Yonago acta medica最新文献

{"title":"Selective PPARα Modulator (SPPARMα) in the Era of the MASLD Pandemic: Current Insights and Future Prospects.","authors":"Takaaki Sugihara","doi":"10.33160/yam.2025.05.002","DOIUrl":"10.33160/yam.2025.05.002","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a significant global health concern, affecting approximately 30% of the population. In Japan, its prevalence is also rising rapidly and is expected to reach 50% by 2040. This situation can be described as a \"MASLD pandemic\", emphasizing the urgent need for effective therapeutic interventions. Peroxisome proliferator-activated receptors (PPARs) are nuclear receptors that play essential roles in lipid metabolism, inflammation regulation, and fibrosis modulation. Among them, PPARα is a key regulator of lipid homeostasis, primarily expressed in the liver and other metabolically active tissues. Its activation promotes fatty acid oxidation and improves lipid profiles, making it a crucial target for metabolic disorders. In Japan, a novel selective PPARα modulator (SPPARMα) was developed as a lipid-lowering agent for treating dyslipidemia. Over time, increasing clinical evidence has suggested that SPPARMα has beneficial effects on MASLD patients' liver function. This review aims to summarize the therapeutic potential of SPPARMα in MASLD by examining the functional mechanisms of PPARα, preclinical studies in animal models, and accumulating clinical evidence from MASLD patients. Furthermore, we provide an overview of ongoing clinical trials investigating SPPARMα for MASLD treatment.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"68 2","pages":"91-105"},"PeriodicalIF":0.9,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectal Resection with Hysterectomy for Locally Advanced Rectal Cancer Using the hinotori Surgical Robot System: The First Ever Case Report.","authors":"Takuki Yagyu, Manabu Yamamoto, Hiroaki Komatsu, Chiharu Yasui, Ryo Ishiguro, Yusuke Kono, Kyoichi Kihara, Yuki Iida, Tomoyuki Matsunaga, Naruo Tokuyasu, Teruhisa Sakamoto, Yoshiyuki Fujiwara","doi":"10.33160/yam.2025.05.005","DOIUrl":"10.33160/yam.2025.05.005","url":null,"abstract":"<p><p>The number of reports of robotic surgery for rectal cancer with combined resection of other organs is increasing gradually, with most procedures performed using the da Vinci Surgical System. The hinotori Surgical Robot System, developed in Japan, was approved for gastrointestinal surgery and gynecology in 2022. Here, we report the first case of en-bloc rectal resection with hysterectomy using the hinotori Surgical Robot System. A 77-year-old woman was referred to our institution with a diagnosis of rectal cancer (cT4bN1bM1a), with uterine invasion and a resectable liver metastasis. We performed rectal resection with total hysterectomy and bilateral salpingo-oophorectomy using the hinotori Surgical Robot System. Two surgical teams, a gastroenterological team and a gynecological team, performed en-bloc resection of the rectum and uterus. Because of in-depth consultation between the teams, the operation was performed safely with no unplanned additional ports, robotic arm interference or arm collision with the assistant surgeon. Including the preceding stoma closure, the operative time was 473 minutes, and blood loss was 60 mL. The patient experienced no complications ≥ Clavien-Dindo classification grade III. Robot-assisted extended surgery for locally advanced rectal cancer using the hinotori Surgical Robot System can be performed safely, which may lead to an expanded treatment option in the future.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"68 2","pages":"152-157"},"PeriodicalIF":0.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5-Aminolevulinic Acid-Mediated Metronomic Photodynamic Therapy for Mouse Mammary Tumors.","authors":"Tomohiro Osaki, Hikaru Shiomi, Takahiro Nishimura, Kei Sakanoue, Kazuhiro Eguchi, Yutaka Miyazono, Ryoichi Yamaguchi, Katsuhiko Fujita, Kenji Kuwata, Naoki Kobayashi, Tsuyoshi Goya, Katsuyuki Morii, Urara Ota, Hideo Imazato, Kiwamu Takahashi, Masahiro Ishizuka","doi":"10.33160/yam.2025.05.004","DOIUrl":"10.33160/yam.2025.05.004","url":null,"abstract":"<p><strong>Background: </strong>Metronomic photodynamic therapy (mPDT) is a novel cancer treatment strategy that uses low-dose light delivery and photosensitizers. 5-aminolevulinic acid (5-ALA), a precursor of protoporphyrin IX (PpIX) was previously used to treat human colorectal and esophageal cancer cells. However, no study has evaluated the efficacy of 5-ALA-mPDT using light of different wavelengths. Therefore, we evaluated cytotoxicity induced by 5-ALA-PDT and the antitumor effect of 5-ALA-mPDT.