Einstein-Sao Paulo最新文献

{"title":"APENDIC-RADS: an ultrasound reporting system for the diagnosis of acute appendicitis.","authors":"Marcos Roberto Gomes de Queiroz, Victor Arantes Jabour, José Leão de Souza Junior, Milena Ribeiro Paixão, Paulo Savoia Dias da Silva, Davi Wen Wei Kang, Gaby Cecilia Yupanqui Guerra Barboza, Guilherme Muniz Bourroul, Juliana Maria Haddad de Lamare, Irline Cordeiro de Macedo Pontes, Gabriela Cauper de Carvalho Pereira, Wanessa Rolando Roselli, Marcelo Rocha Corrêa da Silva, Antonio Rahal Junior, Cesar Augusto Passos Braga, Miguel José Francisco Neto","doi":"10.31744/einstein_journal/2024AO1164","DOIUrl":"10.31744/einstein_journal/2024AO1164","url":null,"abstract":"<p><strong>Objective: </strong>Abdominal ultrasonography is widely used to evaluate suspected cases of appendicitis. Objective descriptions of the direct and indirect signs of appendicitis result in varied assessments of its likelihood. This study introduces the Appendix Imaging Reporting and Data System (APENDIC-RADS) to standardize the reporting of appendix ultrasound findings.</p><p><strong>Methods: </strong>This single-center retrospective study included consecutive patients of all ages who underwent abdominal ultrasonography for the investigation of acute appendicitis. The primary outcome was histopathological confirmation of acute appendicitis post-surgery. The imaging findings were classified into five categories: APENDIC-RADS 0, where the appendix cannot be visualized; APENDIC-RADS 1, indicating a normal appendix; APENDIC-RADS 2, describing an appendix that is likely normal but only partially visualized; APENDIC-RADS 3, appendicitis cannot be ruled out due to uncertain features and APENDIC-RADS 4, acute appendicitis.</p><p><strong>Results: </strong>A total of 747 patients were assessed for suspected acute appendicitis using ultrasonography. Of the diagnosed patients, 52% were male, primarily exhibiting symptoms such as nausea and/or vomiting (60%), right iliac fossa pain (54%), and sudden decompression in the right iliac fossa (24%). Stratification into APENDIC-RADS categories revealed a significant variation in the incidence of acute appendicitis, with incidence rates of 4.5% for category 0 and 0.7%, 2.2%, 11.5%, and 93.5% for categories 1 to 4, respectively (p<0.001). The APENDIC-RADS showed excellent discriminative ability, evidenced by an area under the receiver operating characteristic curve of 0.950 (95%CI=0.899-1).</p><p><strong>Conclusion: </strong>APENDIC-RADS categorization demonstrated excellent performance in standardizing the ultrasound-determined probability of acute appendicitis. Its implementation could improve physician communication and standardization of patient management.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO1164"},"PeriodicalIF":1.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856208","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":"Nephropulmonary fistula with coralliform stone migration into the thorax: a case report.","authors":"João Marco Braz Scarpa Mariano Pereira, Leonardo de Oliveira Antunes, Laiane Bicho Janegitz, Matheus José Maia Pereira, Luiz Carlos Maciel, Alberto Kalil Kobbaz","doi":"10.31744/einstein_journal/2024RC1220","DOIUrl":"10.31744/einstein_journal/2024RC1220","url":null,"abstract":"<p><p>A nephropulmonary fistula is a rare complication of a non-functioning kidney, associated with a history of infection. Medical literature describes it as an adult disease in the pre-antibiotic era, and nowadays, is a rare complication. This study reports the case of a patient with nephrolithiasis who developed a nephropulmonary fistula resulting in the migration of renal coralliform stones to the lung parenchyma. The treatment included posterior mini-thoracotomy with partial costectomy of the 9th right costal arch, pneumonotomy for the lung abscess, stone removal, abscess drainage with a Foley probe, and pleural drainage with a tubular drain.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRC1220"},"PeriodicalIF":1.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855692","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":"Association between physical activity levels and lower urinary tract symptoms: a cohort study in 20,732 Brazilian men.","authors":"Rafael Mathias Pitta, Oskar Kaufmann, Raphael Mendes Ritti-Dias, Luana de Lima Queiroga, Nelson Wolosker","doi":"10.31744/einstein_journal/2024AO1204","DOIUrl":"10.31744/einstein_journal/2024AO1204","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the association between physical activity levels and lower urinary tract symptoms in 20,732 Brazilian men.</p><p><strong>Methods: </strong>This cohort study included 20,732 men of ≥40 years of age, who participated in health screening between January 2008 and December 2018. Standardized health data (anthropometric, laboratory, clinical, and lifestyle data) were collected. A logistic regression model was used to examine associations based on the occurrence of lower urinary tract symptoms.