Mediterranean Journal of Rheumatology最新文献

{"title":"The Effect of Lupus on Pregnancy and the Foetus: Should we really be Worried? A Single-Centre Retrospective Study.","authors":"Emre Kaan Cadir, Nazife Sule Yasar Bilge, Muzaffer Bilgin, Timucin Kasifoglu","doi":"10.31138/mjr.150923.swr","DOIUrl":"10.31138/mjr.150923.swr","url":null,"abstract":"<p><strong>Objective/aim: </strong>Systemic Lupus Erythematosus (SLE), is common in women of childbearing age and is associated with obstetric complications. The aim of this study was to evaluate the course of pregnancy and its results in SLE patients with a history of pregnancy.</p><p><strong>Methods: </strong>Pregnant patients with SLE who applied to the Rheumatology outpatient clinic of between 2010 and 2020 were retrospectively screened.</p><p><strong>Results: </strong>Fifty-five pregnancies of 31 SLE patients were included in the study. Spontaneous abortion was observed in 27.3% (n:15) and foetal loss in 18.2% (n:10). Neonatal loss or maternal death was not observed in any of the patients. The rate of patients with renal involvement was 34.5% (n:19), and the rate of exacerbation was higher in pregnant women with kidney involvement (26% vs 0% (p:0.006)). Antiphospholipid antibody syndrome (APS) was present in 32.7% (n:18) of the cases, and there was a history of foetal loss before diagnosis in 50% (n:9) of the cases with APS. The foetal loss was seen only in pregnant women with APS (55.6% (n:10) vs. 0% (n:0) (p<0.001)). Six (10.9%) of 55 pregnancies in our study were unplanned pregnancies. Of these, five resulted in abortion. Exacerbation was observed in 3 of the unplanned pregnancies.</p><p><strong>Conclusion: </strong>Pregnancy complications were significantly lower in patients who were in remission since contraception. Exacerbations were more common in unplanned pregnancies and in patients with renal involvement. The presence of APS was associated with increased pregnancy morbidity.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"464-468"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Physical Activity in the Curricula of Medical Schools and Healthcare Professions Across Europe: The VANGUARD Project Study Protocol.","authors":"George S Metsios, Ioannis D Morres, Ioannis Fatouros, Ian M Lahart, Ramune Zilinskiene, Natalja Istomina, Rytis Jankauskas, Jarek Maestu, Katerina Tzika, Eve Unt, Romeu Mendes, Ana Barbosa, Anne Vuillemin, David Darmon, Ann B Gates","doi":"10.31138/mjr.290724.iac","DOIUrl":"10.31138/mjr.290724.iac","url":null,"abstract":"<p><strong>Introduction: </strong>The 2018 published World Health Organisation (WHO) Europe physical activity factsheet reports, specify agreed targets for physical activity and articulate the need to improve the education of medical doctors and healthcare practitioners in order to increase physical activity and reduce sedentary time in people at risk and/or living with Noncommunicable Diseases (NCDs). Given the dearth of relevant initiatives and the continuous need to increase physical activity participation towards better health management of NCDs, the aim of this study is to embed physical activity in the undergraduate curricula of future frontline healthcare professionals (medical doctors and allied health professions) in European countries.</p><p><strong>Methods: </strong>The <b>V</b>irtual <b>A</b>dvice, <b>N</b>urturing, <b>G</b>uidance on <b>U</b>niversal <b>A</b>ction, <b>R</b>esearch and <b>D</b>evelopment for physical activity and sport engagement (VANGUARD) project consists of a collaborative partnership Consortium between six European Universities, WHO Europe and Ministry representatives that has been developed to implement physical activity in the curricula of medical schools and healthcare professions. The methodology of the VANGUARD project is informed by the WHO implementation guidance and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.</p><p><strong>Discussion: </strong>Through a carefully planned implementation process and via using established appropriate implementation evaluation tools, the end result of the VANGUARD project will be the a) implementation of a physical activity module in six different European Universities (five medical schools and one physiotherapy department) and b) development of a toolkit/guide, in order to assist other healthcare systems and European Universities to develop relevant grass-root innovations for addressing the decline in physical activity levels.