United European Gastroenterology Journal最新文献

{"title":"Unlocking hope: The future of ustekinumab biosimilars in Crohn's disease treatment.","authors":"Ferdinando D'Amico, Sarah Bencardino, André Gonçalves, Mariangela Allocca, Federica Furfaro, Alessandra Zilli, Tommaso Lorenzo Parigi, Gionata Fiorino, Laurent Peyrin-Biroulet, Silvio Danese","doi":"10.1002/ueg2.12682","DOIUrl":"10.1002/ueg2.12682","url":null,"abstract":"<p><p>Biologic therapies have revolutionized Crohn's disease (CD) management, but their high costs pose a significant barrier to access. Biosimilars can provide increased access to treatment because of significant cost-savings. Ustekinumab is a biological drug against interleukin 12-23 that is employed in treating moderate-to-severe CD. As the patent of the reference product (RP) is expiring, ustekinumab biosimilars have been developed and are currently becoming available for patients. Available data demonstrate that ustekinumab biosimilars exhibit comparable efficacy, pharmacokinetics, safety and immunogenicity as the RP. Ustekinumab biosimilars have been approved for CD based on extrapolation and there is no real-world data available yet for this indication. While biosimilars of ustekinumab promise cost savings in treating moderate-to-severe CD, it is not yet known whether their availability will change the treatment algorithm in CD. This review focuses on the available data on ustekinumab biosimilars, focusing on their pros and cons for their forthcoming role in treating moderate to severe CD.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"186-200"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450232","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}

{"title":"What Constitutes a High-Quality Guideline: Exploring Consumers' Views.","authors":"Alberto Balduzzi, Francesco Maria Carrano, Yngve Falck-Ytter, Haluk Tarik Kani, Iris Levink, Yasuko Maeda, Irene Marafini, Adele Sayers","doi":"10.1002/ueg2.70000","DOIUrl":"10.1002/ueg2.70000","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical guidelines are a cornerstone of evidence-based medicine. Little is known about clinicians' knowledge of guideline development and how they perceive guideline quality.</p><p><strong>Methods: </strong>A survey protocol was designed according to the CHERRIES (improving the quality of web surveys: the Checklist for Reporting Results of Internet E-Surveys) checklist. The survey explored three main aspects: high-quality markers of guidelines, knowledge of guideline development, and areas for improvement. The survey was conducted by contacting UEG and affiliated societies by email and via social media. All valid answers to each question were counted.</p><p><strong>Results: </strong>A total of 585 participants responded during the 3-month period. Some 65.8% were aged between 30 and 60 years, and 75.4% were doctors. The most important perceived quality indicators within a guideline were 'clear and actionable recommendations (97%)', followed by 'based on systematic literature review' (96%), and 'transparent methodology' (90%). 230 (39.3%) respondents were previously involved in clinical guideline development. However, the experience of working with a methodologist (18.8%) and using well-established guideline checklists (AGREE-II [21.0%]), RIGHT (Reporting Items for Practice guidelines in HealThcare) (9.9%) were limited. Just under half of the responders (289, 49.4%) were familiar with the GRADE methodology. Apps (78.5%), webinars (73.8%), and short videos (68.2%) were popular tools to access clinical guidelines. Over 90% of responders stated that the reputation of the journal (92%) and the name of the society involved in guideline development (91%) were important. Two-thirds of the responders preferred to see abridged versions of guidelines and 69.2% preferred freely accessible or open access guidelines.</p><p><strong>Conclusion: </strong>Consumers are keen to read clear and actionable guidelines that are developed transparently. There is a gap in guideline development knowledge. Initiatives by medical journals and professional societies are important to ensure the development of accessible and robust clinical guidelines.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"268-275"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523550","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}

{"title":"T1 Colorectal Cancer: What Are the Barriers to Minimizing Unnecessary Surgical Interventions?","authors":"Katsuro Ichimasa, Shin-Ei Kudo, Masashi Misawa","doi":"10.1002/ueg2.12729","DOIUrl":"10.1002/ueg2.12729","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"278-279"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772743","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}

{"title":"Response to \"Reflections on the Study of Physiological Determinants in Cirrhosis With Ascites\".","authors":"Nikhilesh R Mazumder, Elliot B Tapper, Anna S Lok","doi":"10.1002/ueg2.12748","DOIUrl":"10.1002/ueg2.12748","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"282-283"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898540","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}

