Rambam Maimonides Medical Journal最新文献

{"title":"Differential Diagnosis of Orofacial and Jaw Pain: A Clinical Review for Physicians.","authors":"Waseem A Abboud, Tatiana Sella Tunis, Oren Peleg, Dror Shamir, Rania Elkhatib Fahoum, Shoshana Reiter, Michael V Joachim","doi":"10.5041/RMMJ.10584","DOIUrl":"https://doi.org/10.5041/RMMJ.10584","url":null,"abstract":"<p><p>Orofacial and jaw pain represents a diagnostic challenge frequently encountered across multiple medical specialties. Although odontogenic disease is a common cause of pain in the facial region, the present review focuses on non-odontogenic causes that should be considered when no clear dental source is identified or symptoms remain unexplained or persist despite appropriate dental treatment. Such pain may originate from the temporomandibular joints, masticatory muscles, cranial nerves, facial skeleton, adjacent head-and-neck structures, systemic diseases, or distant referred sources. This comprehensive review presents a systematic clinical approach to differential diagnosis, classifying non-odontogenic orofacial pain into ten distinct categories: temporomandibular joint disorders, masticatory muscle pain, skeletal disorders of the jaws, space-occupying lesions, infectious processes, neuropathic orofacial pain, idiopathic and nociplastic pain, orofacial pain resembling a presentation of primary headache, systemic diseases with orofacial manifestations, and referred orofacial pain from distant medical conditions. This classification aligns with the International Classification of Orofacial Pain (ICOP-2020) while emphasizing practical clinical applicability for physicians across various specialties. Each category is characterized by unique clinical features, examination findings, and diagnostic considerations. Proper recognition of these patterns enables accurate diagnosis, appropriate treatment, and timely specialist referral when indicated. The approach emphasizes clinical assessment techniques accessible to physicians across various healthcare settings, focusing on detailed history-taking and physical examination. Identification of red flag symptoms requiring urgent evaluation is highlighted throughout. This systematic framework aims to reduce diagnostic errors, improve patient outcomes, and enhance interdisciplinary collaboration in managing complex orofacial pain presentations.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002448","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":"Fetal Pain: Neurobiology, Clinical Practice, and Compassionate Care-A Narrative Review.","authors":"Omri Dominsky, Ido Solt","doi":"10.5041/RMMJ.10583","DOIUrl":"https://doi.org/10.5041/RMMJ.10583","url":null,"abstract":"<p><strong>Background: </strong>Whether a fetus can experience pain remains scientifically and clinically contested, particularly as invasive fetal procedures become more common.</p><p><strong>Objectives: </strong>To review fetal nociceptive development, the evidence and uncertainties relevant to pain perception, and the clinical rationale for fetal analgesia during invasive procedures.</p><p><strong>Methods: </strong>We performed a targeted narrative search of PubMed/MEDLINE, Google Scholar, the Cochrane Library, reference lists, and professional society websites. The final synthesis comprised 34 core sources.</p><p><strong>Results: </strong>Functional nociceptive and neuroendocrine responses to noxious stimuli are documented from the mid-second trimester and can be attenuated by fetal opioids. Early thalamic and subplate circuitry may challenge the claim that mature cortical architecture is required for all pain-related processing, but this circuitry has not been shown to be sufficient for conscious pain. Continuous endogenous fetal sedation is not supported by behavioral evidence, although the fetal neurochemical environment may modulate arousal and sensory processing. Maternal anesthesia, especially regional anesthesia, may not provide reliable fetal analgesic exposure. Professional guidance differs on the gestational age at which pain perception becomes possible.</p><p><strong>Conclusions: </strong>The clinical case for fetal analgesia should be separated from the unresolved question of conscious pain. Potential rationales include preventing possible suffering, attenuating documented physiological stress responses, and facilitating procedural stability. Decisions should therefore be based on a proportionate, procedure-specific maternal-fetal risk-benefit assessment rather than a universal precautionary default.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913744","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":"Physician-assigned Diagnosis Versus Questionnaire-based Measures in Individuals with Nociceptive, Neuropathic, and Nociplastic Pain: A Mechanism-based Characterization of Chronic Pain Patients.","authors":"Netanel Kamel, Tseela Hoffman, May Haddad, Amir Minerbi","doi":"10.5041/RMMJ.10580","DOIUrl":"10.5041/RMMJ.10580","url":null,"abstract":"<p><strong>Background: </strong>The International Association for the Study of Pain (IASP) has defined three mechanisms for chronic pain: nociceptive, neuropathic, and nociplastic. Accurate differentiation between these mechanisms is essential for treatment selection but remains challenging due to symptom overlap and reliance on clinical judgment. Patient-reported questionnaires may support diagnosis, though their diagnostic accuracy relative to physician assessment has not been fully established.