Indian Journal of Otolaryngology and Head and Neck Surgery最新文献

{"title":"Effect of Lifestyle Modifications on Polysomnography in Obstructive Sleep Apnea.","authors":"Reshma Raj, Sandeep Bansal, Nancy Sahni, Ramandeep Singh Virk, Naresh Kumar Panda, Otolaryngology Pgimer, Chandigarh India","doi":"10.1007/s12070-025-05434-3","DOIUrl":"10.1007/s12070-025-05434-3","url":null,"abstract":"<p><strong>Background: </strong>Lifestyle modifications (LSM) is an ignored but essential component for Obstructive sleep apnea (OSA) treatment. We aimed to assess the role of LSM in OSA with customized program and its effect on polysomnographic parameters and body mass index (BMI).</p><p><strong>Methods: </strong>Prospective study of fifty six OSA patients randomized into 2 groups after establishing the diagnosis by polysomnography (PSG). Both the groups were advised LSM which included weight loss and incorporating physical activity as first line of treatment. Group A had 28 OSA patients who were given a customized diet chart, counselled and kept on regular follow. Group B with 28 OSA patients were advised by the treating physician to lose weight with no specific tailor-made diet plan. Patients were reassessed at the end of 6 months and underwent a repeat PSG. BMI along with PSG parameters like Apnea hypopnea index (AHI), lowest saturation (LSAT), and time of SpO2 < 90% (cT90) were analysed.</p><p><strong>Results: </strong>We analysed 54 subjects (mean age 42.38, 92.9% men). In Group A, 89.28% of the subjects had a significant decrease in AHI (<i>p</i> < 0.001) and time of SpO2 < 90% (<i>p</i> < 0.001) with improvement in mean LSAT (<i>p</i> < 0.001) and % of time with saturation < 90% (<i>p</i> = 0.001) and but in Group B only LSAT (<i>p</i> = 0.008) and cT90 (<i>p</i> = 0.028) showed improvement.</p><p><strong>Conclusion: </strong>Lifestyle modifications in the form of a customised diet programme with proper diet plan, emphasis on incorporation of physical activity and periodic counselling has a better outcome which can act as an adjuvant for OSA treatment.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 6","pages":"2227-2233"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151743","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":"Role of Diffusion Weighted Magnetic Resonance Imaging in Oral Cancer in Predicting Response to Neoadjuvant Chemotherapy.","authors":"Aswathi Asok, S H Chandrashekhara, Raju Sharma, Sanjay Thulkar, Ashu Seith Bhalla, Dipin Sudhakaran, Devasenathipathy Kandasamy, Lalit Kumar, Sunil Kumar, Sudheer Arava","doi":"10.1007/s12070-025-05511-7","DOIUrl":"10.1007/s12070-025-05511-7","url":null,"abstract":"<p><p>To downstage the locally advanced or inoperable oral cancer, neoadjuvant chemotherapy (NACT) is required. Early response assessment to chemoradiotherapy is needed to avoid unnecessary treatment in patients who are nonresponders. We conducted a prospective study to evaluate the role of diffusion weighted imaging (DWI) in predicting the response after NACT in locally advanced carcinoma of oral cavity. After ethical approval, A total of 19 patients were enrolled for the study. MRI were performed using T1W, T2W, T1W post contrast and DW images (b values b0, 100, 500, and 1000 sec/mm²). Timing of scans were fixed as- pretreatment, 2 weeks after the initiation of first cycle of NACT after 3rd cycle of NACT. ADC values of the tumors were assessed in each scan. The mean age of the population was 46 years and majority were males. ​​In our study, most patients had buccal mucosal cancer (13 patients). Patients with stable disease and progressive disease were labelled as non-responders, whereas patients with partial response and complete response were designated as responders. In our study, 11 patients were responders and 8 patients were non-responders. There was a significant difference between the baseline ADC values of responders and non-responders (p value = 0. 017). The increase in the mean absolute ADC and nADC values at the early time point was greater in the responders than the non-responders, and the difference was statistically significant (p values = 0.05 and 0.04 respectively). There was a significant difference between the baseline ADC values of responders and non-responders (p value = 0. 017). ADC values of diffusion weighted MRI can be utilized to predict the response to neoadjuvant chemotherapy in squamous cell carcinoma of oral cavity as masses with high baseline ADC values are less likely to respond to chemotherapy.