Medical Journal Armed Forces India最新文献

{"title":"A review of vaccines and antivirals against human poxviruses with special emphasis on mpox virus","authors":"Sasidharanpillai Sabeena","doi":"10.1016/j.mjafi.2025.04.005","DOIUrl":"10.1016/j.mjafi.2025.04.005","url":null,"abstract":"<div><div>A significant proportion of the global population with waning immunity to smallpox is susceptible to poxviruses. Zoonotic orthopoxviruses are re-emerging and emerging worldwide, including the mpox virus, vaccinia virus, and cowpox virus. Knowledge gaps exist regarding reservoir hosts for many poxviruses, modes of transmission, zoonotic potential, and vaccine effectiveness. The precise natural reservoir of many emerging zoonotic infections such as vaccinia virus, cowpox virus, and mpox virus is unknown which is a significant barrier to the development of appropriate public health preventive measures, including vaccines and antivirals. Accurate diagnosis of the pox virus causing lesions in animals is essential for proper veterinary preventive measures including vaccinating noninfected neighboring herds. Adopting strict personal hygiene among farm workers, butchers, and veterinarians will prevent the spread from animals to humans. The availability of specific anti–pox virus medications is limited, and many candidate drugs are undergoing clinical trials. Management of any health emergency requires regional collaboration and efficient public health leadership. Antivirals or vaccines to manage many pox viruses are inaccessible in endemic countries, home to many rare zoonotic pox viruses.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 259-267"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908326","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":"Which test results to believe? Comparison of different ELISA kits for detection of SARS-CoV-2-neutralizing antibody among COVID-vaccinated individuals","authors":"Uday Yanamandra ,&nbsp;Kundan Tandel ,&nbsp;Karthik Rayapureddi ,&nbsp;Sanjay Pratap Singh ,&nbsp;Balakrishnan Arivalagan ,&nbsp;Dinesh Kumar Kalra ,&nbsp;Rajesh Sahu ,&nbsp;Anil Shankar Menon ,&nbsp;Narendra Kotwal","doi":"10.1016/j.mjafi.2024.05.014","DOIUrl":"10.1016/j.mjafi.2024.05.014","url":null,"abstract":"<div><h3>Background</h3><div>In the context of SARS-CoV-2, infection and immunization lead to varied levels of neutralizing antibodies<span> (NAbs) crucial for protective immunity. In the lack of universal availability of plaque reduction neutralization tests, the gold standard centers rely on surrogate kits, for which performance standards and validation are lacking. Hence, we assessed three NAb kits available in India to determine their agreement and concordance.</span></div></div><div><h3>Methods</h3><div>It's a single-center cross-sectional observation study conducted during the third wave of the pandemic starting in January 2022 amongst individuals (n: 247) who received the first two doses of Covishield^TM<span><span>. Samples were analysed using kit-A (Indian Council of Medical Research (ICMR) approved NAb microlisa kit, J. Mitra &amp; Co. Pvt. Ltd), kit-B (Food and Drug Administration–approved NAb surrogate virus neutralisation test, GenscriptTM), and kit-C (NARI- and ICMR-approved anti–SARS-CoV-2 IgG antibodies kit using indirect </span>ELISA principle, ErbaLisa® COVID-19 IgG). Cohen's kappa and concordance were analyzed using JMPver20.0.0.</span></div></div><div><h3>Results</h3><div>NAb was detected in 80.4%, 82.9%, and 21% samples using the three different kits. Discordance was observed in 19.68%, 65.7%, and 62.6% between Kit A-B, A-C, and B-C, respectively. The agreement was fair between Kit A-B (κ-0.35; p: 0.06) and Kit B-C (κ-0.09; p: 0.0005). Kit-B showed higher mean percentage inhibition (74.6 ± 32.1%) than Kit-A (68.1 ± 35.7%) (p: 0.0347). The correlation between kit-A and kit-B was moderate (r: 0.57; p &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>There is significant discordance between various commercials, which raises questions about their validity. The research underscores the need for robust validation and standardization of NAb tests to ensure their reliability and effectiveness in guiding public health strategies.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 320-327"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712425","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":"Challenging case of pleuropericardial effusion: Primary extraskeletal Ewing's sarcoma masquerading as tubercular pericarditis","authors":"Manu Chopra ,&nbsp;Jasvinder Kaur Bhatia ,&nbsp;Ritwik Chakrabarti ,&nbsp;Madan Gopal Vishnoi","doi":"10.1016/j.mjafi.2023.07.013","DOIUrl":"10.1016/j.mjafi.2023.07.013","url":null,"abstract":"<div><div>Ewing's sarcoma<span><span> is an aggressive bone and soft tissue cancer<span> of children and young adults, which can rarely affect extraskeletal soft tissues and visceral organs as extraskeletal Ewing's sarcoma (EES). Primary EES of the pleura and </span></span>pericardium<span> is an extremely rare malignancy, and herein we report a case of Primary EES of the pericardium, which to the best of our knowledge is the first case report of the same from India.