</p><p><strong>Objectives: </strong>This study aimed to investigate the prevalence and overlap of chronic pain mechanisms in a tertiary pain clinic population and to compare physician-assigned diagnoses with results from patient-reported questionnaires.</p><p><strong>Methods: </strong>This cross-sectional study recruited 89 adult patients with chronic pain from the Rambam Institute for Pain Medicine at Rambam Health Care Campus in Haifa, Israel. Each participant underwent a comprehensive physician evaluation based on the criteria of the International Classification of Diseases and Related Health Problems, 11th revision, and completed the Central Sensitization Inventory (CSI), PainDETECT, and 2016 American College of Rheumatology (ACR) Fibromyalgia Diagnostic Criteria surveys. Diagnostic agreement, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using physician diagnosis as the reference standard.</p><p><strong>Results: </strong>Physician diagnoses identified neuropathic pain in 51 patients (57.3%), nociceptive pain in 38 (42.7%), and nociplastic pain in 25 (28.1%), with substantial diagnostic overlap (32.6% with ≥2 mechanisms). The CSI demonstrated high sensitivity (92.0%) but low specificity (45.3%) for nociplastic pain. PainDETECT showed moderate accuracy for neuropathic pain (sensitivity 68.6%, specificity 52.6%) and higher specificity for nociceptive pain (86.3%). The 2016 ACR Fibromyalgia criteria provided a more balanced diagnostic profile (sensitivity 88.0%, specificity 68.8%).</p><p><strong>Conclusions: </strong>Questionnaire-based measures are useful for screening chronic pain mechanisms but demonstrate variable accuracy when compared to physician diagnoses, particularly in the context of overlapping pain phenotypes. Refinement of diagnostic thresholds, combined assessment strategies, and updated questionnaires may improve differentiation of pain subtypes and enhance clinical decision-making.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680377","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":"Insomnia as an Independent Behavioral Correlate of Estimated Type 2 Diabetes Risk: Evidence from Three Validated Risk Assessment Scales.","authors":"José Luis Ribes Valles, Pedro Juan Tárraga López, Ángel Arturo López González, Irene Coll Campayo, Carla Busquets-Cortés, José Ignacio Ramírez-Manent","doi":"10.5041/RMMJ.10579","DOIUrl":"10.5041/RMMJ.10579","url":null,"abstract":"<p><strong>Background: </strong>Sleep disturbances, particularly insomnia, are increasingly recognized as behavioral determinants of type 2 diabetes (T2DM). However, their contribution to validated diabetes risk scores beyond traditional sociodemographic and lifestyle factors remains insufficiently explored.</p><p><strong>Objective: </strong>To examine the association between insomnia severity, sociodemographic variables, lifestyle habits, and estimated T2DM risk using three validated non-invasive risk assessment scales.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 84,898 Spanish workers aged 18-69 years undergoing occupational health evaluations (2021-2024). Sociodemographic and behavioral data were collected through standardized questionnaires, including adherence to the Mediterranean diet (MEDAS-14), physical activity (IPAQ-SF), and smoking status. Insomnia was assessed using the Insomnia Severity Index (ISI). Diabetes risk was estimated using three validated non-invasive risk-assessment tools: the Finnish Diabetes Risk Score, the QDScore/QDiabetes, and the Trinidad Risk Assessment Questionnaire for Type 2 Diabetes Mellitus. As these instruments were developed and validated in different populations, comparisons of absolute risk categories across scales should be interpreted with caution. Multivariable logistic regression models adjusted for age, sex, social class, smoking, diet, and physical activity were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Severe insomnia was associated with approximately 2.1-2.6-fold higher odds of high estimated diabetes risk across all three scales in the pooled analyses, with significant trends across categories of insomnia severity (all P for trend <0.001). This association persisted across sex and activity strata. Adding ISI modestly improved model discrimination (ΔAUC ≈ +0.015; P≤0.003) and reclassification (continuous net reclassification improvement [NRI], 6.5%-8.1%).</p><p><strong>Conclusions: </strong>Insomnia severity was independently associated with higher estimated risk of T2DM beyond measured sociodemographic and lifestyle determinants. Incorporating sleep health-via brief tools such as the ISI-into diabetes risk assessment could enhance early prevention strategies in clinical and occupational settings.