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 6","pages":"2352-2362"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152529","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":"Glomus Tumours of the Temporal Bone: Our Experience in a Tertiary Hospital.","authors":"Sathishkumar Jayagandhi, Thirunavukarasu Palanisamy, Prasannakumar Saravanam, Somu Lakshmanan, Vinoth Manimaran","doi":"10.1007/s12070-025-05503-7","DOIUrl":"10.1007/s12070-025-05503-7","url":null,"abstract":"<p><p>Glomus tumours of the temporal bone, including glomus tympanicum and glomus jugulare, are rare, slow-growing, hypervascular neoplasms. To characterize the clinical presentation, Pre operative investigations, Management of cohort of patients with Glomus tumours of temporal bone managed in a single institute. Retrospective chart review of patients were conducted in a tertiary hospital situated in South India. there were 17 patients, 9 patients with Glomus tympanicum and 8 patients with Glomus jugulare. The tumour have female predilection. Male patients had more right sided tumours when compared to female patients. More number of patients were in 5th and 6th decade. Mean time before diagnosis was 24 months. A slow growing tumour with benign nature. Prompt early diagnosis may reduce morbidity related to surgery. Early microsurgical removal is the treatment of choice. Considering the benign nature adherent tumour maybe left as remnant over critical structures to avoid morbidity. We acknowledge the limitations posed by the small sample size and the need for long-term follow-up.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 6","pages":"2337-2343"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152227","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":"Skull Base Osteomyelitis- Microbiological Profile and Management Implications.","authors":"Katti Blessi Sara, Zachariah Thomas, P Lokesh Kumar, Arun Paul Charlu, Beula Subashini, Rajan Sundaresan Vediappan, Regi Thomas","doi":"10.1007/s12070-025-05442-3","DOIUrl":"10.1007/s12070-025-05442-3","url":null,"abstract":"<p><p>Skull base osteomyelitis (SBO) is a potent life-threatening infection that can be either otogenic, rhinogenic or odontogenic in origin. The characteristic features of this disease include severe nocturnal pain and cranial nerve palsies, thus causing severe morbidity and even mortality. Clinical data of 134 patients diagnosed with Skull base Osteomyelitis were retrospectively reviewed, and their demographic details, clinical features, surgical procedure, microbiolgical profile were analysed. In this cohort, 123 patients underwent targeted biopsy and debridement, which showed a male preponderance with a mean age of 60 and uncontrolled diabetes with a mean HbA1C of 8.4. The most common symptom was severe otalgia followed by facial nerve palsy. 85.4% of the patients were culture-positive and 14.6% were culture-negative. <i>Pseudomonas spp</i> was isolated in 32.6%, followed by <i>Aspergillus</i> <i>spp</i> (26%), <i>Staphylococcus</i> <i>spp</i> (25%) and atypical organisms (37%). The patients who underwent targeted biopsy and debridement followed by culture-specific antibiotics for appropriate duration showed 85% improvement in clinical symptoms with a significant improvement in culture positive group (<i>p</i><0.05). SBO, a potent fatal infection, can be secondary to bacterial or fungal infection. Early diagnosis and targeted biopsy may yield a culture-positive rate of 84.6%. Treatment with long-term culture-specific antibiotics/antifungals has improved clinical outcomes.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 6","pages":"2234-2238"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152638","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":"Metastatic Amelanotic Malignant Melanoma of the Parotid Gland.","authors":"Laavanya Rajendran, Chee Chean Lim, Chong Aun Wee","doi":"10.1007/s12070-025-05499-0","DOIUrl":"10.1007/s12070-025-05499-0","url":null,"abstract":"<p><strong>Introduction: </strong>Amelanotic malignant melanoma is a rare subtype, comprising only approximately 2-8% of all malignant melanoma. Amelanotic melanoma of the parotid gland is even more scarce and difficult to diagnose thus causing a diagnosis dilemma when encountered. In this case report, we highlight the importance of consideration of diagnosis of amelanotic melanoma in parotid gland malignancies which will ensure prompt investigation and treatment. We further discuss the challenges in diagnosing amelanotic melanoma and relevant clinical examination and investigation.</p><p><strong>Case presentation: </strong>We report a rare case of metastatic malignancy of parotid gland in a 74-year-old gentleman who presented with a parotid mass and overlying skin changes. Initial histopathology reports pointed towards sarcoma and lymphoma which caused a delay in diagnosis. However, a thorough examination and PET CT which revealed hypermetabolic peri and intra parotid lymph nodes prompted early surgical intervention of total parotidectomy. Special immunochemistry staining including vimentin, HMB45 and CD56 revealed metastatic amelanotic malignant melanoma of parotid gland. The patient then underwent adjuvant oncological treatment and recovered well.