Turkish Journal of Obstetrics and Gynecology最新文献

{"title":"Assessing lipoxin-mediated inflammatory responses in the second trimester of pregnancy among women with obesity: A comprehensive analysis","authors":"Önder Otlu, R. Melekoğlu, T. Kıran, Feyza Inceoğlu, A. S. Erenler","doi":"10.4274/tjod.galenos.2023.16678","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.16678","url":null,"abstract":"Objective: This study aimed to explore the relationship between maternal plasma lipoxin A4 (LXA4) levels during the second trimester of pregnancy and certain proinflammatory molecules, such as interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), as well as the antiangiogenic factor vascular endothelial growth factor receptor 1 (VEGFR-1), in conjunction with obesity among pregnant women. Materials and Methods: A total of 30 pregnant women with obesity were compared with 30 pregnant women of normal weight, matched for both age and gestational week. Plasma samples were collected from all participants between the 18th and 28th weeks of pregnancy. The levels of LXA4, VEGFR-1, IL-6, and TNF-α were quantified using enzyme-linked immunosorbent assay. Results: Plasma levels of LXA4 were notably lower in pregnant women with obesity, whereas levels of TNF-α and VEGFR1 were significantly higher (p=0.041, p<0.001, and p<0.001, respectively). There was no significant difference in IL-6 levels between groups (p=0.072). The binary logistic regression model revealed significant associations between obesity and the examined inflammatory mediators. Specifically, the results demonstrated that higher levels of LXA4 were linked to a reduced obesity risk, with each unit increase corresponding to a 0.926-fold decrease in the likelihood of obesity. Conversely, elevated levels of TNF-α and VEGFR1 were associated with an increased risk of obesity. Conclusion: The study concluded that increased body mass index during pregnancy affects the levels of plasma lipoxin, cytokines, and angiogenesis-related factors. Although the exact mechanisms remain unclear, the observed changes suggest a disruption in the metabolic systems of women with obesity, which may influence physiological changes during pregnancy and lead to obesity-related pathological conditions.","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138612416","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":"Live donor uterine transplant with vascular reconstruction: Advancing reproductive medicine","authors":"Faiza Ahsan, Abdul Wahid, Sadia Tahir, Amna Tariq","doi":"10.4274/tjod.galenos.2023.19949","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.19949","url":null,"abstract":"","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138613556","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":"Individual effects of GSTM1 and GSTT1 polymorphisms on the risk of polycystic ovarian syndrome: A systematic review and meta-analysis","authors":"M. H. Makoui, Shiva Fekri, R. H. Makoui, Negar Ansari","doi":"10.4274/tjod.galenos.2023.66263","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.66263","url":null,"abstract":"This study aimed to understand the relationship between two specific genetic variations (GSTT1 and GSTM1 polymorphisms) and the risk of developing polycystic ovarian syndrome (PCOS). PCOS is a common endocrinologic disorder that affects women. Oxidative stress may play a significant role in the development of PCOS. Certain enzymes, such as glutathione S-transferases, help protect cells against oxidative stress. However, previous research on the correlation between these specific genetic variations and PCOS risk has produced inconsistent findings. To address this, a meta-analysis was conducted to examine the potential impact of these genetic variations on PCOS. We conducted a thorough search of the Embase, PubMed, Scopus, Web of Science, and Google Scholar databases to find studies that met our criteria. We used fixed-effects or random-effects models to determine the pooled odds ratios (ORs) and 95% confidence intervals (CIs) of the GSTT1 and GSTM1 polymorphisms related to PCOS. We also performed subgroup analyses based on ethnicity, mean age of participants, and PCOS diagnostic protocols. After screening, we found five studies with 1.607 participants (872 in the PCOS group and 735 in the control group) to be suitable for our meta-analysis. Our analysis showed that GSTM1 and GSTT1 null genotypes were not linked to an increased risk of PCOS (OR: 0.925, 95% CI: 0.755-1.134; OR: 1.175, 95% CI: 0.614-2.247 respectively). Additionally, both Begg’s and Egger’s tests revealed no publishing bias. This meta-analysis confirmed that there is no association between GSTM1 and GSTT1 polymorphisms and an increased risk of PCOS. However, further studies are required to validate this conclusion.","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138619703","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":"Does the use of low-molecular-weight heparin during pregnancy change the expression of