</p><p><strong>Methods: </strong>In an <i>in vitro</i> experiment, we evaluated the cytotoxicity induced by 5-ALA-PDT using several fluence rates of light-emitting diode (LED) at wavelengths of 532 and 620 nm. In an <i>in vivo</i> experiment, we evaluated the antitumor effect of 5-ALA-mPDT using a newly developed implantable device emitting 532 or 620 nm. Moreover, we used <i>in silico</i> simulations to compare the differences in the distribution of the accumulated singlet oxygen concentrations between 532 and 620 nm.</p><p><strong>Results: </strong>In the <i>in vitro</i> experiment, the percentages of late apoptotic/Dead and Dead cells in the 542-nm groups irradiated at light intensities of 1 mW/cm² were significantly higher than those of cells in the 620-nm group. In contrast, in the <i>in vivo</i> experiment, the antitumor effect of mPDT using an implantable organic light-emitting diode (OLED) at 620 nm was significantly higher than that of mPDT using OLED at 542 nm.</p><p><strong>Conclusion: </strong>Considering the results of our <i>in silico</i> study, the antitumor effect of 5-ALA-mPDT may be dependent on the distribution range of the accumulated singlet oxygen concentration rather than the accumulated singlet oxygen concentration.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"68 2","pages":"114-122"},"PeriodicalIF":0.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Providing Educational Leaflet after Screening on Hazardous and Harmful Alcohol Use in the Workplace: Study Protocol for a Randomized Controlled Trial.","authors":"Yuki Kuwabara, Aya Kinjo, Hongja Kim, Yoneatsu Osaki","doi":"10.33160/yam.2025.05.003","DOIUrl":"10.33160/yam.2025.05.003","url":null,"abstract":"<p><strong>Background: </strong>Despite evidence regarding the effectiveness of screening and brief interventions for excessive alcohol consumption, these interventions are not widely used. Although several studies have suggested that face-to-face interventions in the workplace may be effective, developing an implementable intervention strategy for alcohol users, including light drinkers, is warranted. This study aimed to develop a study protocol to evaluate the effect of providing an educational leaflet at the workplace on reducing hazardous or harmful alcohol use.</p><p><strong>Methods: </strong>A randomized controlled trial involving employees (aged ≥ 20 years) of a local administrative office in Japan who were screened using the Alcohol Use Disorder Identification Test (AUDIT) is ongoing. Participants were randomized into \"Educational leaflet\" and \"Control (no intervention)\" groups. The primary outcome was the difference in negative status on the AUDIT (proportion of participants scoring < 8 points on the AUDIT) between the intervention and control groups in the following year. For the secondary outcomes, laboratory marker data at annual health checkups were collected and assessed.</p><p><strong>Results: </strong>A total of 400 participants were randomized into educational leaflet (<i>n</i> = 200) and control (<i>n</i> = 200) groups. The basic characteristics of all participants included sex (men 79.3%; women 20.8%), mean (standard deviation) of age 48.5 (9.7 years), 40.0% of AUDIT ≥ 8 points, 46.8% of drinking alcohol ≥ 4 times a week, and 33.8% of heavy episodic drinking. No significant differences were observed between the intervention and control groups in terms of the baseline variables.</p><p><strong>Conclusions: </strong>This study protocol developed the first trial in Japan to investigate the impact of providing an educational leaflet after screening for hazardous and harmful alcohol use in a workplace setting. The findings of this study can provide the first evidence that an implementable alcohol intervention strategy targeting alcohol users, including light drinkers in the workplace, is effective in reducing hazardous or harmful alcohol use.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"68 2","pages":"106-113"},"PeriodicalIF":0.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Insights into the Relationship Between Sleep Disordered Breathing and Cardiovascular Disease.","authors":"Masahiko Kato","doi":"10.33160/yam.2025.05.001","DOIUrl":"10.33160/yam.2025.05.001","url":null,"abstract":"<p><p>Sleep disordered breathing, represented by sleep apnea syndrome, not only significantly reduces the quality of daily life but is also known to contribute to the development of various cardiovascular diseases. Since 2000, sleep apnea syndrome has become widely recognized by the general public. However, the number of suspected patients who seek medical consultation remains low, and even fewer receive a proper diagnosis and treatment. One reason for this is the lack of information that apnea is linked to cardiovascular disease, even among individuals experiencing typical sleep apnea syndrome symptoms such as daytime sleepiness and general fatigue. Additionally, healthcare providers may not be effectively guiding patients while providing sleep hygiene education. Furthermore, the limited number of medical facilities and technicians capable of conducting overnight polysomnography tests for diagnosing sleep disordered breathing is another factor preventing more patients from benefiting from treatment. This article explores the relationship between sleep disordered breathing and the onset of cardiovascular diseases, as well as the latest treatment approaches.