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"498-503"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sulfasalazine-Induced Agranulocytosis: A Case Series and Review of Literature.","authors":"Nikita Chettri, Mahabaleshwar Mamadapur, Ramaswamy Subramanian, Dharmarajan Sandhya, Jaidev Kumar B R","doi":"10.31138/mjr.010124.sia","DOIUrl":"10.31138/mjr.010124.sia","url":null,"abstract":"<p><p>Sulfasalazine (SSZ) remains a valuable treatment option for Rheumatoid Arthritis (RA), especially in women of childbearing age, and is considered safe in pregnancy and lactation. However, the adverse effects in the form of allergic reactions, rashes, feverishness, and gastrointestinal symptoms are not uncommon and usually resolve on discontinuation of the drug. Despite the potential adverse effects, the occurrences are infrequently reported. Agranulocytosis (ANC < 500 cell/cumm) is a rare complication of SSZ that may be potentially life-threatening. We report two cases of SSZ-induced agranulocytosis after 6 weeks of initiation of treatment for RA despite normal leucocyte counts in the initial phase of treatment. There was complete recovery of the counts following discontinuation, along with the institution of colony-stimulating factors and antibiotics for febrile neutropenia. Notably, Granulocyte Colony-Stimulating Factor (G-CSF) did not produce any adverse effects, and the patients were discharged after their ANC levels returned to normal. It is, therefore, essential to regularly monitor blood counts following the initial treatment.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"479-483"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catatonia in Juvenile Systemic Lupus Erythematosus: A Case Series.","authors":"Mahabaleshwar Mamadapur, Sabarinath Mahadevan, Ponniah Subramanian ArulRajamurugan","doi":"10.31138/mjr.311223.cij","DOIUrl":"10.31138/mjr.311223.cij","url":null,"abstract":"<p><p>Neuropsychiatric systemic lupus erythematosus (NPSLE) presents a significant diagnostic and therapeutic challenge due to its varied clinical manifestations. The prevalence of NPSLE ranges widely, reported between 37% and 95% in different case series, reflecting this condition's complex and heterogeneous nature. Here we report three cases of juvenile systemic lupus erythematosus (SLE) presenting with catatonia as a rare neuropsychiatric manifestation. Case 1 is a 15-year-old male with fever, and pancytopenia, diagnosed with SLE and subsequent development of catatonia. Case 2 is a 14-year-old female with a history of SLE presenting with altered sensorium, restlessness, and catatonia. Case 3 is a 15-year-old male with SLE exhibiting abnormal behaviour and catatonia. Treatment strategies for these cases include high-dose steroids, immunosuppression, and benzodiazepines. This case series emphasises the importance of a multidisciplinary approach, prompt diagnosis, aggressive treatment, and vigilant follow-up to optimise outcomes in these vulnerable paediatric patients. In conclusion, this case series contributes to the literature on catatonia in paediatric SLE, emphasising the need for expanded awareness, early recognition, and comprehensive management strategies. Further research is warranted to refine predictive factors and establish optimal maintenance protocols for this complex neuropsychiatric manifestation.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"474-478"},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicentric Osteolysis Nodulosis and Arthropathy (MONA): A Case Series and Review of the Literature.","authors":"Mahabaleshwar Mamadapur, Sabarinath Mahadevan, Ponniah Subramanian ArulRajamurugan, Srilakshmi Gandham, Swati Singh","doi":"10.31138/mjr.311203.mon","DOIUrl":"10.31138/mjr.311203.mon","url":null,"abstract":"<p><p>Multicentric Osteolysis Nodulosis and Arthropathy (MONA) is a rare skeletal disorder driven by mutations in the MMP2 gene, leading to bone and joint degradation. This case series presents three unique MONA cases, highlighting clinical, radiological, and genetic aspects. These insights shed light on the complexities of MONA, aiding early diagnosis and multidisciplinary management. Case 1 is a 13-year-old male, born to consanguineous parents, presented with a 5-year history of progressive joint deformities, pain, and difficulty walking. Initially diagnosed as juvenile idiopathic arthritis (JIA), despite treatment, his symptoms persisted. Examination revealed multiple clinical findings, including joint contractures and nodules. Genetic analysis identified a pathogenic variant in the MMP2 gene, confirming MONA. Case 2 and Case 3 were two siblings, aged 12 and 17 years respectively, who presented progressive joint contractures in their hands and feet since early childhood. Clinical examinations revealed contractures and subcutaneous nodules. Genetic analysis confirmed MONA with a shared homozygous pathogenic MMP2 variant, emphasising the genetic basis of this rare disorder.