PD-1 and PDL-1 in women with recurrent pregnancy loss?","authors":"Begum Kurt, C. Hepokur, Z. D. Şahin İnan, İ. Küçükyıldız","doi":"10.4274/tjod.galenos.2023.95769","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.95769","url":null,"abstract":"Objective: The programed cell death gene-1 ligand (PDL-1) is expressed by villous syncytiotrophoblasts, cytotrophoblasts, and fetal cells in close contact with maternal tissue and blood. Programmed cell death gene-1 (PD-1) and the PDL-1 pathway cooperate with human leucocyte antigen-G (HLA-G), expressing intermediate trophoblastic cells and syncytiotrophoblasts to inhibit the function of activated T-cells. With this mechanism, the immunosuppressive microenvironment protects the placenta. This study investigated changes in PD-1 and PD-L1 gene expression in patients with a history of recurrent pregnancy loss (RPL). Materials and Methods: Sixty patients participated in the study and were divided into three groups. Group 1 (G1): healthy pregnancy, G2: RPL but not low-molecular-weight heparin (LMWH), and G3: RPL and LMWH. PD-1 gene expression in placental tissue samples was measured by reverse-transcriptase polymerase chain reaction and PD-L1 Elisa assay, and the study was supported by histopathology. Results: The PD-L1 value decreased significantly in G2. A significant difference was observed between the groups in PD-1 gene expression levels in G1 and G2. It was observed that vascularization increased and the villi structures intensified in G3. In G2, there was villus dysplasia in the placenta, enlargement in the intervillous region, and fibrin deposition. It was observed that the villi structures in G3 returned to a morphology similar to that of G1. Conclusion: T-cells are activated in patients using LMWH, and a new therapeutic strategy can be developed to prevent pregnancy loss by targeting the PD-1 pathway.","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138624528","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":"Integrated analysis of differentially expressed genes implicated in ovarian cancer progression","authors":"Bahriye Gür, Nurhan Külcü Sarıkaya, Deniz Sünnetçi Akkoyunlu","doi":"10.4274/tjod.galenos.2023.65072","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.65072","url":null,"abstract":"Objective: Ovarian cancer (OC) is a common gynecological malignancy associated with high morbidity and generally poor prognosis despite treatment. The aim of this study was to understand the influence of gene expression differences and pathways in OC development and progression. Materials and Methods: One hundred and thirty-three OC samples and 34 normal ovarian tissues were included in the study from the Gene Expression Omnibus database. GeneSpring Software was used to obtain differentially expressed genes (DEGs) in all stages comparing tumor and normaltissue. DEGs were analyzed using the DAVID interface for Kyoto Encyclopedia of Genes and Genomes pathway analysis. Most most connected genes were selected as hub genes for each stage using the STRING application in Cytoscape software. Results: DEGs were found to be associated with cell cycle and herpes simplex virus infection pathways. A total of 19 genes (ACTB, AKT1, ALB, CTNNB1, EGFR, EP300, ESR1, FN1, GAPDH, HSPA4, IL6, JUN, MYC, PTEN, RPS27A, SRC, TNF, TP53 and UBC) were identified as hub genes. Among the hub genes, the TP53 gene was found to have the highest level of connections in all stages. EGFR, RPS27A, and AKT1 were found to have high numbers of connections in stages II, III, and IV, respectively. Conclusion: The results of the current study may provide new insights into OC pathogenesis and suggest potential prognostic and therapeutic targets.","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138623795","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":"Pre-treatment inflammatory and immune system parameters predicting cervical cancer metastasis","authors":"Mirah Avisha, N. Pelupessy, Abdul Rahman, Syahrul Rauf, Nur Rakhmah, Firdaus Hamid","doi":"10.4274/tjod.galenos.2023.80912","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.80912","url":null,"abstract":"Objective: This study aimed to evaluate the relationship between mannose-binding lectin-associated serine protease-2 as an immune system parameter and neutrophil lymphocyte ratio (NLR) as an inflammatory parameter to predict cervical cancer metastasis. Materials and Methods: This cross-sectional study included 70 patients diagnosed with cervical cancer between January 2022 and February 2023 at Dr. Wahidin Sudirohusodo Hospital, Hasanuddin University Hospital, and Ibnu Sina Hospital, Makassar, Indonesia. Blood samples taken before therapy as well as clinical and histological data were gathered and examined. MASP-2 levels and NLR were measured by ELISA and flow cytometry respectively. Results: The median age of the patients was 46 years (range, 24-72 years), with the majority of patients aged between 41 and 52 years. Statistical analysis showed that MASP-2 was