{"title":"Prospective Evaluation of Real-Time Artificial Intelligence for the Hill Classification of the Gastroesophageal Junction.","authors":"Ioannis Kafetzis, Philipp Sodmann, Bianca-Elena Herghelegiu, Markus Brand, Wolfram G Zoller, Florian Seyfried, Karl-Hermann Fuchs, Alexander Meining, Alexander Hann","doi":"10.1002/ueg2.12721","DOIUrl":"10.1002/ueg2.12721","url":null,"abstract":"<p><strong>Background: </strong>Assessment of the gastroesophageal junction (GEJ) is an integral part of gastroscopy; however, the absence of standardized reporting hinders consistency of examination documentation. The Hill classification offers a standardized approach for evaluating the GEJ. This study aims to compare the accuracy of an artificial intelligence (AI) system with that of physicians in classifying the GEJ according to Hill in a prospective, blinded, superiority trial.</p><p><strong>Methods: </strong>Consecutive patients scheduled for gastroscopy with an intact GEJ were recruited during clinical routine from October 2023 to December 2023. Nine physicians (six experienced, three inexperienced) assessed the Hill grade, and the AI system operated in the background in real-time. The gold standard was determined by a majority vote of independent assessments by three expert endoscopists who did not participate in the study. The primary outcome was accuracy. Secondary outcomes were per-Hill grade analysis and result comparison for experienced and inexperienced endoscopists separately.</p><p><strong>Results: </strong>In 131 analysed examinations the AI's accuracy of 84.7% (95% CI: 78.6-90.8) was significantly higher than 62.5% (95% CI: 54.2-71) of physicians (p < 0.01). The AI outperformed physicians in all but one cases in the per-Hill-class analysis. AI was significantly more accurate than inexperienced physicians (85% vs. 56%, p < 0.01) and in trend better than experienced physicians (84% vs. 69.6%, p = 0.07).</p><p><strong>Conclusions: </strong>AI was significantly more accurate than examiners in assessing the Hill classification. This superior model performance can prove beneficial for endoscopists, especially those with limited experience.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06040723.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"240-246"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819201","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}

{"title":"The Long-Term Risk of Metachronous Advanced Adenoma Recurrence After Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Propensity-Score Matched Longitudinal Cohort With 5-Year Follow-Up.","authors":"Min Dai, Xiang Xiao, Cosmos L T Guo, Rashid N Lui, Hon Chi Yip, Simon Chu, Sok Fei Hon, Simon S M Ng, Philip W Y Chiu, Siew C Ng, Francis K L Chan, Louis H S Lau","doi":"10.1002/ueg2.12735","DOIUrl":"10.1002/ueg2.12735","url":null,"abstract":"<p><strong>Introduction: </strong>Long-term data on metachronous advanced adenoma (AA) recurrence after endoscopic submucosal dissection (ESD) remain scarce, leading to a lack of a standardized surveillance strategy. This study aims to evaluate the long-term risk of recurrent AA after ESD.</p><p><strong>Materials and methods: </strong>A longitudinal retrospective cohort study with propensity-score matching was conducted in a tertiary hospital in Hong Kong. Subjects who underwent colorectal ESD between 2011 and 2017 were enrolled and defined as the post-ESD group. Selected subjects who underwent polypectomy in their index colonoscopy between 2011 and 2017 were enrolled and stratified into the low- intermediate- and the high-risk groups according to the US Multi-Society Task Force (USMSTF) guideline. The risks of recurrent AA were assessed by Cox proportional hazards regression in the matched cohorts.</p><p><strong>Results: </strong>A total of 1745 subjects were included, with 203 post-ESD subjects fully matched with 729 high-risk and 813 low-intermediate-risk subjects, respectively. The 5-year cumulative incidence of recurrent AA in the post-ESD group was 7.8%. After 5 years, the post-ESD group was not associated with a higher rate of recurrent AA to the low-intermediate-risk group (7.8% vs. 5.5%; adjusted HR [aHR] 1.64, 95% CI 0.77-3.48, p = 0.197) but a lower rate of recurrent AA (7.8% vs. 11.8%; aHR 0.40, 95% CI 0.19-0.85, p = 0.017) than the high-risk group.</p><p><strong>Conclusion: </strong>Subjects who underwent ESD were not associated with an increased 5-year risk of metachronous AA recurrence than low-intermediate or high-risk groups in USMSTF. The findings will inform future guidelines on post-ESD surveillance colonoscopy strategies.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"210-219"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872968","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}