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"486-489"},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Trials of Interferon Inhibitors in Systemic Lupus Erythematosus and Preliminary Real-World Efficacy of Anifrolumab.","authors":"Samuel Díaz-Planellas, Dimitrios Katsifis-Nezis, Antonis Fanouriakis","doi":"10.31138/mjr.260624.cto","DOIUrl":"10.31138/mjr.260624.cto","url":null,"abstract":"<p><p>Approval of anifrolumab for the treatment of moderate-to-severe systemic lupus erythematosus (SLE) in 2021 marked the success of a long quest to target the interferon system, in a disease wherein the latter has long been considered to play a pivotal role. Prior to anifrolumab, a number of agents had been tested in early phase clinical trials in patients with SLE, with equivocal results. Following its approval and marketing in several countries, the first reports regarding efficacy and safety in real-life clinical settings have been published, which suggest remarkable efficacy in skin manifestations of the disease, even after prior failure to multiple immunosuppressive therapies. In this report, we provide a short overview of IFN inhibitors that have been used in clinical trials of SLE, with a focus on anifrolumab; we also review all available evidence to date regarding its real-world efficacy and safety.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 Suppl 2","pages":"381-391"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving Concepts in Treat-to-Target Strategies for Systemic Lupus Erythematosus.","authors":"Dionysis Nikolopoulos, Maria Helena Lourenço, Roberto Depascale, Konstantinos Triantafyllias, Ioannis Parodis","doi":"10.31138/mjr.290424.eci","DOIUrl":"10.31138/mjr.290424.eci","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that is characterised by a wide range of symptoms and a risk for irreversible organ damage, leading to increased morbidity and mortality. To improve long-term outcomes, innovative therapeutic goals have been explored, including attainment and maintenance of remission or low disease activity, with minimal use of glucocorticoids. Other goals encompass early diagnosis, potent yet less toxic therapies, appropriate glucocorticoid tapering, and better quality of life for the patients. Implementing a treat-to-target (T2T) approach involves treatment adjustments to achieve predefined objectives. Evidence from other chronic diseases, like hypertension and diabetes, supports the success of target-based approaches. In rheumatic diseases, the multitude of clinical features adds complexity to T2T strategies, but in rheumatoid arthritis, T2T has yielded improved outcomes. The application of T2T in SLE requires realistic therapeutic goals and practical tools for their measurement. International task forces have developed T2T recommendations for SLE, focusing on limiting disease activity, preventing organ damage, and minimising glucocorticoid use, while considering patients' quality of life. Advancements in defining clinically meaningful remission and low disease activity states, coupled with promising novel therapies, have spurred progress in the management of SLE.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 Suppl 2","pages":"328-341"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Approaches to Prevent or Reverse Microbiome Dysbiosis in Chronic Inflammatory Rheumatic Diseases.","authors":"Jan René Nkeck, Ange Larissa Tchuisseu-Kwangoua, Adeline Pelda, Wilson Chia Tamko, Saquinatou Hamadjoda, Doris Bibi Essama, Baudelaire Fojo, Moustapha Niasse, Saïdou Diallo, Madeleine Ngandeu-Singwé","doi":"10.31138/mjr.240224.cap","DOIUrl":"https://doi.org/10.31138/mjr.240224.cap","url":null,"abstract":"<p><p>Advances in knowledge of the microbiome and its relationship with the immune system have led to a better understanding of the pathogenesis of chronic inflammatory rheumatic diseases (CIRD). Indeed, the microbiome dysbiosis now occupies a particular place with implications for the determinism and clinical expression of CIRD, as well as the therapeutic response of affected patients. Several approaches exist to limit the impact of the microbiome during CIRD. This review aimed to present current strategies to prevent or reverse microbiome dysbiosis based on existing knowledge, in order to provide practical information to healthcare professionals treating patients suffering from CIRD.