Technical Innovations and Patient Support in Radiation Oncology最新文献

{"title":"Dealing with rectum motion during radiotherapy: How can we anticipate it?","authors":"","doi":"10.1016/j.tipsro.2024.100277","DOIUrl":"10.1016/j.tipsro.2024.100277","url":null,"abstract":"<div><h3>Introduction</h3><div>Intra- and inter-fraction rectum motion is important for pelvic radiotherapy (RT). This study assesses how RT session duration, the presence or the absence of an intra-rectal tumour, and the distance from the anorectal junction (ARJd) impact rectal motion.</div></div><div><h3>Materials and methods</h3><div>Analyses used cone-beam computed tomographies (CBCTs) from RT patients treated for rectal and prostate cancer. Three structures were evaluated: (1) the entire rectum in patients without a rectal tumour (Rectum_Prostate); (2) the non-invaded portion (Rectum_Rectum) and (3) the tumour-invaded portion (Rectum_Tumour) in rectal cancer patients.</div><div>Intrafraction motion was assessed using the Hausdorff distance 95% and the Mean distance-to-agreement between structures delineated on the first CBCT and the 2 subsequent CBCTs within a same RT session. Interfraction motion was quantified by comparing structures delineated on the planning-CT and the first CBCT of each session.</div><div>Linear mixed model evaluated rectum motion in relation to time, tumour presence, and ARJd, respectively.</div></div><div><h3>Results</h3><div>We included 10 patients with and 10 without rectal cancer, collecting 385 CBCTs. A significant correlation (p &lt; 0.05) between rectum motion and RT session duration was found. Intrafraction motion was significantly higher in prostate cancer patients (Rectum_Prostate motion &gt; Rectum_Rectum and Rectum_Tumour, p &lt; 0.01). For interfraction motion, only the mean distance to agreement was significantly higher for Rectum_Prostate (p &lt; 0.05). Motion increased significantly with ARJd for all three structures (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Session duration, absence of a tumour, and ARJd are associated with larger intra- and interfraction rectal motion. This highlights the need for tailored RT treatment, including online-adaptive RT, to manage intra- and interfraction variations. Rectal motion should be handled differently for patients with prostate cancer and those with rectal cancer.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326870","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":"Assessment of usage, reuse and disposal of thermoplastic masks among radiotherapy technologists in India: A nationwide perspective","authors":"","doi":"10.1016/j.tipsro.2024.100278","DOIUrl":"10.1016/j.tipsro.2024.100278","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiotherapy (RT) relies on devices like thermoplastic masks (TMs), that are made up of specialized thermoplastic polymers, and used as an immobilization tool. The study aims to assess the practice of usage and reuse of TMs among radiation therapy technologists (RTTs) in India and explore their awareness of environmental impact during disposal.</div></div><div><h3>Materials and Methods</h3><div>A cross-sectional survey was conducted among RTTs working in different healthcare settings. A structured questionnaire designed by a team of RTTs and radiation oncologists was used to collect responses. Questionnaire encompassed data pertaining to demographics, existing patient load, daily utilisation and reuse practice of TMs, preferred method of disposal and awareness of RTTs regarding environmental consequences associated with TM disposal.</div></div><div><h3>Results</h3><div>A total of 430 RTTs participated in the study, with a median age of 31 years and a median professional experience of 8 years. Among the participants, 213 (49.6 %) reported daily TM utilization in more than 50 patients. TM reuse was reported by 350 (81.1 %) RTTs, with 257 (60 %) reusing TMs in both curative and palliative treatments. Reuse of TMs was observed more commonly in RTTs working in government facilities (81.2 %).</div><div>Regarding disposal preferences, 381 (88.6%) participants preferred discarding used TMs in biomedical waste and 64.8% of these ultimately ended up as discarded scrap. Awareness regarding adverse environmental impact associated with TM disposal was reported by 320 (74.4%) participant RTTs.</div></div><div><h3>Conclusion</h3><div>The study highlights the prevalent practice of reuse of TMs, especially in curative treatments, government-run facilities and busy treatment settings. Additionally, it emphasises the imperative for enhanced bio-medical waste management practices to facilitate more effective handling and disposal of used TMs.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326933","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":"Socioeconomic disadvantage and its impact on patient satisfaction at a multi-site radiation oncology center","authors":"","doi":"10.1016/j.tipsro.2024.100276","DOIUrl":"10.1016/j.tipsro.2024.100276","url":null,"abstract":"<div><h3>Purpose</h3><p>Despite the importance of patient satisfaction (PS) on healthcare outcomes, the factors that influence PS in radiation oncology remain unexplored. This study assesses the influence of socioeconomic status (SES) on PS in radiation oncology, using the Area Deprivation Index (ADI) as a measure of SES.