</p><p><strong>Conclusion: </strong>Although rare, metastasis to the parotid gland from a primary amelanotic melanoma should be considered one of the differentials in parotid gland tumours, hence the proposed investigations for early detection, prompt diagnosis and treatment to ensure a better prognosis and quality of life.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 6","pages":"2401-2403"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152441","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":"Misuse of Steroids in Hoarseness of Voice: A Retrospective Study.","authors":"Nupur Kapoor Nerurkar, Apurva Vatkar, Sonali Tyagi, Payal Kumbhat","doi":"10.1007/s12070-025-05515-3","DOIUrl":"10.1007/s12070-025-05515-3","url":null,"abstract":"<p><p>To retrospectively audit the total number of patients visiting our voice center with hoarseness of voice who had been previously treated with steroids and referred to our center when no improvement was seen. We retrospectively reviewed the documentation and stroboscopies of patients presenting to our voice clinic with change in voice over a period of 2 years and noted how many of these patients had been prescribed steroids with or without any diagnosis. From the voice clinic records, the data of age, gender, presenting complaints, route, duration and dosage of steroid intake was noted. The speciality of doctors prescribing the steroids and the prior laryngeal evaluation was also noted. A total of 164 patients were included in the study where 104 were males and 60 females. Out of 164, 128 patients were seen by ENT surgeons, 26 by general physicians and 10 by chest physicians. Most common presenting complaint was hoarseness of voice (HOV) in 100%of the patients with 5% also having complaints of vocal fatigue dry cough, globus sensation and throat irritation. Primary laryngeal diagnosis had been made in 110 (67%) patients before prescribing steroids. We performed stroboscopies for all 164 patients and further classified the number of patients where steroids were actually indicated which was 104 patients (60%). The total number of patients who visited the voice clinic over the study period of 2 years with change in voice was 1550 which was considered as the denominator. A total of 10.6% patients presenting to our voice clinic with HOV had been prescribed steroids prior to being referred to us. In our study an unindicated use of steroids in hoarseness of voice was seen in 40% of patients who had been prescribed steroids. As a consequence of steroids, fungal laryngitis had developed in 16% of these patients. An accurate diagnosis of HOV prior to treating patients with steroids is essential.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 6","pages":"2370-2374"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152444","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":"'Nasolabial Flap': A Versatile Solution for Oromandibular Defect Reconstructions in Patients with Lip and Oral Cavity Malignancies.","authors":"Dillip Kumar Samal, Vinusree Karakkandy, Pradipta K Parida, Pradeep Pradhan, Saurav Sarkar, Safia Saleem, Swagata Chakraborty, Abhijit Mishra, Yash Mittal, Aswathi Kallyadan Veetil","doi":"10.1007/s12070-025-05423-6","DOIUrl":"10.1007/s12070-025-05423-6","url":null,"abstract":"<p><p>Oro-mandibular defect reconstruction is always a challenge following the excision of oral cavity malignancies. Free flaps are considered ideal for the reconstruction of postexcision defects. Alternatively, regional flaps, like Nasolabial flaps, can be used as a workhorse for the reconstruction of various oral cavity defects with acceptable cosmesis. We have described here the various innovations and modifications of this flap that can be used for the repair of different subsites of the oral cavity. Fifty-eight nasolabial flap reconstructions in fifty-seven patients with malignancy of lips and oral cavity patients were included and evaluated retrospectively. They underwent wide local excision of the tumour with or without mandibular resection and cervical lymph node dissection, as per their extent of involvement. In all these patients, the oromandibular and lip defects were closed using nasolabial flaps as single or twostage procedures. Flap survival, outcomes and complications, if any, were evaluated based on their respective reconstruction subsites. Buccal mucosa, gingivobuccal sulcus, lip, tongue, retromolar trigone, upper alveolus and hard palate are the various subsites repaired with nasolabial flaps. Two patients had partial flap loss, and one had complete flap necrosis. None of the patients had significant donor site issues, except four patients who had ectropion, for which ophthalmologist intervention was sought. Most of the oral cavity defects can be reconstructed with various modifications of the nasolabial flaps. Considering favourable aestehtic and functional outcome, it may be used as an alternative to free flap reconstruction in selected cases of small to medium defects with minimal donor site morbidity.