Tunisie Medicale最新文献

{"title":"Andes Hantavirus at FIFA World Cup 2026: No vaccine, no protocol, no time.","authors":"Ismail Dergaa, Helmi Ben Saad","doi":"10.62438/tunismed.v104i05.6989","DOIUrl":"https://doi.org/10.62438/tunismed.v104i05.6989","url":null,"abstract":"<p><p>NO.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"683-685"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Associated factors of difficult-to-treat spondyloarthritis].","authors":"Séiny Kanta, Najlae El Ouardi, Mahamadou Sagara, Houda El Assad, Hajar Zouaki, El Kacem El Marbouh, Alassane Alidou Garba, Abdellah Ould Mohamed, Laila Taoubane, Abderrahim Majjad, Hamza Toufik, Ahmed Bezza","doi":"10.62438/tunismed.v104i05.6683","DOIUrl":"https://doi.org/10.62438/tunismed.v104i05.6683","url":null,"abstract":"<p><strong>Introduction: </strong>Biotherapies have revolutionised the management of spondyloarthritis (SpA). Despite these advances, there is still a proportion of patients with multiple changes in biological markers, which may correspond to difficult-to-treat spondyloarthritis (SPA D2T). Our study aims to explore the prevalence of this particular entity and to characterise its clinical aspects in a Moroccan population.</p><p><strong>Methods: </strong>This is a comparative cross-sectional study that included patients with SpA admitted to the department on biologic therapies. Sociodemographic, comorbidity, clinical, paraclinical and therapeutic data were collected. Patients who had received at least two biologics were considered to be SpA D2T. A comparison was made with a control group of non-multi-switchers (SpA-non-D2T).</p><p><strong>Results: </strong>210 patients were included, 56.2% of whom were men. The prevalence of multi-switchers was 32,7%. D2T SpA patients were predominantly female (53,6% versus 39%, p= 0,04), had more axial involvement (76,8% versus 91,5%, p= 0,003), CsDMARD use (97,1% versus 31,9%, p= 0,001). Disease activity at the initiation of biotherapy was higher in D2T-ASDs. The time between diagnosis and use of the first biologic was longer (4 [2,25-6] years versus 3 [1-4] years, p = 0,03). All D2T-SPA patients had received anti-TNFα.</p><p><strong>Conclusion: </strong>Our study found a high prevalence of D2T-SpA.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"646-650"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and tolerability of Methylphenidate in children and adolescents with ADHD : A Systematic Review.","authors":"Nour El Houda Ayadi, Randaline Ayoub, Hela Ben Abid, Maha Ajmi, Asma Guedria","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Methylphenidate is the most commonly prescribed first-line stimulant for managing Attention-Deficit/Hyperactivity Disorder (ADHD, yet concerns remain regarding its safety and potential impact on neurodevelopment during critical growth periods.</p><p><strong>Aim: </strong>To systematically review the literature in order to evaluate the efficacy and tolerability of methylphenidate in the treatment of children and adolescents with Attention-Deficit/Hyperactivity Disorder, and to assess the applicability of international guidelines in Tunisia.</p><p><strong>Methodology: </strong>A systematic literature review was conducted following the PRISMA methodology. The search was conducted in PubMed, google scholar and science direct using the following terms: « methylphenidate », « children and adolescents », « efficacy », « tolerability » and « ADHD ». The search covered the period from 2015 to 2025.</p><p><strong>Results: </strong>Our review included 28 articles, comprising clinical trials, randomized controlled trials, and case reports. Findings consistently demonstrate that methylphenidate improves core ADHD symptoms, including attention, hyperactivity, and impulsivity, while also enhancing executive functions, social cognition, and emotional regulation. This treatment is generally well-tolerated, with commonly reported adverse events including decreased appetite, insomnia, irritability, and mild cardiovascular changes. Growth effects are typically modest and reversible, and serious adverse events are rare.</p><p><strong>Conclusion: </strong>Our findings support the short-term efficacy and acceptable safety of methylphenidate in children and adolescents with ADHD, while highlighting uncertainties regarding long-term outcomes.