</p></div><div><h3>Methods</h3><p>This single-institution cross-sectional study used the National Research Council (NRC) PS survey at four radiation oncology sites from 2021 to 2023. SES was measured using ADI data from the Neighborhood Atlas. Univariate (UVA) and multivariable (MVA) logistic regression analyses were conducted on recommendation scores (0–10 scale, with 9 or higher indicating a likelihood to recommend).</p></div><div><h3>Results</h3><p>In our analysis of 7,501 survey responses, most patients were female (55.3 %), had curative treatment intent (81.5 %), and were diagnosed with breast cancer (30.4 %), with most being follow-up visits (69.0 %). Average scores for state and national ADI were 3.94 and 50.75, respectively. UVA identified factors such as curative intent (OR 1.68, p &lt; 0.001), follow-up visits (OR 1.69, p &lt; 0.001), and breast cancer diagnosis (OR 1.42, p = 0.018) as enhancing the likelihood of recommending the facility or provider. Those with a national ADI above the mean showed lower propensity to recommend the facility (OR 0.81, p = 0.050) or provider (OR 0.71, p = 0.002). MVA confirmed the significance of national ADI on provider recommendations (OR 0.730, p = 0.005) but not facility recommendations (OR 0.832, p = 0.089).</p></div><div><h3>Conclusion</h3><p>Patients facing higher SES disadvantages are less inclined to recommend their healthcare provider. These results highlight the role of SES in PS assessments and advocate for further investigation into how SES impacts PS and patient-provider relationships.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240563242400043X/pdfft?md5=88efb89a04100f6514f2cffd0fe7aaf5&pid=1-s2.0-S240563242400043X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142163457","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":"Corrigendum to “Empowering radiation therapists: The role of an African Community of Practice in developing radiation Therapist education curriculum” [Tech. Innov. Patient Support Radiat. Oncol. 31 (2024) 100256]","authors":"","doi":"10.1016/j.tipsro.2024.100274","DOIUrl":"10.1016/j.tipsro.2024.100274","url":null,"abstract":"","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000416/pdfft?md5=81d31a38d28fb4ee0f0272fcbfa56199&pid=1-s2.0-S2405632424000416-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151318","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":"Symptom experience and symptom distress in patients with malignant brain tumor treated with proton therapy: A five-year follow-up study","authors":"","doi":"10.1016/j.tipsro.2024.100269","DOIUrl":"10.1016/j.tipsro.2024.100269","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Since patients with primary brain tumor are expected to become long-term survivors, the prevention of long-term treatment-induced side effects is particularly important. This study aimed to explore whether symptom experience and symptom distress change over five years in adults with primary brain tumors treated with proton therapy. An additional aim was to explore whether symptom experience and symptom distress correlate.</p></div><div><h3>Materials and methods</h3><p>The study had a longitudinal observational design. Adult (≥18 years) patients (n = 170) with primary brain tumors treated with proton therapy were followed over five years. Symptom experience and symptom distress were evaluated using the patient-reported Radiotherapy-Related Symptom Assessment Scale. Data from baseline, 1, 12, and 60 months were analyzed using non-parametric tests.</p></div><div><h3>Results</h3><p>Of the 170 patients, the levels of symptoms and symptom distress were low. Fatigue increased at 1 (p=0.005) and 12 months (p=0.025) and was the most frequent symptom from baseline to 60 months’ follow-up. Cognitive impairment increased at 12 (p=0.027) and 60 months (p&lt;0.001) and was the most distressing symptom at 60 months’ follow-up. There were significant, moderate to strong, correlations at all time points between symptom experience and symptom distress of fatigue, insomnia, pain, dyspnea, cognitive impairment, worry, anxiety, nausea, sadness, constipation, and skin reactions.</p></div><div><h3>Conclusion</h3><p>Symptom experience and symptom distress changed in intensity over time with cognitive impairment as the most distressing symptom at 60 months. Future research should focus on identifying effective interventions aimed at alleviating these symptoms and reducing symptom distress for this vulnerable group of patients.