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 5","pages":"2026-2031"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055586","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":"Navigating the Complexities of Parotid Gland Arteriovenous Malformation: A Surgical Insight.","authors":"Leena Balachandar, Narendra Reddy, Dhanush Nayak","doi":"10.1007/s12070-025-05456-x","DOIUrl":"10.1007/s12070-025-05456-x","url":null,"abstract":"<p><p>Arteriovenous malformations (AVMs) are high-flow vascular anomalies consisting of a complex network of primitive vessels that directly connect feeding arteries to draining veins. A 34-year-old female presented to our ENT outpatient department with a 15-year history of a swelling below and in front of the left ear. The lesion measured approximately 6 × 5 cm, was firm in consistency, non-tender and non-pulsatile. Surgical resection, including superficial or total conservative parotidectomy with facial nerve preservation, remains the treatment of choice, with embolization serving as an adjunctive therapy.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 5","pages":"2153-2156"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056232","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":"Spontaneous Orbital Emphysema: A Case Report.","authors":"Hetal Marfatia, Anav Rattan, Ritika Dixit, Prateek Mohapatra","doi":"10.1007/s12070-025-05441-4","DOIUrl":"10.1007/s12070-025-05441-4","url":null,"abstract":"<p><p>This study aims to present two rare cases of spontaneous orbital emphysema and analyze the literature to understand its etiology, clinical presentation, and management. This report describes two cases of spontaneous orbital emphysema, which was followed by a bout of sneezing in one case and following valsalva manoeuvre in the other. CT scan of the paranasal sinuses and the orbit demonstrated a fracture of the Lamina Papyracea in both cases. Spontaneous orbital emphysema is rare and self-limiting condition, triggered by actions like sneezing, nose blowing or valsalva manoeuvre. Most cases resolve with conservative treatment; however, some require urgent intervention to prevent vision loss. Spontaneous orbital emphysema, while rare, should be considered in patients with sudden periorbital swelling without history of trauma. Conservative management is often effective, but vigilant monitoring is crucial.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 5","pages":"2145-2148"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993279","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":"Impact of Vitamin D3 Supplementation on Symptom Severity & IgE in Persistent Allergic Rhinitis.","authors":"Amit Kumar Rana, Rohit Sharma, Mamta Verma, Abhay Deep Singh, Ashish Mehrotra","doi":"10.1007/s12070-025-05476-7","DOIUrl":"10.1007/s12070-025-05476-7","url":null,"abstract":"<p><p>The potential for vitamin D₃ supplementation as adjunctive therapy in allergic rhinitis (AR) management remains a topic of considerable interest. Studies have investigated the relationship between serum vitamin D levels and AR severity, with conflicting results. To evaluate the impact of vitamin D₃ supplementation on symptom severity and IgE levels in patients with persistent allergic rhinitis (AR), and to assess the role of sustained supplementation in achieving long-term benefits. A randomized, double-blind, prospective interventional study was conducted at a teaching institute in India with 600 AR patients randomized into three groups: Group A (intranasal corticosteroids and placebo), Group B (intranasal corticosteroids and vitamin D₃ supplementation with maintenance doses), and Group C (intranasal corticosteroids and vitamin D₃ without maintenance doses). A control group of 200 healthy individuals was also included. Vitamin D₃, IgE levels, and Total Nasal Symptom Score (TNSS) were measured at baseline, 2 months, and 6 months. At baseline, 81.66% of AR patients had suboptimal vitamin D₃ levels compared to 65% in the control group. Group B showed the most significant improvement in vitamin D₃ levels, with 80% achieving normal levels by 6 months. TNSS and IgE levels also improved significantly in Group B, with sustained reductions compared to Groups A and C (<i>p</i> < 0.001). Group C showed a rebound in symptoms and IgE levels after discontinuation of supplementation. Sustained vitamin D₃ supplementation significantly improves symptom severity and IgE levels in patients with persistent AR. These findings suggest vitamin D₃ as a promising adjunct to standard AR treatment.</p>","PeriodicalId":49190,"journal":{"name":"Indian Journal of Otolaryngology and Head and Neck Surgery","volume":"77 5","pages":"2123-2130"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023945","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}