associated with cervical cancer stage (p≤0.000), organ metastasis (p=0.011), and lymphovascular invasion (p=0.036). In addition, NLR was associated with cervical cancer stage (p=0.004), histopathology type (p=0.031), tumor size (p=0.019), and organ metastasis (p=0.013). Conclusion: Pretreatment with MASP-2 as an immune system parameter and NLR as an inflammatory parameter is associated with cervical cancer metastasis. The NLR indicator can be applied in clinical practice because it is simple and reasonably priced.","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138612345","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":"What is the effect of sildenafil citrate intake on women undergoing assisted reproduction? A systematic review and meta-analysis of randomized controlled trials","authors":"Saeed Baradwan, Mohammed Abuzaid, Majed Alshahrani, H. Sabban, W. Alkhamis, Ehab Badghish, Ammar Y. Alkhiary, I. Bukhari, Abdullah Alyousef, O. Alomar, A. Abu-Zaid","doi":"10.4274/tjod.galenos.2023.59207","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.59207","url":null,"abstract":"Assisted reproductive technologies (ART) have become a vital option for women facing fertility challenges. One of the potential interventions being explored is the use of sildenafil citrate (SC) to improve clinical outcomes in ART procedures. The aim of this study was to assess the impact of SC on clinical outcomes in women undergoing ART. A comprehensive literature search was conducted using multiple databases, including PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. The search covered studies from inception until April 15, 2023, and identified relevant randomized controlled trials (RCTs) for inclusion in the analysis. The endpoints were summarized as risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI). After meticulous analysis, twenty-eight RCTs comprising 3,426 women were included in the study. The results revealed significant findings regarding the impact of SC on clinical pregnancy (CP) rates. Women receiving SC demonstrated a significantly higher probability of CP compared to the control group (n=21 RCTs, RR=1.43; 95% CI: 1.29, 1.59). Additionally, when SC was combined with other medications like clomiphene citrate (CC) or estradiol valerate, it further improved the likelihood of CP compared to these medications alone (RR=1.35, 95% CI: 1.19, 1.53; RR=1.55, 95% CI: 1.08, 2.22, respectively). Furthermore, the study observed that the mean endometrial thickness (ET) was significantly higher in women who received SC compared to the control group, which involved other active interventions or placebo (SMD=0.77, 95% CI: 0.20, 1.34). Particularly, the administration of SC resulted in a notably higher ET level compared to the placebo (SMD: 1.33, 95% CI: 0.15, 2.51). The findings suggest that luteal supplementation of SC can be considered a beneficial approach to enhance ET and improve the CP rate in women undergoing ART.","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138619106","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":"Predictive score for postpartum hemorrhage in vaginal deliveries following frozen embryo transfer","authors":"Akitoshi Yamamura, Akiko Okuda, Akiko Abe, Yuki Kashihara, Ayako Moribe, Yuki Kozono, K. Sekiyama, Yumiko Yoshioka, Toshihiro Higuchi","doi":"10.4274/tjod.galenos.2023.77392","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.77392","url":null,"abstract":"Objective: To develop a predictive score for life-threatening severe postpartum hemorrhage in vaginal deliveries following frozen embryo transfer. Materials and Methods: We conducted a retrospective cohort study of 315 singleton vaginal deliveries following frozen embryo transfer from 2017 to 2022. Severe postpartum hemorrhage was defined as hemorrhage exceeding 1500 mL. A predictive score was generated from maternal characteristics and obstetric complications before delivery. We performed multivariable logistic regression analysis using 2017-2020 data and assigned points to identified risk factors. The predictive score’s accuracy was evaluated using 2021-2022 data. Results: A large baby (birth weight ≥3500 g), pre-delivery maternal body mass index ≥25 kg/m2, marginal or velamentous umbilical cord insertion, and history of postpartum hemorrhage were identified as risk factors. We assigned one point to a large baby, a pre-delivery maternal body mass index ≥25 kg/m2, and marginal or velamentous umbilical cord insertion, and two points to a history of postpartum hemorrhage. The sum of the points was defined as the predictive score. The cut-off was set at two points, with a score ≥2 points being the high-risk group and a score ≤1 point being the low-risk group. The predictive score demonstrated a sensitivity of 47.8%, specificity of 85.4%, positive predictive value of 45.8%, and negative predictive value of 86.4% in the 2021-2022 validation cohort. Conclusion: The predictive score identified severe postpartum hemorrhage in approximately half of the