{"title":"Metabolic Dysfunction-Associated Steatotic Liver Disease and Pancreatic Disease-A Population-Based Nationwide Cohort and Sibling-Controlled Study.","authors":"Miroslav Vujasinovic, Fahim Ebrahimi, Bjorn Roelstraete, David Bergman, Jiangwei Sun, Omid Sadr-Azodi, J-Matthias Löhr, Jonas F Ludvigsson","doi":"10.1002/ueg2.12761","DOIUrl":"10.1002/ueg2.12761","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) has been linked to pancreatic diseases, but evidence from population-based studies with liver histology is lacking.</p><p><strong>Aims and methods: </strong>In this population-based cohort including all Swedish adults (n = 8563) with biopsy-proven MASLD, we aimed to investigate incidences of pancreatic diseases compared with matched reference individuals from the general population (n = 38,858) and full siblings (n = 6696). Using Cox proportional hazard models, we calculated multivariable adjusted hazard ratios (aHRs) and confidence intervals (CIs).</p><p><strong>Results: </strong>We documented 359 incidents of pancreatic diseases in MASLD patients and 880 events in matched reference individuals, resulting in an incidence rate difference of 1.54 (95% CI, 1.25-1.84). The relative risk of pancreatic disease was highest in the first two years after MASLD diagnosis (aHR, 2.19 [95% CI, 1.92-2.50), but remained statistically significant increased even up to ten years [aHR, 1.60 (95% CI, 1.38-1.85)]. The most common pancreatic disease in individuals with MASLD was acute non-biliary pancreatitis (1.44 vs. 0.44 events/1000 PY), followed by chronic pancreatitis (0.54 vs. 0.12/1000 PY) and pancreatic cancer (0.88 vs. 0.47/1000 PY). We documented 130 versus 344 pancreas-related deaths among individuals with MASLD and their matched comparators, yielding an absolute risk difference of 0.51/1000 PY and an aHR of 2.41 (95%CI = 1.95-2.97). The findings were consistent in sibling-controlled analyses with an aHR of 2.21 (95%CI = 1.69-2.90).</p><p><strong>Conclusions: </strong>MASLD was associated with significantly higher rates of acute and chronic pancreatitis of predominantly non-biliary origin, as well as an increased risk of pancreatic cancer and pancreas-related mortality.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"247-256"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048137","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}

{"title":"High Incidence and Impact of Suspected Exocrine Pancreatic Insufficiency in Patients Post-Hematopoietic Stem Cell Transplantation: A Single-Center Prospective Observational Study.","authors":"Michael Launspach, Aurika Mindermann, Joachim Schulz, Lina Alasfar, Sandra Cyrull, Felix Zirngibl, Lena Oevermann, Annette Künkele, Hedwig E Deubzer, Horst von Bernuth, Axel Pruß, Peter Lang, Philip Bufler, Angelika Eggert, Arend von Stackelberg, Johannes H Schulte","doi":"10.1002/ueg2.12769","DOIUrl":"10.1002/ueg2.12769","url":null,"abstract":"<p><p>Exocrine pancreatic insufficiency (EPI) is suspected but remains understudied in immunosuppressed conditions such as post-hematopoietic stem cell transplantation (HSCT). This prospective observational study aimed to investigate the incidence, impact, and risk factors of EPI in a cohort of 83 pediatric and young adult patients who underwent allogeneic HSCT at Charité - Universitätsmedizin Berlin between 2020 and 2023. Fecal pancreatic elastase (PE) measurements and transabdominal ultrasound were utilized to evaluate pancreatic function over a one-year period. Secondary analysis explored the association of EPI with clinical complications and included a multivariable regression analysis of potential risk factors. Low PE levels significantly correlated with pathological pancreatic imaging findings, independent of concurrent diarrhea. EPI was suspected in 45% (32/71) of patients (95%CI: [34.1%, 56.6%]), with 29% (13/45) (95%CI: [17.7%, 43.4%]) showing signs of prolonged EPI (pEPI) lasting at least 8 weeks. After excluding cases with confounding factors such as missing enteral nutrition and diarrhea, the cumulative incidence of prolonged EPI was 20% (8/41) (95%CI: 10.2%-34.0%) in the overall cohort. EPI was associated with weight loss, prolonged dependence on parenteral nutrition, and extended hospitalizations. Adenovirus (ADV) infection emerged as a significant risk factor for EPI (hazard ratio 3.22 [95%CI:1.26-8.2], p = 0.014), along with additional factors such as higher BMI pre-HSCT, pre-existing pancreatic damage and early post-HSCT fasting. The persistence of pancreatic atrophy and EPI beyond two years post-HSCT in individual cases suggests a potential for permanent pancreatic damage. This study underscores that EPI is a common complication following HSCT, with ADV infection being an important risk factor. The findings support routine PE measurements and early initiation of pancreatic enzyme replacement therapy (PERT), alongside aggressive treatment of ADV infections. Further research is necessary to evaluate the effects of PERT in this population and to explore the applicability of these findings in other immunosuppressed groups.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"257-267"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426182","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}