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"591-601"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative benchmarking of three artificial intelligence chatbots (ChatGPT-5.1, Qwen- 3 Max, and Perplexity AI) on faculty validated undergraduate respiratory physiology multiple-choice examinations.","authors":"Khouloud Kchaou, Salma Mokaddem, Soumaya Khaldi, Yacine Ouahchi, Khadija Ayed, Rym Baati","doi":"10.62438/tunismed.v104i05.6620","DOIUrl":"https://doi.org/10.62438/tunismed.v104i05.6620","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) chatbots are increasingly used by medical students for learning and examination preparation. However, their reliability in mechanistically demanding disciplines such as respiratory physiology remains insufficiently evaluated using authentic examination material. This study aimed to assess and compare the performance of three AI chatbots on validated undergraduate respiratory physiology examination questions.</p><p><strong>Methods: </strong>We conducted a cross-sectional analytical study including all respiratory physiology multiple-choice questions (MCQs), each comprising five propositions, used in official undergraduate examinations at the Faculty of Medicine of Tunis during the academic years 2023-2024 and 2024-2025 (101 questions). Three AI chatbots (ChatGPT-5.1, Qwen-3 Max, and Perplexity AI) were evaluated using standardized French-language prompts. Exact question-level concordance with the faculty-validated answer key, established by the teaching staff responsible for respiratory physiology examinations, was compared using Cochran's Q test and pairwise McNemar tests. At the proposition level, responses were analyzed as binary outcomes (true/false) to compute accuracy, sensitivity, and specificity.</p><p><strong>Results: </strong>Question-level exact concordance differed significantly across models (Cochran's Q = 10.18, p = 0.006). ChatGPT showed the highest concordance rate (79.2%), followed by Qwen (74.3%) and Perplexity (62.4%). At the proposition level (505 propositions), ChatGPT achieved the highest overall accuracy (94.1%) and sensitivity for true propositions (96.5%), whereas Qwen demonstrated the highest specificity for false propositions (94.2%).</p><p><strong>Conclusion: </strong>Although all evaluated AI chatbots performed well on respiratory physiology MCQs, substantial variability was observed across models. These findings indicate that AI chatbots are not interchangeable and underscore the need for institution-level evaluation using local examination material before their integration into medical education.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"634-639"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Meteorological Variables on the Occurrence of Deep Venous Thrombosis.","authors":"Ahmed Guiga, Rahma Labiadh, Amel Amara, Asma Ghrissi, Nouha Douss, Maissa Thabet, Amal Bayya Chatti, Amira Atig, Wissal Ben Yahia, Neirouz Ghannouchi","doi":"10.62438/tunismed.v104i05.6557","DOIUrl":"https://doi.org/10.62438/tunismed.v104i05.6557","url":null,"abstract":"<p><strong>Background: </strong>Deep venous thrombosis (DVT) risk factors are well-established, yet meteorological influences remain debated, especially in North Africa.</p><p><strong>Aim: </strong>We assessed associations between meteorological factors, seasonal patterns, and DVT incidence in central Tunisia.</p><p><strong>Methods: </strong>This monocentric cross-sectional study included 211 patients with 217 ultrasound-confirmed DVT episodes (2009-2021) residing in Sousse or Kairouan. Meteorological data were obtained from national sources. Multivariate analysis adjusted for residence and the COVID-19 period (2020-2021).</p><p><strong>Results: </strong>Idiopathic DVT accounted for 53.9% of cases, peaking in winter (p=0.010), while cancer-associated DVT peaked in summer (p=0.017). No significant differences emerged between Sousse and Kairouan residents. Months with DVT exhibited higher cloud cover (19.2% vs. 16.89%, p=0.032) and lower atmospheric pressure (1018.36 vs. 1020.13 hPa, p=0.042). Multivariate analysis confirmed increased cloud cover (aOR=1.04, p=0.046) and lower pressure (aOR=0.88, p=0.047) as independent risk factors. COVID-19 period incidence was higher (IRR=1.46, p=0.032) but did not alter meteorological associations. Summer 2021 heatwave analysis confirmed result stability.</p><p><strong>Conclusion: </strong>Lower atmospheric pressure and greater cloud cover independently increase DVT risk in central Tunisia. Seasonal patterns vary by etiology. Despite pandemic-related incidence increases, meteorological associations remained robust, suggesting weather modulates thrombotic risk.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"640-645"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors of low anterior resection syndrome: Meta-analysis with Subgroup Analysis.","authors":"Mohamed Mehdi Trabelsi, Neirouz Kammoun, Salsabil Nasri, Amine Ben Safta, Imen Samaali, Ramzi Nouira, Chadli Dziri","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of major LARS and its associated risk factors remains variably reported in the literature. This meta-analysis aimed to assess the pooled prevalence of major LARS and to identify its predictive factors.