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680352","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":"Response to Savel's \"Reconsidering the Scope and Structural Integration of Leadership Education for Clinicians\".","authors":"Nabilah Maher Chowdhury","doi":"10.5041/RMMJ.10582","DOIUrl":"10.5041/RMMJ.10582","url":null,"abstract":"","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686359","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":"Anatomy of Antisemitism in Health Professions Education and Practice: A Narrative Review.","authors":"Hedy S Wald, Steven Roth","doi":"10.5041/RMMJ.10581","DOIUrl":"10.5041/RMMJ.10581","url":null,"abstract":"<p><p>There has been an international resurgence in antisemitism in healthcare education and practice since October 7, 2023, prominently affecting the United States (US), United Kingdom (UK), Canada, and Australia. In the US, federal investigations by the US Department of Justice and the Congressional Subcommittee on Education and the Workforce were initiated into antisemitic harassment and hostile learning environments in medical schools. Healthcare organizations in the UK also came under investigation, and the US Congress opened an investigation into alleged antisemitism within a national psychological association. Quantitative and descriptive studies of the prevalence and characteristics of this phenomenon within medical, psychology, and social work education and practice are scant. We conducted a narrative review given the under-recognized nature of antisemitism in this context and the limited literature on this international, inter-professional issue. We searched PubMed using a search string to capture peer-reviewed descriptive and quantitative studies of antisemitism in medicine, psychology, social work, nursing, pharmacy, physician assistant, dentistry, physical, and occupational therapy education and practice. We searched 17 ProQuest databases for media and other online or written materials and conducted a hand search for additional relevant publications. We identified studies showing a high prevalence of antisemitism particularly in medical education, psychology, and social work, where >50% of subjects experienced antisemitism since October 7, 2023. Fewer than 2% of institutions had incorporated education about antisemitism into anti-discrimination training. Our review revealed that antisemitism as a form of bigotry, hatred, and discrimination has been inadequately addressed, now taking on urgency given its reach including an anti-Israel bias \"mutation\" and the need to assure unbiased healthcare. Actionable recommendations to counter antisemitism in healthcare derived from the publications to date are presented.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680379","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":"Mifepristone: Reflections on its Early Clinical Development for Medical Abortion.","authors":"Irving M Spitz","doi":"10.5041/RMMJ.10576","DOIUrl":"10.5041/RMMJ.10576","url":null,"abstract":"<p><p>Mifepristone (RU-486), the first clinically effective progesterone antagonist, was initially identified as having antiglucocorticoid activity. Although early interest focused on its role as a glucocorticoid receptor antagonist, recognition of its antiprogesterone effects led to studies of its role in pregnancy termination. This article reviews the steps leading to its use as an abortifacient, from its initial identification for this indication and draws on the author's direct involvement in the field with reflections on his contribution to the early clinical development of mifepristone. These studies established the efficacy of mifepristone in pregnancy termination. Unfortunately, its wider therapeutic applications have received limited attention.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785158","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":"Relationship Between Visual Perception and Participation Performance in Children with Autism Spectrum Disorder Aged 4-6 Years: A Cross-Sectional Study.","authors":"Redkar Simran Sandeep, Ganapathy Sankar Umaiorubagam","doi":"10.5041/RMMJ.10572","DOIUrl":"10.5041/RMMJ.10572","url":null,"abstract":"<p><strong>Objectives: </strong>This study explored the relationship between visual perceptual skills and participation performance in 4-6-year-old children diagnosed with autism spectrum disorder (ASD).</p><p><strong>Methods: </strong>A cross-sectional design was employed for children diagnosed with ASD. Visual perceptual abilities were assessed using the Motor-Free Visual Perception Test-Fourth Edition (MVPT-4), and participation levels were measured using the Children Participation Questionnaire (CPQ). Statistical analysis was done using SPSS version 26, employing one-sample t-tests and Pearson correlation analysis.