</p><p><strong>Results: </strong>Depressive symptoms (p<0.001), age (p<0.001), erectile dysfunction (p<0.001), and total prostate-specific antigens (p<0.001) were associated with higher odds of lower urinary tract symptoms in men, after adjusting the other factors. However, physical activity levels were associated with lower odds of developing lower urinary tract symptoms (low active, p<0.001; active, p=0.002; and high active, p=0.005).</p><p><strong>Conclusion: </strong>All physical activity levels were associated with lower odds of lower urinary tract symptoms in 20,732 Brazilian men.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO1204"},"PeriodicalIF":1.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856225","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":"Beyond the rare: a case of pseudomyogenic hemangioendothelioma treated sequentially with everolimus, denosumab, and pazopanib.","authors":"Douglas Dias E Silva, Camila Bobato Lara Gismondi, Murilo Marques Almeida Silva, Renee Zon Filipi, Fernando Moura, Reynaldo Jesus-Garcia, Roberto Carmagnani Pestana","doi":"10.31744/einstein_journal/2024RC1107","DOIUrl":"10.31744/einstein_journal/2024RC1107","url":null,"abstract":"<p><p>Pseudomyogenic hemangioendothelioma is an ultra-rare vascular sarcoma that most commonly affects young adults, with a male predominance. It is diagnosed using a combination of imaging studies, histopathological examinations, and immunohistochemical staining. Surgical excision is the mainstay of treatment for pseudomyogenic hemangioendothelioma, with the goal of achieving a wide local excision and reducing the risk of recurrence. The role of systemic therapies is not well established because of the rarity of pseudomyogenic hemangioendothelioma, uncertainty regarding its response to currently approved medications, and lack of randomized controlled trials. We describe the case of an 18-year-old male patient diagnosed with multifocal pseudomyogenic hemangioendothelioma of the left lower limb who was treated with everolimus in addition to denosumab, achieving a partial response that was consolidated with resection, radiofrequency ablation, and radiotherapy of multiple local lesions, achieving a long-lasting response. Following subsequent disease progression, the patient responded favorably to pazopanib, with no significant toxicities.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRC1107"},"PeriodicalIF":1.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856241","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":"Frailty over the rainbow: a cross-sectional study of LGBT+ adults aged over 50 years.","authors":"Leonardo Rabelo de Melo, Milton Roberto Furst Crenitte, Richard Green, Wilson Jacob Filho, Thiago Junqueira Avelino-Silva","doi":"10.31744/einstein_journal/2024AO0937","DOIUrl":"10.31744/einstein_journal/2024AO0937","url":null,"abstract":"<p><strong>Objective: </strong>To investigate differences in the prevalence of frailty between LGBT+ and non-LGBT+ older adults.</p><p><strong>Methods: </strong>A cross-sectional study involving Brazilians aged 50 and over was performed. The participants were invited to participate in an anonymous online survey between August 2019 and January 2020. The survey was widely distributed in neighborhood associations, day centers, non-governmental organizations, and social media. Those who identified as homosexual, bisexual, pansexual, non-heterosexual, transgender, travesti, or non-binary were grouped as LGBT+. Participants who were both cisgender and heterosexual were categorized as non-LGBT+. Frailty was measured using the FRAIL scale, and the participants were categorized as robust, prefrail, or frail. Generalized ordered logistic models were used to examine the adjusted association between LGBT+ status and frailty according to age and sex.</p><p><strong>Results: </strong>The study sample included 6,693 participants with a median age of 60 years. Overall, 1,332 patients were LGBT+ (19.9%), and 5,361 were non-LGBT+ (80.1%). Pre-frailty or frailty was observed in 656 (49%) LGBT+ participants and 2,460 (46%) non-LGBT+ participants (p=0.03). Multivariate analyses showed that being LGBT+ was independently associated with frailty in female participants aged ≥50 years (OR=1.52, 95%CI=1.08-2.13, p=0.02) and male participants aged ≥60 years (OR=2.83, 95%CI=1.41-5.69, p=0.004). Non-cisgender participants were also more likely to be frail than cisgender participants (OR=2.21, 95%CI=1.42-3.42, p<0.001).</p><p><strong>Conclusion: </strong>LGBT+ status was independently associated with frailty in female adults aged >50 years and males aged > 60 years. More research in this area and inclusive government policies are needed to promote the healthy aging of the LGBT+ population.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0937"},"PeriodicalIF":1.