reumatismo.2026.1852","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to identify factors associated with higher Rheumatoid Arthritis Articular Damage (RAAD) scores in rheumatoid arthritis (RA) patients and to evaluate correlations between disease duration, joint involvement, extra-articular manifestations, and functional outcomes with the severity of articular damage.</p><p><strong>Methods: </strong>This multicenter, cross-sectional study was conducted across 8 tertiary care centers in India using the Indian Rheumatology Association database (2019-2022). Patients fulfilling the 2010 ACR/EULAR RA criteria were included. Demographic, clinical, socioeconomic, comorbidity, and disease-specific variables were collected. Articular damage was assessed using the RAAD score. Logistic regression was performed to identify predictors of damage.</p><p><strong>Results: </strong>Of 4641 recruited patients, 4213 were analyzed (mean age 52.8 years; 87.6% female). Severe damage was observed in 9%, moderate in 9.2%, and absent in 81.9%. Patients with severe damage had longer disease duration (median 13 vs. 8 years; p<0.001), more frequent extra-articular (10.3%) and systemic features (7.9%), and greater functional disability (mean health assessment questionnaire 11.12 vs. 3.96; p<0.001). Logistic regression identified longer disease duration [odds ratio (OR) 1.008, p<0.001], higher visual analog scale pain (OR 1.054, p=0.009), physician (OR 1.134, p=0.004) and patient global assessments (OR 1.224, p<0.001), extra-articular features (OR 2.885, p<0.001), and systemic features (OR 4.935, p<0.001) as independent predictors of joint damage.</p><p><strong>Conclusions: </strong>Severe joint damage is associated with delayed presentation, higher disease activity, and extra-articular/systemic features. Socioeconomic factors and comorbidities also influence outcomes. Early referral and comprehensive management are essential to reduce long-term disability in RA.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Italian Society of Rheumatology clinical practice guidelines for the management of vaccines in adult patients with rheumatic diseases.","authors":"Nicola Ughi, Roberto Padoan, Giovanni Adami, Marta Mosca, Fabrizio Conti, Carlo Perricone, Matteo Piga, Serena Fasano, Roberto Caporali, Alessandra Bortoluzzi, Carlo Salvarani, Serena Bugatti, Serena Guiducci, Gian Domenico Sebastiani, Laura Sticchi, Giovanni Gabutti, Khadija El Aoufy, Silvia Tonolo, Greta Carrara, Gianpiero Landolfi, Davide Rozza, Andrea Doria","doi":"10.4081/reumatismo.2026.1895","DOIUrl":"10.4081/reumatismo.2026.1895","url":null,"abstract":"<p><strong>Objective: </strong>Rheumatic and musculoskeletal diseases (RMDs) represent a significant public health challenge in Italy. RMDs are often chronic and lead to increased morbidity and mortality, partly due to an increased risk of infections. Patients with RMDs and those on immunosuppressive therapy show a higher susceptibility to vaccine-preventable diseases and to serious complications in case of infection. Therefore, vaccination is a crucial tool to reduce these risks. This guideline was developed by the Italian Society of Rheumatology and aimed to provide updated national recommendations for clinical practice on vaccinations in adult patients with RMDs.</p><p><strong>Methods: </strong>The GRADE ADOLOPMENT approach to combine adoption, adaptation, or de novo development of recommendations was used, and the 2022 American College of Rheumatology (ACR) guideline on vaccinations in RMDs was used as reference. The development process included an updated systematic review of the available evidence and an assessment of the ACR guidelines and their adaptability to the Italian context, followed by a discussion with experts in rheumatology and public health and representatives of healthcare professionals and patients.</p><p><strong>Results: </strong>A set of recommendations was developed, and special attention was given to the current vaccination schedule and to the adjustment of anti-rheumatic drugs to optimize the response to vaccines.</p><p><strong>Conclusions: </strong>This guideline is a step forward in enhancing management and clinical practice for RMD patients in Italy and provides specific and evidence-based indications for infection prevention through vaccination. Their use is intended to promote health and alleviate the burden of morbidity and mortality in this vulnerable population.