</p><p><strong>Results: </strong>A total of 48 participants were included in the study: mean age, 4.98±0.82 years; 66.7% were male; 79.2% attended regular schools. One-sample t-tests indicated significant deficits across all CPQ dimensions (P<0.001). Visual perception was negatively correlated with autism severity (r=-0.429, P=0.002) and positively correlated with participation diversity (r=0.404, P=0.004). In the activities of daily living (ADL) and instrumental ADL (IADL) occupations, visual perception was significantly associated with all CPQ elements. Conversely, play and leisure occupations showed mostly negative correlations with the CPQ occupations, while social participation and education showed mixed results. Visual perception was positively correlated with most elements but negatively associated with enjoyment (r=-0.428; P=0.002).</p><p><strong>Conclusions: </strong>Preschool children with ASD demonstrate significant participation restrictions. Visual perception emerged as a critical determinant of participation, particularly in ADL and educational contexts. Early interventions targeting visual perception skills may enhance independence and functional engagement, though interventions should also address the enjoyment and emotional experience occupations to ensure holistic participation outcomes.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785194","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":"Deprescribing: Reducing Harm, Enhancing Care.","authors":"Carla Matos, Cindy Pinheiro","doi":"10.5041/RMMJ.10575","DOIUrl":"10.5041/RMMJ.10575","url":null,"abstract":"<p><strong>Introduction: </strong>Polypharmacy carries the potential for increased risk and severity of adverse reactions. Deprescribing may reduce adverse events and possibly hospitalizations, although evidence on hard outcomes such as mortality is mixed. As the medication experts responsible for the close monitoring of their patient, doctors, nurses, and pharmacists play a crucial role in the process of medication deprescribing. They are involved in the therapeutic process and contribute to the appropriate use of medications and the proper discontinuation of those that no longer benefit the patient or are harmful. This role is particularly important for vulnerable groups, such as older people, who often take chronic medication.</p><p><strong>Objective: </strong>This study aims to review the literature on polypharmacy and the importance of suspending unnecessary or harmful medications in older people, emphasizing the role of healthcare professionals in the process.</p><p><strong>Methods: </strong>A narrative review of recent publications (articles from 2023 to 2025) in Web of Science, PubMed, and Scopus databases, addressing polypharmacy and deprescribing in older adults was conducted.</p><p><strong>Conclusions: </strong>A multidisciplinary team including doctors, nurses, and pharmacists plays a pivotal role in this process by reviewing patients' therapeutic regimens, identifying inappropriate medications, and monitoring the withdrawal process. Their intervention can support more appropriate medication use, may improve patients' quality of life, and has the potential to reduce healthcare costs.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785219","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":"Why Is PaO₂ Not Enough? Arterial Oxygen Content as a Prognostic Indicator in COPD Patients.","authors":"Stephany Ivonne Briones Alvarado, Walther Iván Girón Matute","doi":"10.5041/RMMJ.10573","DOIUrl":"10.5041/RMMJ.10573","url":null,"abstract":"<p><strong>Background: </strong>Chronic hypoxemia in patients with COPD is associated with increased morbidity and mortality. Although arterial partial pressure of oxygen (PaO₂) is widely used, it does not adequately reflect systemic oxygen transport. Arterial oxygen content (CaO₂) may provide a more comprehensive assessment.</p><p><strong>Objective: </strong>This study aimed to evaluate whether or not CaO₂ is a better predictor of mortality than PaO₂ in patients with COPD.</p><p><strong>Methods: </strong>This retrospective observational cohort study included 147 COPD patients aged ≥45 years. Patients were categorized according to CaO₂ levels (low, normal, high). Mortality at 1, 3, and 5 years was analyzed. Statistical methods included ROC curves, Kaplan-Meier survival analysis, and Cox regression models.</p><p><strong>Results: </strong>A total of 66 deaths (45.2%) occurred in the study cohort. Mortality was highest in the low CaO₂ group. The CaO₂ demonstrated better predictive performance than PaO₂ (AUC 0.73 versus 0.53, respectively). Low CaO₂ was associated with a 2.5-fold increased risk of mortality. Despite improvements in PaO₂ after long-term oxygen therapy, CaO₂ did not significantly change.</p><p><strong>Conclusions: </strong>The CaO₂ is a more informative marker of oxygen transport and mortality risk than PaO₂ in COPD patients. It should be considered a complementary parameter in clinical assessment.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785171","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}