{"title":"Pancreatic \"supercyst\".","authors":"Dennis Christoph Harrer, Patricia Mester, Bernhard Michels, Arne Kandulski, Stephan Schmid, Wolfgang Herr, Martina Müller, Vlad Pavel","doi":"10.1002/ueg2.12695","DOIUrl":"10.1002/ueg2.12695","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"286-287"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508926","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}

{"title":"Surveillance of Barrett's Esophagus Patients in an Expert Center is Associated With Low Disease-Specific Mortality.","authors":"Judith Honing, W Keith Tan, Victor Yan Zhe Lu, Vlasios Gourgiotis, Isaac M Gianfrancesco, Alina A Schumacher, Shriya Vishwanathan, Calvin Cheah, Ines Modolell, Vijay Sujendran, Rebecca C Fitzgerald, Massimiliano di Pietro","doi":"10.1002/ueg2.12759","DOIUrl":"10.1002/ueg2.12759","url":null,"abstract":"<p><strong>Introduction: </strong>Specialist guidelines recommend endoscopic surveillance for Barrett's esophagus to reduce mortality related to esophageal adenocarcinoma, but the setting for optimal Barrett's esophagus monitoring is unclear. We assessed progression rate and disease-specific mortality in a large cohort of patients followed up at a single Barrett's esophagus expert center.</p><p><strong>Methods: </strong>For this prospective longitudinal single center cohort study, we recruited patients with a previous diagnosis of Barrett's esophagus between 2004 and 2022. Endoscopists were trained in Barrett's esophagus surveillance standards and image-enhanced techniques, and biopsies were reviewed by expert pathologists. Exclusion criteria were a single surveillance endoscopy, high-grade dysplasia, or esophageal adenocarcinoma at or within 12 months from index endoscopy and patients with < 12 months follow-up. The primary outcome was the neoplastic progression rate of Barrett's esophagus with intestinal metaplasia to high-grade dysplasia/esophageal adenocarcinoma. Secondary outcomes included cancer stage and disease-specific mortality, risk factors for progression and progression rate in patients with Barrett's esophagus with only gastric metaplasia or irregular z-line and intestinal metaplasia (IZL-IM).</p><p><strong>Results: </strong>A total of 1932 patients were recruited, of which 969 were included in the primary analysis with a median follow-up of 5.8 years. Of these, 109 developed high-grade dysplasia or esophageal adenocarcinoma with a progression rate of 1.63%/year. Overall, 48 patients received an esophageal adenocarcinoma diagnosis, of which 89,5% (43/48) had stage 1%, and 0.3% patients (3/969) had disease-specific mortality. Multivariate analysis showed that age, alcohol consumption, esophagitis, Barrett's esophagus length, hiatus hernia length, low-grade dysplasia and neutrophil/lymphocyte ratio were risk factors for progression. The rate of progression in patients with Barrett's esophagus-gastric metaplasia or IZL-IM was 0.06%/year.</p><p><strong>Conclusions: </strong>Endoscopic surveillance in an expert Barrett's esophagus center leads to a high neoplastic progression rate, and a low rate of disease-specific mortality. Further research to correlate disease-specific mortality and cancer stage with dysplasia detection rate is warranted to develop diagnostic quality indicators specific for Barrett's esophagus.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"220-228"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415367","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}