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000362/pdfft?md5=325e199b3373d09fb84b6f5f14132223&pid=1-s2.0-S2405632424000362-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095693","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":"Comparing the effects of warm footbath and foot reflexology on depression of patients undergoing radiotherapy: A randomized clinical trial","authors":"","doi":"10.1016/j.tipsro.2024.100270","DOIUrl":"10.1016/j.tipsro.2024.100270","url":null,"abstract":"<div><h3>Background</h3><p>Cancer diagnosis not only impacts physical health but also mental well-being, often leading to significant stress, fear, and depression among patients.The utilization of CAM has shown a rising trend, influenced by the availability of different modalities offered by healthcare services, sometimes in an ad hoc fashion. This study seeks to examine and compare the respective impacts of warm foot baths and foot reflexology on depression in patients undergoing radiotherapy.</p></div><div><h3>Methods</h3><p>A randomized clinical trial was conducted at Mashhad University of Medical Sciences in Iran in 2019, following CONSORT guidelines. Participants included non-metastatic cancer patients aged 18–60 undergoing a 28-day radiotherapy course. Patients were randomly assigned to receive either warm footbaths or foot reflexology as interventions, performed daily for 20 min over 21 days. The data were analyzed using appropriate statistical tests.</p></div><div><h3>Results</h3><p>Statistical analysis indicated no significant differences in demographic attributes between the two groups. Both interventions led to a significant reduction in depression scores post-treatment compared to pre-treatment assessments. Foot reflexology showed a greater reduction in depression scores compared to footbaths with warm water.</p></div><div><h3>Conclusions</h3><p>Both warm footbaths and foot reflexology are effective in alleviating depression in patients undergoing radiotherapy, with foot reflexology showing a greater impact on improving depression levels. The study recommends foot reflexology as a preferred intervention for managing depression in these patients if conditions and facilities permit.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000374/pdfft?md5=5665cb35ed8a97681a72cbb4576544d8&pid=1-s2.0-S2405632424000374-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095694","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":"Optimized needle configuration for operational seed (ONCOSEED) efficiency and deployment for prostate seed implants","authors":"","doi":"10.1016/j.tipsro.2024.100273","DOIUrl":"10.1016/j.tipsro.2024.100273","url":null,"abstract":"<div><p>Due to anatomical changes between pre-planning and implantation, there exists a need for tools that can streamline the adjustment of needle and seed configurations in low dose rate brachytherapy for prostate cancer. Specifically, upon taking a second ultrasound on the day of treatment, the distribution of seeds and needles will differ drastically from the original plan. Clinics that employ this method must then spend time and resources to generate a workflow to manipulate the original configuration to the new configuration. ONCOSEED extracts data from VariSeed treatment plans, calculating a labor score (LScore) to optimize adjustments to needle configurations. A case study of three simulated VariSeed treatment plans was used to compare the ONCOSEED software to the manual method of generating a workflow. In the same method that was used at the authors’ clinic, several assistants annotated by hand the original plan to convert it to the new plan. The time taken to do so was recorded and compared to the runtime of the software when generating a workflow for the same plan. Results showed that ONCOSEED was on average 28 times faster than generating a workflow by hand. ONCOSEED enhances the efficiency of seed replacement in LDR brachytherapy, promoting the adoption of adaptive brachytherapy practices.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000404/pdfft?md5=07aef45c04b54114bac9cc376fd4fd18&pid=1-s2.0-S2405632424000404-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148227","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":"Global assessment of swallow function (GASF) following VMAT radiotherapy for head and neck squamous cell carcinoma","authors":"","doi":"10.1016/j.tipsro.2024.100272","DOIUrl":"10.1016/j.tipsro.2024.100272","url":null,"abstract":"<div><h3>Aim</h3><p>This study aimed to conduct a global assessment of swallow function (GASF) using a range of swallow outcome tools, in a cohort of patients pre- and post-treatment with image-guided volumetric modulated arc therapy (VMAT) radiotherapy.</p></div><div><h3>Materials and methods</h3><p>All patients receiving radical (chemo)radiation for SCC of the larynx, oro-, hypo- or nasopharynx between October 2016 – 2021 were eligible for inclusion.Patients were treated with VMAT radiotherapy according to institutional and national protocols.</p><p>Patients underwent GASF pre- and 6 months post-treatment. Data were collated from the MD Anderson Dysphagia Inventory (MDADI), the Functional Oral Intake Scale (FOIS), the Performance Status Scale-Head and Neck: Normalcy of Diet scale (PSS-NoD), the 100 ml water swallow test (WST) for capacity and maximal interincisal opening (MIO).