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855689","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":"Percutaneous radiofrequency ablation of an actively bleeding renal angiomyolipoma.","authors":"Pedro Ivo Ravizzini, Henrique Augusto Lino, Gregory Ravizzini, Luís Gustavo Morato de Toledo","doi":"10.31744/einstein_journal/2024RC1008","DOIUrl":"10.31744/einstein_journal/2024RC1008","url":null,"abstract":"<p><p>We report a case of computed tomography-guided percutaneous radiofrequency ablation of a bleeding renal angiomyolipoma. Radiofrequency ablation was performed as an alternative to partial nephrectomy and super-selective renal artery embolization for ruptured renal angiomyolipoma with slow persistent bleeding in a patient with elevated serum creatinine levels and other comorbidities. Computed tomography-guided radiofrequency ablation successfully stopped the active hemorrhage and did not affect long-term renal function during the 3-year follow period. No complications were associated with the procedure. Radiofrequency ablation of a bleeding renal angiomyolipoma may be considered a more invasive surrogate procedure in an urgent setting; however, further studies are necessary to evaluate the long-term benefits of this approach and its overall impact on renal function compared to traditional methods.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRC1008"},"PeriodicalIF":1.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855695","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":"Use of convalescent plasma in COVID-19 treatment: is clinical severity more important than the intervention?","authors":"Valéria de Freitas Dutra, Heitor Duarte de Andrade, Viviane Regina Hernandez Nunes, Gabriella Mafra Elia, Juliane Roberta Dias Torres, Carolina Bonet Bub, Ana Paula Hitomi Yokoyama, José Mauro Kutner","doi":"10.31744/einstein_journal/2024AO0563","DOIUrl":"10.31744/einstein_journal/2024AO0563","url":null,"abstract":"<p><strong>Objective: </strong>This study compared the outcomes of two cohorts of patients with coronavirus disease 2019 (COVID-19) who received COVID-19 convalescent plasma transfusions between 2020 and 2021.</p><p><strong>Methods: </strong>This retrospective study was conducted at a tertiary hospital in São Paulo, Brazil. We included a retrospective cohort of patients who received convalescent compassionate plasma, and another group of patients from a previous clinical study. We collected clinical and laboratory data on the day of and 5 days after transfusion. Patients with hematological or immunological conditions were excluded. Statistical significance was set at p<0.05.</p><p><strong>Results: </strong>COVID-19 convalescent plasma did not affect the outcomes of patients with severe COVID-19 when comparing the two cohorts transfused with different volumes and titers of neutralizing antibodies. Despite improvements in some laboratory parameters, no effect on clinical outcomes was observed. Dialysis negatively affected the length of intensive care unit stay, hospitalization, and mechanical ventilation use. Each higher point on the day 0 World Health Organization scale reduced the probability of hospital and intensive care unit discharge and the risk of mechanical ventilation discontinuation.</p><p><strong>Conclusion: </strong>Dialysis and the assessed clinical severity represented by the World Health Organization scale on day 0 influenced the outcomes, whereas COVID-19 convalescent plasma transfusion did not.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0563"},"PeriodicalIF":1.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855904","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":"Average direct cost of peripherally inserted central catheterization by nurses in hospitalized patients: a cost estimate.","authors":"Maithê Gomes Lima Zandonadi, Danielly Negrão Guassú Nogueira, Amanda Salles Margatho do Nascimento, Paula Buck de Oliveira Ruiz, Natália Marciano de Araújo Ferreira, Suellen Karina de Oliveira Giroti, Flávia Meneguetti Pieri","doi":"10.31744/einstein_journal/2024GS0982","DOIUrl":"10.31744/einstein_journal/2024GS0982","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to estimate the direct costs of peripherally inserted central catheterization by nurses for hospitalized patients.</p><p><strong>Methods: </strong>A cost estimation study using a quantitative approach was conducted in a public teaching hospital in northern Paraná to calculate the direct costs of peripherally inserted central catheterization. The population included all medical records of patients between 15 and 99 years of age who were hospitalized and underwent peripherally inserted central catheterization by nurses between January 1, 2019, and December 31, 2021, totaling 664 insertions. The sample comprised 631 insertions.