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myasthenic syndrome in systemic lupus erythematosus successfully treated with plasma exchange: through one of the unexplored faces of neuropsychiatric involvement.","authors":"Sara Ferrigno, Immacolata Prevete, Valeria Orefice, Chiara Scirocco, Gian Domenico Sebastiani","doi":"10.4081/reumatismo.2026.1956","DOIUrl":"10.4081/reumatismo.2026.1956","url":null,"abstract":"<p><p>Neuropsychiatric systemic lupus erythematosus (NPSLE) encompasses a wide range of neurological manifestations, including, though rarely, myasthenia gravis (MG). We report the case of a 47-year-old woman with long-standing systemic lupus erythematosus (SLE) who developed diplopia and fluctuating muscle weakness. Electromyography revealed a decremental response to low-frequency stimulation in the absence of MG-specific autoantibodies. These neurological features were interpreted as manifestations of NPSLE and were initially treated with azathioprine and then rituximab, the latter discontinued due to an adverse reaction. Several years later, immunosuppressive therapy with mycophenolate mofetil and voclosporin was initiated following a renal flare. Although renal remission was achieved, the patient experienced a concomitant relapse of neurological symptoms. After multidisciplinary consultation with neurologists, the patient underwent 3 monthly cycles of plasma exchange combined with corticosteroid pulses, resulting in marked clinical improvement of neurologic symptoms and sustained serological and clinical stability during the follow-up. The coexistence of SLE and MG is uncommon; distinguishing between an overlap syndrome or lupus-related myasthenic manifestations and choosing the optimal therapeutic strategy remain challenging. In this case, plasma exchange proved to be an effective rescue therapy, highlighting the importance of a multidisciplinary approach and individualized treatment strategies in managing complex NPSLE presentations.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there still someone laughing at Christopher Columbus?","authors":"Leonardo Punzi, Alberto Perez-Negrete, Marco Amedeo Cimmino, Andrea Doria, Roberto Gerli, Gian Domenico Sebastiani, Luigi Sinigaglia, Piero Marson","doi":"10.4081/reumatismo.2026.2253","DOIUrl":"10.4081/reumatismo.2026.2253","url":null,"abstract":"<p><p>Dear Editor, Cristopher Columbus's voyages have undoubtedly changed the history of humankind. Despite already being a public figure in his lifetime, several facts concerning Columbus's life, including his final illness, are still under debate...</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypocomplementemic urticarial vasculitis: a rare presentation revealing systemic lupus erythematosus and Sjögren's disease.","authors":"Said Taharboucht, Chaima Mehiris, Sonia Bellil, Zahira Chikh Salah, Lydia Bentaleb","doi":"10.4081/reumatismo.2026.1930","DOIUrl":"10.4081/reumatismo.2026.1930","url":null,"abstract":"<p><p>Hypocomplementemic urticarial vasculitis (HUV) is a rare small-vessel vasculitis that may occur as a primary form or secondary to systemic disease. Its concurrent association with systemic lupus erythematosus (SLE) and Sjögren's disease (SD) remains exceptional. Diagnosis is particularly challenging due to overlapping clinical and immunological features among these entities. We report the case of a 46-year-old woman with no significant medical history, presenting with recurrent chronic urticaria resistant to antihistamines. Clinical, biological, and histological investigations led to the diagnosis of HUV associated with SLE and SD without severe organ involvement. Treatment with colchicine and hydroxychloroquine resulted in complete remission of symptoms. This case highlights the importance of considering HUV in any patient with chronic or refractory urticaria and of systematically screening for associated autoimmune diseases, particularly SLE and SD.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telerheumatology to improve first access outcomes in outpatients: a prospective monocentric pilot study.","authors":"Maria Chiara Gerardi, Nicola Ughi, Eleonora Giacobbe, Antonella Adinolfi, Laura Belloli, Cinzia Casu, Maria Di Cicco, Davide Filippini, Clizia Gagliardi, Marina Muscarà, Elisa Verduci, Chiara De Stefani, Oscar Massimiliano Epis","doi":"10.4081/reumatismo.2026.1843","DOIUrl":"10.4081/reumatismo.2026.1843","url":null,"abstract":"<p><strong>Objective: </strong>The present pilot study aimed to assess the feasibility of a \"teletriagerheum\" service before the first rheumatology visit and identify potential benefits and disadvantages by comparing a regular visit with a first face-to-face visit preceded by the \"teletriagerheum\" service.</p><p><strong>Methods: </strong>A prospective monocentric pilot study was conducted from October to December 2021. Consecutive patients were contacted to investigate their willingness to receive a phone call (\"teletriagerheum\" service) from a physician of the Rheumatology Unit before the first rheumatology visit. The number of definite diagnoses at the first visit in the \"teletriagerheum\" group was compared with patients receiving a regular first visit, as well as socio-demographic characteristics, the reason for the visit, face-to-face visit duration, and the number of additional exams.</p><p><strong>Results: </strong>Overall, 75 patients performed the \"teletriagerheum\" (\"teletriagerheum\" group), and 74 patients were included in the control group. In the \"teletriagerheum\" group, a higher number of conclusive diagnoses was observed (72% vs. 58%, p=0.020) with a higher probability of receiving a conclusive diagnosis compared with the control group, both at univariate [odds ratio (OR) 2.28, p=0.021] and multivariate analyses adjusting for the only differences between the two groups (marital status and information and communication technologies skills; OR 2.95, p=0.007). At the first face-to-face visit, fewer additional tests were prescribed in the \"teletriagerheum\" group; however, the overall number of tests (including those prescribed during teletriage) was higher.