</span></span></div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 356-360"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135249069","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":"Determinants of outcomes of childhood severe Malaria: A multi-centric study","authors":"Mahfuz Babatunde Adigun ,&nbsp;Michael Abel Alao ,&nbsp;Abimbola Ellen Akindolire ,&nbsp;Bello Mohammed Suleiman ,&nbsp;Olayinka Rasheed Ibrahim","doi":"10.1016/j.mjafi.2023.09.011","DOIUrl":"10.1016/j.mjafi.2023.09.011","url":null,"abstract":"<div><h3>Backgrounds</h3><div>Severe malaria (SM) has remained a major global health challenge, disproportionately affecting children in endemic areas. Understanding the factors that influence childhood SM outcomes is critical for developing contextualized early warning scores, effective prevention, and treatment strategies.</div></div><div><h3>Methods</h3><div>This is a retrospective, multicenter study conducted between year 2019 and 2022 involving children diagnosed with SM based on World Health Organization (WHO) diagnostic criteria. Multivariate logistic regression<span> was used to identify the determinants of in-hospital mortality from significantly associated factors on bivariate analysis.</span></div></div><div><h3>Results</h3><div><span>Of the 7765 children admitted to emergency rooms, 997 (12.8%) had SM, with a median age of 4 (IQR: 2.7). M: F ratio of 1.2:1. Anemia<span><span><span> (353: 35.4%), hemoglobinuria<span> (348: 34.9%), cerebral malaria<span> (331: 33.1%), and prostration (325: 32.6%) were the most common manifestations of SM. Half (494, 49.5%) of the children had only one form of SM, followed by a combination of three forms (270: 27.1%) of SM. Nine of 43 children with severe acute kidney injury received </span></span></span>peritoneal dialysis<span>, while 19 received haemodialysis. Severe </span></span>shock<span> (75.0%) and a patient with respiratory distress syndrome received </span></span></span>mechanical ventilation support. The determinants of increased mortality included the first day of admission [OR (95% CI):24.44 (9.792, 61.007)], and manifestations of shock with a 17-fold [OR (95% CI): 17.682 (4.159, 75.196)] increased mortality.</div></div><div><h3>Conclusion</h3><div>SM still carries a significant risk of increased mortality, the need for dialysis, and mechanical ventilation support. The first 24 h after admission, as well as the shock, are determinants of increased mortality.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 282-290"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135410362","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":"Single high-dose amphotericin B for cryptococcal meningitis: First Indian experience","authors":"Rohit Vashisht ,&nbsp;Sumit Arora ,&nbsp;Abhinav Kumar ,&nbsp;Ankita Patel ,&nbsp;Surbhi Saxena ,&nbsp;Akhil Rohan ,&nbsp;Ashok Narayan","doi":"10.1016/j.mjafi.2023.08.001","DOIUrl":"10.1016/j.mjafi.2023.08.001","url":null,"abstract":"<div><div><span><span>Cryptococcus is a common organism causing </span>central nervous system disease in people living with HIV (PLHIV). The treatment of this infection entails a costly regimen of </span>Amphotericin<span><span>. World Health Organization (WHO) recently recommended a cost-effective single high-dose regimen with liposomal amphotericin B for the treatment of </span>cryptococcal meningitis. We hereby present an Indian experience with this regimen in two patients managed at immunodeficiency centers of the Armed Forces.</span></div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 361-365"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135662080","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":"Trials and tribulations: Developing an artificial intelligence for screening malaria parasite from peripheral blood smears","authors":"Shilpi Saxena ,&nbsp;Parikshit Sanyal ,&nbsp;Mukul Bajpai ,&nbsp;Rajat Prakash ,&nbsp;Shiv Kumar","doi":"10.1016/j.mjafi.2023.10.007","DOIUrl":"10.1016/j.mjafi.2023.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Detection of malaria parasite from blood smears remains the gold standard for confirmation of diagnosis. Screening blood smears for malaria parasite has a sensitivity of 75 %, and requires intensive training of the laboratory technician. In the present study, we have attempted to develop an artificial intelligence to automate the process of malaria parasite detection.