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 2","pages":"220-233"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultural Adaptation and Development of an Educational Intervention <i>'Meri Sehat, Mere Rules'</i> Relating to Cardiovascular Disease Associated with Rheumatoid Arthritis for South Asian People.","authors":"Ruman Tiwana, Atiya Kamal, Dilsher Singh, Durga Prasanna Misra, Afshan Salim, Faika Usman, Holly John, George D Kitas, Sheila Greenfield, Prem Kumar, Claire Ray, Ailsa Bosworth, Ayesh Ahmad, Joti Reehal, Kanta Kumar","doi":"10.31138/mjr.120623.ado","DOIUrl":"https://doi.org/10.31138/mjr.120623.ado","url":null,"abstract":"<p><strong>Background: </strong>The cardiovascular disease (CVD) risk is elevated by 1.5 times among South Asians with rheumatological conditions like rheumatoid arthritis (RA) in the UK. However, there is a dearth of culturally sensitive educational interventions tailored to this population. We have culturally adapted an existing cognitive behavioural patient education intervention, originally designed for predominantly White populations, to address this gap.</p><p><strong>Methods: </strong>The adaptation process followed the Ecological Validity Model, comprising four phases: stage-setting and expert consultations, preliminary content adaptation, iterative content adaptation with patient partners, and finalisation with patient partners and feedback. The Theoretical Domains Framework (TDF) was employed to evaluate the relevance, acceptability, and cultural adaptation of the existing intervention. Seven South Asian Patient Experts with RA were interviewed, and their input aided in developing new content for the culturally sensitive intervention.</p><p><strong>Results: </strong>The intervention was successfully adapted to suit South Asians. Cultural adaptation involved reviewing elements of the existing intervention, including language tone, content, and metaphors. Moreover, by incorporating behaviour change techniques, the content was designed to enhance understanding of RA, CVD risk associated with RA, and promote a healthy lifestyle. The newly developed educational intervention addressed topics such as community resistance, perspectives on health and culture, societal pressure, and opportunities for change. Key messages were visually illustrated through pictorial diagrams in a twenty-five-minute online resource.</p><p><strong>Conclusion: </strong>The first culturally adapted CVD intervention targeting South Asian individuals with RA, particularly those who are non-English-speaking, is now accessible free of charge at www.nras.org.uk/apnijung nationally and internationally.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 2","pages":"272-282"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, Causes and Outcomes of Acute Gastrointestinal Bleeding in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.","authors":"Shobhit Piplani, Vladimir Jelic, Adejoke Johnson, Usman Shah, Shiny Kolli, Steve Kong, Nikola Tanasijevic, Vishal Reddy Bejugam, Sumaja Reddy Goguri, Phanidhar Mogga, Sripada Preetham Kasire, Salil Chaturvedi, Priyanshu Jain","doi":"10.31138/mjr.230324.pca","DOIUrl":"https://doi.org/10.31138/mjr.230324.pca","url":null,"abstract":"<p><strong>Aim: </strong>The present study aims to investigate the prevalence, causes and outcomes of acute gastrointestinal (GI) bleeding in Rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 14^th November 2023. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in prevalence and their corresponding 95% confidence interval (CI). Other outcomes were assessed using qualitative analysis.</p><p><strong>Results: </strong>A total of eight studies (six observational studies and 2 trials were used to conduct this systematic review and meta-analysis. A total population of 138,041 patients was used. Pooled analysis showed a statistically significant risk of GI bleeding in RA patients receiving NSAIDs (prevalence = 2% (1%, 3%); P < 0.00001; I2 = 98%). Qualitatively, causes and outcomes were discussed.</p><p><strong>Conclusion: </strong>Our study showed that 2% RA patients were subjected to GI bleeding, when they used NSAIDs. Other causes of GI bleeding were age-related factors, cardiovascular events, history of GI complications, and peptic ulcers. Outcome varied by the use of specific NSAIDs and the presence of comorbidities. Recent guidelines for the management of RA may mention GI bleeding as a potential complication, but the level of emphasis placed on this issue varies. Some guidelines provide comprehensive recommendations for its prevention and management, while others offer limited guidance.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 2","pages":"210-219"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}