high-risk cases. Implementing measures such as autologous blood storage may facilitate rapid response during heavy bleeding and improve maternal prognosis.","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610755","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 maternal complications between fresh and frozen embryo transfer during gestation","authors":"Sedigheh Hosseinimousa, Maryam Ziaee, H. Zeraati, Seyed Mahyar Ghasemi","doi":"10.4274/tjod.galenos.2023.02043","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.02043","url":null,"abstract":"Objective: Maternal complications in infertile women undergoing in vitro fertilization are an important discussion, and patients should be informed about these complications depending on the method of embryo transfer. In this study, maternal complications during gestation were compared between frozen and fresh embryo transfer in infertile women who underwent in vitro fertilization at Shariati Hospital from 2018 to 2021. Materials and Methods: This study was a retrospective cohort study, and patient data were collected using archive files. From 396 in vitro fertilization patients, 302 were in the frozen embryo transfer group and 94 were in the fresh embryo transfer group. Patients in both groups were similar in terms of the number of transferred embryos and age (p>0.05). Data regarding threatened miscarriage, early miscarriage, placenta previa occurrence, gestational hypertension, preterm birth, gestational diabetes, and pre-eclampsia were gathered and compared between the two groups. Results: The rates of threatened miscarriage, placenta previa, gestational hypertension, gestational diabetes, preterm birth, and pre-eclampsia were not significantly different between the fresh and frozen embryo transfer groups (p>0.05). However, the early miscarriage rate in the fresh embryo transfer group was significantly higher (34% vs. 16.2%, p<0.001). Conclusion: According to the results of this study, maternal complications, except early miscarriage, were not different between fresh and frozen embryo transfer. However, frozen embryo transfer is safer in terms of the early miscarriage rate.","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138617049","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":"Threatened miscarriage and recurrent miscarriage: Expert opinions on progesterone therapy and treatment challenges.","authors":"Süleyman Cansun Demir,&nbsp;Ali Gedikbaşı,&nbsp;Hakan Timur,&nbsp;Cihan Çetin,&nbsp;Halil Gürsoy Pala,&nbsp;Çağrı Gülümser","doi":"10.4274/tjod.galenos.2023.66789","DOIUrl":"https://doi.org/10.4274/tjod.galenos.2023.66789","url":null,"abstract":"<p><p>It is crucial to gain a better understanding of threatened and recurrent miscarriages, including the existing knowledge and unknowns, as well as to discuss medical approaches and assess the situation. These issues are outstanding problems, causing significant physical and emotional burdens on women and their families, not only in Turkey but also worldwide. This article aims to explore the topic of miscarriages, including the implications, challenges, and potential therapeutic approaches in Turkey. Nineteen statements were presented to 6 Turkish perinatologists and obstetricians and gynecologists to evaluate the management of threatened and recurrent miscarriage and to compare the results with literature recommendations in an expert opinion meeting. Turkish perinatologists and obstetricians & gynecologists provided their responses using a 5-point Likert scale and discussed every statement. Progesterone use, particularly oral dydrogesterone, was supported by most of the experts. Opinions varied on the preference for dydrogesterone in recurrent miscarriage treatment. Experts unanimously agreed on the efficacy and safety of dydrogesterone and its recommendation in guidelines for threatened and recurrent miscarriage. Regarding progesterone therapy, vaginal progesterone was not associated with an increased rate of live births. Side effects of vaginal and oral micronized progesterone were acknowledged, and compliance with oral progesterone treatment was generally agreed upon. Dydrogesterone activity and effectiveness in threatened miscarriage received positive responses, while opinions on its effectiveness in recurrent miscarriage were divided. The loading dose of dydrogesterone and the practice of checking blood progesterone levels had different opinions among experts.This manuscript provides valuable insights in the management of threatened and recurrent miscarriages, highlighting the role of progesterone therapy, specifically dydrogesterone, and the need for adherence to relevant guidelines. Further research and a national Turkish guideline are warranted to address areas of uncertainty and optimize the management of these conditions.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/7e/TJOG-20-242.PMC10478724.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10166434","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}