</p></div><div><h3>Results</h3><p>One hundred and seventy-five patients were included. 55.2 % of patients experienced a fall in MDADI-Composite score greater than the published meaningful clinical important difference (MCID).A trend for a decrease in FOIS score reflects a decrease in range of diet textures and increase in reliance on enteral feeding at 6 months post-treatment.Mean PSS-NoD score decreased reflecting increased restriction in diet textures.20 patients’ WST capacity improved by the minimal clinically important difference of &gt; 4mls whilst 37 % of patients experienced a decrease in WST capacity of 4mls or more. 12.6 % of patients developed trismus following radiotherapy.</p></div><div><h3>Conclusions</h3><p>This paper adds new detail to the understanding of the decline in measured eating, drinking and swallowing function that patients treated with VMAT radiotherapyexperience at 6 months post treatment. However, gaps are highlighted in the evidence base in terms of interpretation of swallow outcomes tool scores; future research in HNC should include ongoing discussion and development around robust outcomes tools and data collection.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000398/pdfft?md5=4727b7d813d751526c4252ff827f404f&pid=1-s2.0-S2405632424000398-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270354","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":"Evaluating pre-consult patient education videos for patients with newly-diagnosed anal squamous cell carcinoma: Impact on patient comprehension, satisfaction and distress","authors":"","doi":"10.1016/j.tipsro.2024.100271","DOIUrl":"10.1016/j.tipsro.2024.100271","url":null,"abstract":"<div><div>We hypothesized that pre-consult patient education videos can improve patient understanding about their diagnosis, lead to high satisfaction and low distress. In this pilot study, we developed a patient education video curriculum for patients with newly-diagnosed anal cancer. Comprehension of key content was evaluated by comparing pre- and post-test scores. Patient satisfaction scores were collected. Patient distress scores (0–10) were collected at the beginning of their consult visit prior to seeing the physician. We found that patient education videos prior to consult improved patient understanding, resulted in high patient satisfaction, and low patient distress at the time of consult.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358535","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":"Evaluation of helical tomotherapy as an alternative for left-sided breast cancer patients not compliant with deep inspiration breath hold","authors":"","doi":"10.1016/j.tipsro.2024.100268","DOIUrl":"10.1016/j.tipsro.2024.100268","url":null,"abstract":"<div><h3>Purpose</h3><p>The aim of this study is to investigate, from a dosimetric perspective, whether helical Tomotherapy (HT) during free breathing (FB) can serve as an alternative technique for treating left-sided breast cancer patients who are unable to comply with the deep inspiration breath hold (DIBH) technique.</p></div><div><h3>Material and Methods</h3><p>For this purpose, the CT images of 20 left breast-only cancer patients acquired in both FB and DIBH phases were utilized. The left breast was contoured as the target volume, while the heart, LAD, ipsilateral and contralateral lungs, and contralateral breast were contoured as organs at risk on the CT images obtained in both DIBH and FB. Planning with the volumetric modulated arc therapy (VMAT) technique was performed on the CT scans obtained in the DIBH (VMAT-DIBH), while planning with the HT technique was carried out on the CT scans obtained in the FB (HT-FB). Subsequently, dosimetric comparison of the plans were done in terms of target coverage and preservation of normal tissues.</p></div><div><h3>Results</h3><p>Both techniques achieved the desired target coverage; however, in terms of D2, Vpres values, Conformity Number (CN), and Homogeneity Index (HI), the HT-FB technique was found to be superior. While the mean doses to the heart were similar for both techniques, doses to the LAD and left lung were found to be superior in plans generated with the HT-FB technique. When compared in terms of contralateral breast and right lung protection, VMAT-DIBH technique was found to be significantly superior.</p></div><div><h3>Conclusion</h3><p>The treatment of left breast-only patients with the HT-FB technique has been observed to provide similar heart protection and better LAD and ipsilateral lung protection compared to the VMAT-DIBH technique without compromising target coverage. However, when the HT-FB technique is used, doses to the contralateral lung and contralateral breast should be carefully evaluated.</p></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405632424000350/pdfft?md5=f43887f96759c17f907792661595fe46&pid=1-s2.0-S2405632424000350-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006482","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}