</div></div><div><h3>Methods</h3><div>We acquired 352 images of Leishman–Giemsa-stained peripheral blood smears, containing either normal red blood cells<span> (RBCs) or parasitised RBCs. With a trial and error approach, we developed five deep learning models: (A) Naive deep convolutional neural network (DCNN) for trophozoites, (B) Modified Inception V3 pretrained neural network (C) Combination of model A and B, (D) Segmentation of cells from the images through Watershed Transform and naive tri-class DCNN (normal RBCs, parasitised RBCs, WBC/platelets), and (E) A naive DCNN model to detect ring forms. The images were randomly split into training and test sets and training was imparted on all the models. After completion of training, performance of each model was assessed on the test set.</span></div></div><div><h3>Results</h3><div>Overall, the best combination of sensitivity and specificity was seen in model D (85 % and 94 %, respectively) in detecting parasites; in addition to trophozoites, model D could also detect ring forms. The performance of model A, B &amp; C suffered from lack of either sensitivity or specificity.</div></div><div><h3>Conclusion</h3><div>The present study represents the first step towards development of a complete module for screening malaria parasites from automated microphotography/whole slide images.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 291-300"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139190129","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":"Process improvement in automated blood cultures: Our road to better patient care","authors":"Anisha M. Fernandes ,&nbsp;Sevitha Bhat ,&nbsp;Archana Bhat K ,&nbsp;Pooja Rao ,&nbsp;Suchitra Shenoy M","doi":"10.1016/j.mjafi.2023.12.001","DOIUrl":"10.1016/j.mjafi.2023.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Blood cultures (BC) are a complex multistep process susceptible to errors at multiple levels. Our study was conducted to monitor the compliance to standard operating procedures, design an intervention plan for improvement and monitor the impact of the intervention. The study design focuses on the intervention.</div></div><div><h3>Methods</h3><div>A hospital-based prospective interventional study was carried out, monitoring various pre-analytical, analytical, and post-analytical factors in two phases. Our interventions focused on communication and training for the deficiencies noted in completeness of test request form, contamination rates, and sample loading interval.</div></div><div><h3>Results</h3><div>Comparison between both phases showed a statistically significant improvement (p &lt; 0.05, Chi square test) following our interventions in the completeness of test request form, contamination rates and sample loading interval. There was an improvement in the intimation of critical Gram stain from positive flagged bottles, which was not statistically significant.</div></div><div><h3>Conclusion</h3><div>Our study highlights how educational interventions can influence quality of BC. Continuous monitoring and interventions are key for quality improvement in BC processes.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 314-319"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540235","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":"Clinicoepidemiological profile of measles in adults: A study from semi-urban area in South India","authors":"Balakrishnan Arivalagan ,&nbsp;Rohit Vashisht ,&nbsp;T. Diwakar ,&nbsp;Sunitha Pakalapaty ,&nbsp;K.S. Sreekanth ,&nbsp;Veera Kumar A. Marippan ,&nbsp;Srishti Bhardwaj ,&nbsp;A. Athira ,&nbsp;Kamal Kumar ,&nbsp;Vijoy Kumar Jha","doi":"10.1016/j.mjafi.2024.03.004","DOIUrl":"10.1016/j.mjafi.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Measles is a highly contagious, </span>airborne disease<span><span> caused by rubeola virus<span> of paramyxoviridae family. It presents with fever, rash, and other associated symptoms like headache, cough, </span></span>coryza, and </span></span>conjunctivitis. It is common in children, and when occurs in adults, it is usually morbid. The clinical data on adults’ measles in Indian scenario are sparse. We report here an outbreak of measles affecting 52 adults. The primary objective of the study was to describe the clinical and laboratory findings obtained in an outbreak of adult measles cases from semi-urban area in India.</div></div><div><h3>Methods</h3><div>The study was an observational study conducted in a secondary care health center over a period of 2 months.</div></div><div><h3>Results</h3><div><span><span><span><span>Fifty-two males with median age of 22.02 ± 3.5yr were diagnosed and treated for measles. All presented with fever and rash. The characteristic Koplik's spots appeared in 21 cases. On the day of their admission, 48% had </span>lymphopenia and only one had </span>thrombocytopenia. </span>Liver enzyme dearrangements were seen in 18 patients. Sixteen patients had complications which included eight pneumonitis, three </span>corneal ulcerations<span><span>, three otitis media, and one case of acute encephalitis and </span>polyserositis each. No deaths were reported in our study. We followed 34 cases and observed that their rashes healed with scars and laboratory parameters got normalized after six weeks.