</p><p><strong>Methods: </strong>We conducted a meta-analysis in accordance with PRISMA 2020 and AMSTAR 2 guidelines to identify studies reporting the prevalence of major LARS or its associated risk factors. Subgroup analyses was used to explain heterogeneity.</p><p><strong>Results: </strong>A total of 21 studies comprising 3,730 patients were included. The pooled prevalence of major LARS was 36.8% (95% CI: 30.1%-44.0%), with a 95% prediction interval of 12.0%-71.2%, indicating substantial heterogeneity. Tumor location < 5 cm from the anal margin (p < 0.001) and neoadjuvant radiochemotherapy (p = 0.006) were significantly associated with increased major LARS risk. No significant associations were found with anastomotic leakage, surgical approach, or stoma closure timing.</p><p><strong>Conclusion: </strong>Our meta-analysis showed a prevalence comparable to previously published data. Low tumor location and neoadjuvant radiochemotherapy were identified as two independent risk factors for major LARS. Prospective randomized trials are necessary to improve risk stratification for the development of major LARS.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"583-590"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Management of Suicide Attempts and Predictive Factors of Mortality Identified During Medical Dispatching.","authors":"Marwa Ben Abdallah, Elyes Kallel, Houssem Affes, Mariam Mallek, Adel Chaari","doi":"10.62438/tunismed.v104i04.6402","DOIUrl":"https://doi.org/10.62438/tunismed.v104i04.6402","url":null,"abstract":"<p><strong>Background: </strong>Prehospital management of suicide attempts (SA) is increasing worldwide and in Tunisia. This study aimed to describe the management of SA in the prehospital setting, and to analyze factors predicting mortality during medical dispatching.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive and analytical study including all SA-related calls managed by the Prehospital Emergency Medical Services (PEMS) between January 2023 and December 2024. We described patients' socio-demographic and clinical characteristics, medical dispatch decisions, prehospital management, and analyzed factors associated with prehospital mortality.</p><p><strong>Results: </strong>The sex ratio was 0.68, and the mean age was 29.6 years. Voluntary intoxication was the most common method (88.8%), followed by hanging (9.6%). A Mobile Intensive Care Unit (MICU) was deployed in 78.4% of cases. In univariate analysis, rural origin (p=0.012), calls made by medical personnel (p<0.001), and medical management initiated prior to MICU arrival (p=0.04) were significantly associated with reduced mortality. In contrast, hanging (p<0.001), calls received within the first hour following the SA (p=0.014), and calls made by Civil Protection Services (CPS) personnel (p=0.023) were associated with increased mortality. In multivariate analysis, hanging(p=0.04 ;OR=2.12 ;IC=[1.28-16.1]) and early received calls (p=0.01 ;OR=8.33 ;IC=[1.76-91.4]) remained independent predictors of mortality, whereas rural origin (p=0.03 ;OR=0.16 ;IC[0.015-0.67])and prior medical management(p=0.03 ;OR=0.33 ;IC=[0.03-0.73]) were protective.</p><p><strong>Conclusion: </strong>Early identification of mortality-related factors in SA may strengthen medical dispatch decision-making. Strengthening the role of PEMS in early management could further improve patient outcomes.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"551-558"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MELD 3.0 is a more accurate predictor of mortality in decompensated cirrhosis than MELD and MELD-Na.","authors":"Amal Khsiba, Sahar Chtioui, Moufida Mahmoudi, Asma Ben Mohamed, Ghada Gharbi, Manel Yakoubi, Mouna Medhioub, Lamine Hamzaoui","doi":"10.62438/tunismed.v104i04.5938","DOIUrl":"https://doi.org/10.62438/tunismed.v104i04.5938","url":null,"abstract":"<p><strong>Backgroud and aim: </strong>Prognostic scores guide organ allocation in cirrhosis.We assessed the performance of MELD, MELD-Na, and MELD 3.0 for predicting mortality in decompensated Tunisian cirrhotic patients Methods: We conducted a retrospective study including decompensated cirrhosis patients in a Tunisian gastroenterology department.</p><p><strong>Results: </strong>152 patients were enrolled (mean age 61 years; viral etiology 65.1%). Mean MELD-Na and MELD 3.0 were 17.7 and 19.4. Mean follow-up: 17.1 months. Decompensation rate: 33.6%; 3-month mortality: 18.4%. For 3-month mortality, AUROCs were 0.786 (MELD), 0.841 (MELD-Na), and 0.850 (MELD 3.0). MELD 3.0 cut-off of 24 yielded sensitivity 68%, specificity 88% (p=0.04 for association with mortality).</p><p><strong>Conclusion: </strong>MELD 3.0 outperformed MELD and MELD-Na in predicting mortality. A MELD 3.0 score ≥24 identifies patients who should be prioritized on the transplant waiting list.