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"68 2","pages":"79-90"},"PeriodicalIF":0.9,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum for Yamanaka et al., \"Parental Issues and Support Needs in Selective Mutism in Japan: A Quantitative Content Analysis\".","authors":"Tomohisa Yamanaka, Honami Koyama, Masahiko Inoue","doi":"10.33160/yam.2024.11.010","DOIUrl":"https://doi.org/10.33160/yam.2024.11.010","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.33160/yam.2024.11.004.].</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"67 4","pages":"363"},"PeriodicalIF":0.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Rapidly Progressing Urothelial Carcinoma Arising After Living Donor Kidney Transplantation Treated with Chemotherapy and Immune Checkpoint Inhibitors.","authors":"Katsuya Hikita, Ryoma Nishikawa, Sosuke Taniguchi, Yukari Mae, Takuji Iyama, Tomoaki Takata, Shuichi Morizane, Masashi Honda, Atsushi Takenaka","doi":"10.33160/yam.2025.02.009","DOIUrl":"10.33160/yam.2025.02.009","url":null,"abstract":"<p><p>The incidence of malignancy following long-term immunosuppression is increased in organ transplant recipients. We report a case of a patient with right ureteral and bladder cancer after living donor kidney transplantation for chronic glomerulonephritis and who was administered chemotherapy and immune checkpoint inhibitors. A 75-year-old male, 20 years post-living donor kidney transplantation for chronic glomerulonephritis, presented with malignant cells in urinary cytology. Despite initial treatments including transurethral resection of the bladder tumor, the tumor progressed to high-grade urothelial carcinoma. Computerized tomography results showed a right ureteral tumor and multiple lymph node metastases. Therefore, the patient underwent systemic chemotherapy with four cycles of gemcitabine and carboplatin. Pembrolizumab was administered due to rapid cancer progression; however, the cancer progressed further, and the patient was treated palliatively. The patient was treated with an immune checkpoint inhibitor with a reduced dose of immunosuppressive drugs with no rejection during the treatment course.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"68 1","pages":"75-78"},"PeriodicalIF":0.9,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Juvenile Trabecular Ossifying Fibroma Arising from the Maxilla in a 2-Year-Old Child.","authors":"Makoto Kawasaki, Rieko Doi, Nobuyuki Fuji, Takayuki Tamura, Isamu Kodani","doi":"10.33160/yam.2025.02.008","DOIUrl":"10.33160/yam.2025.02.008","url":null,"abstract":"<p><p>An ossifying fibroma is a fibroosseous lesion from the maxilla and mandible. Its histopathological subtypes include juvenile trabecular ossifying fibroma (JTOF) and juvenile psammomatoid ossifying fibroma. It commonly affects young individuals and is invasive in nature. A 2-year-old girl with a 2-week history of swelling in the left infraorbital region and a reduced opening of the left eye was referred to our department. Clinical examination revealed a diffuse bone-like swelling extending from the left infraorbital region to the left buccal region. Computed tomography revealed a well-defined 2-cm lesion, and magnetic resonance imaging revealed moderate-to-high signal intensity on T2-weighted imaging. A definitive diagnosis could not be arrived at based solely on imaging findings. A biopsy was initially planned; however, the tumor was extracted because it was relatively easy to separate from the surrounding bone. Histological findings showed fascicular and spiral hyperplasia of the tumor cells containing spindle nuclei and cytoplasm. Fibroma-like stroma, immature chondrocytes, and mature trabecular osteogenesis are also observed. Osteoblast-like or partially chondrocytic sequences were observed at the margins of hard tissue. Thus, a definitive diagnosis of JTOF was established. Although the tumor was extracted only in the present case, JTOF has a high recurrence rate; thus, resection of the surrounding bone is recommended following a definitive diagnosis. In this case, the period from onset to surgery was short, and early treatment allowed the tumor to be removed before it invaded the surrounding bone; therefore, extraction alone prevented recurrence. It can be distinguished from fibrous dysplasia, which has similar pathological findings, based on the observation of osteoblast-like structures at the edge of the trabecular bone. Moreover, the negative guanine nucleotide-binding protein alpha-stimulating activity of polypeptide 1 further confirmed JTOF. No signs of recurrence were observed in this case at 11 years and 9 months postoperatively.