</p><p><strong>Results: </strong>The catheter kits (epicutaneous catheter + introducer + angulators) corresponded to the items with the highest unit costs and the greatest impact on the composition of costs. The cost of peripherally inserted central catheterization was US$ 217.14 (SD=75.21), with the cost of materials and staff's labor being US$ 195.39 (SD=74.15) and US$ 20.00 (SD=2.22), respectively.</p><p><strong>Conclusion: </strong>Materials represented the highest cost, which was explained by the high unit cost of catheters and kits used in echocardiography, followed by the staff's labor costs. The estimated average direct cost allowed for financial visibility of the inputs used. The key challenge is promoting lasting changes in the behavior of managers who carry out administrative functions in healthcare institutions, where proper budget management directly affects the allocative efficiency of resources and the quality of care.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eGS0982"},"PeriodicalIF":1.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856231","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":"Chronic spontaneous non-aneurysmal aortic rupture treated with endovascular surgery.","authors":"Bruno Jeronimo Ponte, Viviane Galli Dib, Andressa Cristina Sposato Louzada, Júlia Freire Castanheiras de Paiva Ferreira, Lucas Lembrança Pinheiro, Cynthia de Almeida Mendes, Nelson Wolosker","doi":"10.31744/einstein_journal/2024RC1113","DOIUrl":"10.31744/einstein_journal/2024RC1113","url":null,"abstract":"<p><p>Spontaneous non-aneurysmal aortic rupture is rare and is usually attributed to penetrating aortic ulcers, infections, tumor infiltrations, or inflammatory and collagen diseases. Chronic rupture is infrequent but extremely rare in non-aneurysmal aortas, which makes diagnosis difficult because the absence of an aneurysm can mislead the physician to rule out rupture. Here, we describe the case of an 85-year-old male, who was undergoing oncological investigation for weight loss, inappetence, and back pain. Computed tomography and magnetic resonance imaging performed 3 months before admission showed a contained pseudoaneurysm of the infrarenal aorta associated with significant aortoiliac calcification and images suggestive of peritoneal implants. The patient was referred to our oncological center and underwent abdominal computed tomography for oncological investigation and staging. The patient was urgently admitted to the intensive care unit after a critical finding of contained rupture of the infrarenal aorta during the scan. Endovascular repair was indicated, and the patient was successfully treated with implantation of an Endurant IIs 25 × 25 × 70 mm endoprosthesis. No procedural complications were observed. Postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Control computed tomography performed 1 and 6 months after surgery showed no leaks. This case emphasizes the importance of communication between the radiologists and attending physicians. As the rupture was punctual and well defined in the computed tomography and angiography images, endovascular repair with an aortic cuff was safely performed, and the procedure time was reduced.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRC1113"},"PeriodicalIF":1.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856272","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":"Point-of-care ultrasonography for diagnosis of purulent pericarditis postappendectomy: a case report.","authors":"José Alexandre Neto, Emanuel Pinheiro Esposito, Marcus Gomes Bastos, Cenilde da Costa Araújo, Luan Moraes Ferreira, Apollo Vinícius Fernandes Neves","doi":"10.31744/einstein_journal/2024RC0962","DOIUrl":"10.31744/einstein_journal/2024RC0962","url":null,"abstract":"<p><p>Purulent pericarditis is rare condition in the modern era of antibiotics. However, it is a serious condition as it has an accelerated progression and is difficult to diagnose due to its nonspecific clinical presentation, resulting in high mortality. Herein, we present a case in which a 36-year-old male patient with otherwise unremarkable medical history developed abdominal sepsis complicated by purulent pericarditis post-appendectomy. While the initial clinical presentation was not compatible with the classic signs of purulent pericarditis, the diagnosis was made using electrocardiography (ST elevation/PR depression) and point-of-care ultrasonography (pericardial effusion). The condition was successfully managed with pericardial drainage and broad-spectrum antibiotics. The present case reinforces and reiterates the need for high diagnostic suspicion and careful clinical reasoning in the diagnosis of purulent pericarditis. Furthermore, it highlights the applicability of point-of-care ultrasonography in the diagnosis of the same.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRC0962"},"PeriodicalIF":1.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855708","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}