</p><p><strong>Conclusions: </strong>A telephone-based telerheumatology service could be an effective triage tool for first visits of new outpatients, enabling more definitive diagnoses, thanks in part to the ability to perform the required investigations in a timely manner in most cases.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From anatomy to therapy: the historical journey to cortisone.","authors":"Ernesto Damiani, Piero Marson, Francesco M Galassi","doi":"10.4081/reumatismo.2025.1935","DOIUrl":"10.4081/reumatismo.2025.1935","url":null,"abstract":"<p><strong>Objective: </strong>To comprehensively trace the historical journey of adrenal gland research from the first anatomical descriptions in the 16th century to the development and clinical application of cortisone in the mid-20th century.</p><p><strong>Methods: </strong>This review examines key phases in adrenal gland research, including anatomical discoveries, microscopic studies, experimental physiology, biochemical advancements, and clinical applications. We analyzed primary historical sources, scientific papers, and medical records to construct a chronological narrative of adrenal gland understanding and cortisone development.</p><p><strong>Results: </strong>The review highlights significant milestones, beginning with Bartolomeo Eustachio's 1564 discovery of the adrenal glands. It details the crucial microscopic phase, initiated by Moritz Nagel's 1836 study, which revealed the cortex-medulla distinction. Julius Arnold's 1866 description of the three-zone cortical structure and the identification of chromaffin cells are also discussed. The experimental physiology phase, featuring groundbreaking work by Thomas Addison and Charles-Édouard Brown-Séquard, established the vital role of the adrenal cortex. The biochemical phase, marked by the isolation and synthesis of cortisone, is examined in depth, with particular focus on the contributions of Edward Calvin Kendall, Tadeus Reichstein, and others. Finally, the clinical phase is detailed, emphasizing Philip Showalter Hench's revolutionary application of cortisone in rheumatoid arthritis treatment in 1948.</p><p><strong>Conclusions: </strong>This historical journey demonstrates how advancements in anatomy, histology, physiology, and biochemistry synergistically contributed to our understanding of the adrenal glands. The development of cortisone, culminating with this collective knowledge, revolutionized the treatment of inflammatory diseases, marking a significant milestone in medical history and setting the stage for modern endocrinology and rheumatology.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term efficacy of intra-articular viscosupplementation in delaying hip osteoarthritis radiographic progression: a retrospective, non-controlled study from the ANTIAGE registry.","authors":"Alberto Migliore, Nazzareno Iannarelli, Antonio Devito, Raffaele Saporito, Luca Saccone, Irene Beriotto, Michele Grassi, Eugenio Cunego, Annamaria Paglionico, Sandro Tormenta","doi":"10.4081/reumatismo.2026.1917","DOIUrl":"10.4081/reumatismo.2026.1917","url":null,"abstract":"<p><strong>Objective: </strong>Viscosupplementation is a recognized treatment for improving pain and joint function in the long term. The study aimed to analyze the radiological changes after 2 years of treatment with HyalOne® (Hyalubrix® 60 Italian brand name) in patients with symptomatic hip osteoarthritis (OA). The primary objective was to evaluate the ability of delaying hip OA progression, measured by the percentage of patients showing no radiological Kellgren-Lawrence (K-L) grade change ≥1 at 2 years. Secondary objectives included variations in pain at rest, Lequesne index, and non-steroidal anti-inflammatory drug (NSAID) intake after 2 years of treatment.</p><p><strong>Methods: </strong>Data of patients suffering from symptomatic hip OA treated with HyalOne®/Hyalubrix® 60 were selected from the ANTIAGE national registry. The analysis included 78 patients aged 50 to 80 years with radiological and clinical OA (K-L grade 1-3), body mass index ≤35, and at least 2 years of radiological follow-up. Patients with significant comorbidities or who received previous treatment within two years after HyalOne®/Hyalubrix® 60 were excluded.</p><p><strong>Results: </strong>This retrospective observational non-controlled study showed that intra-articular injections with HyalOne®/Hyalubrix® 60 were well tolerated and may help maintain clinical and radiographic stability in patients with hip OA. At 2-year follow-up, the K-L grade remained stable in 72 hips (92.31%). Symptom reduction was also observed, supporting lower NSAID consumption and the avoidance of the related adverse events.</p><p><strong>Conclusions: </strong>These results are clinically meaningful and support the treatment with HyalOne® as a valuable background therapy for maintaining clinical and radiographic stability in patients with hip OA.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147309591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}