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"68 1","pages":"68-74"},"PeriodicalIF":0.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Literacy and Related Factors in Perioperative Patients: A Cross-Sectional Descriptive Study.","authors":"Yoshimi Noguchi, Chika Tanimura, Keiko Oba, Hideyuki Kataoka","doi":"10.33160/yam.2025.02.004","DOIUrl":"10.33160/yam.2025.02.004","url":null,"abstract":"<p><strong>Background: </strong>Perioperative patient health literacy influences postoperative recovery and self-management. We conducted a cross-sectional study to determine perioperative patient health literacy levels and associated factors.</p><p><strong>Methods: </strong>From August 2021 to January 2022, 187 patients undergoing surgery at an acute care hospital completed a self-administered questionnaire, based on the Functional, Communicative and Critical Health Literacy (FCCHL) scale, to assess health literacy and related factors. Multiple regression analysis was conducted to identify factors associated with health literacy.</p><p><strong>Results: </strong>Out of 316 surveyed patients, 187 were included in the analysis. Over 70% of perioperative patients in this study were classified as having limited health literacy according to the FCCHL scale. These patients exhibited low communicative and critical health literacy. Factors significantly associated with patients' total health literacy scores included age, knowledge about diseases, education level, use of media about health and disease, and generalized self-efficacy.</p><p><strong>Conclusion: </strong>Healthcare providers should recognize that perioperative patients generally possess low health literacy. Understanding factors influencing individual health literacy levels is essential to provide tailored support in the perioperative patient.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"68 1","pages":"34-44"},"PeriodicalIF":0.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal Clinically Important Difference in the Brief Assessment of Cognition in Schizophrenia-Japanese Version Composite Score: A Single-Center Preliminary Study.","authors":"Ryo Oya, Masaki Fujiwara, Yuto Yamada, Tsuyoshi Etoh, Seiji Katayama, Masatoshi Inagaki","doi":"10.33160/yam.2025.02.005","DOIUrl":"10.33160/yam.2025.02.005","url":null,"abstract":"<p><strong>Background: </strong>Cognitive dysfunction is a major symptom in schizophrenia associated with social skills. It has been reported that cognitive rehabilitation can improve cognitive dysfunction. The Brief Assessment of Cognition in Schizophrenia-Japanese version (BACS-J) is often used as an outcome measure to assess the effectiveness of cognitive rehabilitation. However, the minimal clinically important difference (MCID) in the BACS-J composite score has not been reported. Therefore, we conducted this study to calculate a preliminary MCID in the BACS-J composite score and confirm the feasibility of retrospective data collection and analysis for future large-scale studies.</p><p><strong>Methods: </strong>The medical records of patients with schizophrenia who underwent cognitive rehabilitation were retrospectively surveyed. BACS-J data were collected at the beginning and end of the cognitive rehabilitation, and Clinical Global Impression-Improvement (CGI-I) data obtained at the end of the cognitive rehabilitation were evaluated retrospectively. To calculate the MCID in the BACS-J composite score using distribution-based methods, the standard error of measurement was calculated as a characteristic of the scale itself. To calculate the MCID using anchor-based methods, the mean change in BACS-J score corresponding to \"minimally improved\" on the CGI-I was determined.</p><p><strong>Results: </strong>Twenty-eight patients were included in this study, and BACS-J data were collected from all patients. The CGI-I was completed by 11 patients, 3 of whom showed \"minimally improved\" according to their CGI scores. Distribution-based methods applied to the data of 28 patients revealed an MCID of 0.735 for the BACS-J composite score. Anchor-based methods were ultimately not applied because the sample size was insufficient.</p><p><strong>Conclusion: </strong>This study confirmed that CGI and BACS-J data can be collected and analyzed retrospectively. According to distribution-based methods, an increase of approximately 0.7 in the BACS-J composite score can be considered clinically meaningful. Future studies with larger sample sizes using both calculation methods could provide more accurate MCID.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"68 1","pages":"45-50"},"PeriodicalIF":0.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}