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"559-562"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Patient Satisfaction and Pre-Anesthesia Consultation Practices in a University Hospital: A Cross-Sectional Study.","authors":"Imen Bannour, Omar Kais Gardabbou, Saleh Abusamra, Amani Dahmani, Mouna Ouaz, Hela Attia, Mohamed Ali Chaouch, Ali Majdoub","doi":"10.62438/tunismed.v104i04.6261","DOIUrl":"10.62438/tunismed.v104i04.6261","url":null,"abstract":"<p><strong>Background: </strong>The Pre-Anesthesia Consultation Clinic (PACC) plays a vital role in perioperative care, assessing the' health status of patients, optimizing comorbidities, and providing personalized information on anesthesia. In Tunisia, preoperative anesthesia consultation has been mandatory for all elective surgeries since 2015. This study aimed to evaluate patient satisfaction and the impact of consultation on preoperative anxiety.</p><p><strong>Methods: </strong>We conducted a single-center cross-sectional observational study over one month (January 2025) in the PACC of a Tunisian university hospital. Adults classified as ASA I to III scheduled for elective surgery were included. Data were collected through structured interviews using a questionnaire that covered demographics, medical history, consultation process, complementary testing, clinic environment, and satisfaction, including anxiety evaluation.</p><p><strong>Results: </strong>Out of 125 patients, 83.2% reported being satisfied with the consultation. Satisfaction was significantly associated with factors such as education level, type of surgery, clinic accessibility, waiting room crowding, staffing adequacy, respect for patient privacy, time spent with the physician, and the opportunity to ask and receive adequate answers to questions. Furthermore, 77.6% of patients reported reduced anxiety following the consultation. Younger age, regional anesthesia planning, inadequate privacy, and poor communication were significantly associated with persistent anxiety.</p><p><strong>Conclusion: </strong>The pre-anesthesia consultation effectively contributes to patient satisfaction and reduction in anxiety. However, targeted improvements in patient education, environment, and communication are essential to enhance quality of care and patient-centered outcomes.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"541-546"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the performance of the ABON™ Plus Malaria® and I-test® tests in the diagnosis of imported malaria in Tunisia.","authors":"Dorsaf Aloui, Oumaima Khemis, Mariem Bouchakoua, Sonia Trabelsi","doi":"10.62438/tunismed.v104i04.6592","DOIUrl":"https://doi.org/10.62438/tunismed.v104i04.6592","url":null,"abstract":"<p><strong>Background: </strong>Imported malaria remains a public health challenge in malaria-free countries. Rapid diagnostic tests (RDTs) are used alongside microscopy, but their performance varies with clinical presentation and epidemiological context.</p><p><strong>Methods: </strong>We conducted a retrospective study (2020-2023) at the Parasitology-Mycology Laboratory of Charles Nicolle Hospital, Tunisia, including 25 symptomatic patients and 246 asymptomatic non-permanent resident students from sub-Saharan Africa. Microscopy (thick and thin smears) served as the reference standard. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and Cohen's kappa (κ) were calculated to assess the performance of the ABON™ PLUS Malaria (Abon biopharm, China) et I-test® (Bacterovir laboratoire) RDTs.</p><p><strong>Results: </strong>Malaria was diagnosed in 35 individuals (13%), comprising 12 symptomatic patients (48%) and 23 asymptomatic patients (9.35%). Plasmodium falciparum was the most common species (95%). In symptomatic subjects, parasitemia ranged from 0.5% to 20%, and both tests demonstrated excellent agreement with the thick blood smear (κ=0.91 for ABON™ Plus; κ=1 for I-test®). In contrast, parasitemia was low (<0.1%) in asymptomatic students. For this group, the ABON™ Plus test showed a sensitivity of 48% and a specificity of 100% (PPV: 100%; NPV: 95%), while the I-test® had a sensitivity of 23.8% and a specificity of 100% (PPV: 100%; NPV: 90%). Consequently, agreement with the reference smear was good for the ABON™ Plus test (κ=0.62) but poor for the I-test® (κ=0.35).</p><p><strong>Conclusion: </strong>Both RDTs performed well in symptomatic cases, but low sensitivity in asymptomatic individuals highlights the importance of microscopy and targeted screening to prevent malaria reintroduction in malaria-free countries.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":"104 4","pages":"518-524"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}