</span></div></div><div><h3>Conclusion</h3><div>Clinician should be vigilant of measles as a differential in adults presenting as fever with rash. In doubt, the serological sampling should be carried out. Mass immunization is necessary to prevent the outbreaks.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 307-313"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413423","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":"Comparison of intralesional bleomycin versus salicylic acid 16.5% and lactic acid 16.5% combination paint in management of plantar warts","authors":"Nishu Bala ,&nbsp;Ajay Kumar ,&nbsp;Eeshaan Ranjan ,&nbsp;Vinay Gera ,&nbsp;Rahul Thombre","doi":"10.1016/j.mjafi.2023.04.004","DOIUrl":"10.1016/j.mjafi.2023.04.004","url":null,"abstract":"<div><h3>Background</h3><div><span>Salicylic and lactic acid (SAL) paint is commonly used to treat warts due to ease of application without any instrumentation. Intralesional </span>bleomycin<span><span> has been used for the treatment of warts since the 1970s with high efficacy even at low concentration. The aim of this study was to assess the efficacy of single dose of intralesional </span>bleomycin<span> in the treatment of plantar warts in comparison with a control group of similar sample receiving SAL paint application.</span></span></div></div><div><h3>Methods</h3><div>Patients were randomly divided into two groups to receive either single dose of intralesional bleomycin injection or SAL paint application daily for maximum of two months. Plantar warts of the patients were assessed at baseline and with each return visit including a post-treatment follow-up of six months.</div></div><div><h3>Results</h3><div>Of the 100 patients enrolled in the study, 50 (50%) patients were treated with intralesional bleomycin, and 50 (50%) were treated with SAL paint. Out of total 441 treated warts in 100 patients, 198 (44.89%) warts were treated with intralesional bleomycin, and 243 (55.1%) warts were treated with SAL paint. The clearance rates in the context of number of patients and number of warts were 94% (47 out of 50) and 97.97% (194 out of 198) for bleomycin and 36% (18 out of 50) and 27.5% (67 out of 243) for SAL paint, respectively.</div></div><div><h3>Conclusion</h3><div>Single dose of intralesional bleomycin injection is significantly more effective than SAL paint for the treatment of plantar warts.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 268-274"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49293858","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":"Study on utility of GDH and prevalence of Clostridium difficile infection in ICU patients","authors":"Suby Kuriakose ,&nbsp;Anuj Singhal ,&nbsp;Kiran Kumar Kompella ,&nbsp;Amul Kapoor ,&nbsp;Ashish Bahal ,&nbsp;Shilpa M Paul","doi":"10.1016/j.mjafi.2024.10.005","DOIUrl":"10.1016/j.mjafi.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Clostridium difficile (<em>C difficile</em>) is one of the leading causes of nosocomial diarrhea in developing countries. It is a commonly encountered infection in the ICU setting where critically ill patients are at significant risk. The aim of this study was to study the clinical and microbiological profile of Clostridium Difficile Infection (CDI) in intensive care unit (ICU) settings of a Tertiary Care Hospital with the primary objective to find out the prevalence of <em>C difficile</em> diarrhea among the patients and the secondary objective to find out the utility of Glutamate Dehydrogenase (GDH) in screening for such patients.</div></div><div><h3>Methods</h3><div>This was a single center, prospective, diagnostic study conducted from July to Dec 2023. The study was carried out after obtaining clearance from the Institute Ethics Committee. As per a 2017 study done by Segar et al, keeping the tolerable error as 1.5 at 95% confidence interval, minimum sample size was found to be 200.</div></div><div><h3>Results</h3><div>The prevalence of CDI among ICU patients was 6% and among diarrheic patients the prevalence was 20%. GDH showed a sensitivity and specificity of 100% with all cuture positive cases of CDI also showing GDH positivity. The length of ICU and hospital stay among CDI patients (28±17 days/56±17 days) was significantly longer compared to non CDI patients (11 ± 06 days/26 ± 18 days) (p-0.003). The overall hospital mortality among ICU patients with CDI patients was 33% as compared with 25% among those without CDI thus showing a statistically significant difference in mortality risk (p-0.030).</div></div><div><h3>Conclusion</h3><div>It is concluded that there is a need for additional prevention and treatment studies in this setting. No correlation could be established between the choice or duration of antibiotic therapy and the development of CDI. Similarly no correlation could be established between the primary diagnosis for admission of the patient and development of CDI.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 3","pages":"Pages 345-350"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908278","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}