Medicc Review最新文献

{"title":"Improving Ketosis-Prone Type 2 Diabetes Diagnosis in Africa.","authors":"Dagoberto Álvarez-Aldana","doi":"10.37757/MR2021.V23.N3.11","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N3.11","url":null,"abstract":"Diabetes mellitus (DM) is a serious health problem with high— and increasing—prevalence and incidence around the world. Africa, with a considerable communicable disease burden, is not exempt and is facing greater DM risk due to rapid demographic, sociocultural, economic and nutritional changes. According to the International Diabetes Federation, Africa will experience the largest jump in DM prevalence (143%) of all regions over the next 25 years.[1,2]","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":" ","pages":"61-62"},"PeriodicalIF":2.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39413262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racotumomab in Non-Small Cell Lung Cancer as Maintenance and Second-Line Treatment.","authors":"Haslen Hassiul Cáceres-Lavernia,&nbsp;Elia Nenínger-Vinageras,&nbsp;Leslie M Varona-Rodríguez,&nbsp;Yoli A Olivares-Romero,&nbsp;Irlis Sánchez-Rojas,&nbsp;Zaima Mazorra-Herrera,&nbsp;Denenke Basanta-Bergolla,&nbsp;Dayanis Duvergel-Calderín,&nbsp;Boris L Torres-Cuevas,&nbsp;Concepción Castillo-Carrillo","doi":"10.37757/MR2021.V23.N3.5","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N3.5","url":null,"abstract":"<p><strong>Introduction: </strong>Racotumomab is a therapeutic vaccine based on a monoclonal anti-idiotypic antibody developed by the Molecular Immunology Center in Havana, Cuba, that is registered in Cuba and Argentina for treatment of non-small cell lung cancer. It induces a specific humoral and cellular immune response against the N-glycolyl GM3 (NeuGcGM3) ganglioside present in tumor cells, thereby provoking the death of these cells.</p><p><strong>Objective: </strong>Evaluate racotumomab vaccine use as switch maintenance and second-line therapy for patients with inoperable non-small cell lung cancer in routine clinical practice, outside the framework of clinical studies, and assess the overall survival, stage-specific survival and safety in these patients.</p><p><strong>Methods: </strong>A descriptive, retrospective study was carried out in patients diagnosed with non-small cell lung cancer not suitable for surgical treatment, who received racotumomab as a part of switch maintenance or second-line treatments. Overall survival was defined from diagnosis and from the first immunization, until death.</p><p><strong>Results: </strong>We included 71 patients treated with racotumomab, 57.7% (41/71) of whom were in stages IIIB and IV of non-small cell lung cancer. Of the patients, 84.5% (60/71) had no adverse events, and 15.5% (11/71) had mild adverse reactions. The median overall survival was 24.5 months, calculated from the first immunization, 17.2 months for those who received racotumomab as switch maintenance and 6.8 months for patients who had progressed after the first line of treatment.</p><p><strong>Conclusions: </strong>Racotumomab in routine clinical practice prolonged overall survival in patients with non-small cell lung cancer treated in switch maintenance, and in stage IV patients who received the treatment as second-line therapy. The vaccine was well tolerated.</p>","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":" ","pages":"21-28"},"PeriodicalIF":2.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39431235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cuba's National Regulatory Authority & COVID-19: Olga Lidia Jacobo-Casanueva MS Director, Center for State Control of Medicines and Medical Devices (CECMED).","authors":"Tania L Aguilar-Guerra,&nbsp;Esther María Fajardo-Díaz,&nbsp;Conner Gorry","doi":"10.37757/MR2021.V23.N3.3","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N3.3","url":null,"abstract":"At the time of this writing, more than 10 million Cubans (nearly 90% of the country's population), had received at least their first dose of Soberana 02 or Abdala, two of five vaccine candidates for SARS-CoV-2 developed and produced on the island. Late-phase clinical trial data revealed that Abdala is 92.28% effective after the full, three-dose cycle and Soberana 02 is 91.2% effective after two doses, when followed by a booster of Soberana Plus.[1] Cuban health authorities have committed to vaccinating the entire population, including children aged 3-18 years old, using these vaccines by the end of 2021. The first pre-clinical, peer-reviewed data are available,[2] with clinical trial results already submitted to various international journals. Building on decades of biotechnology know-how developing, producing and administering 11 preventive vaccines for childhood diseases-used in the nation's universal health system and also marketed elsewhere-Cuba is the first, and to date only, country in Latin America and the Caribbean to develop its own vaccine candidates for COVID-19 (Soberana 01; Soberana 02; Soberana Plus; Abdala and Mambisa; see Box on following page). In a strategy designed to ensure comprehensive and importantly, independent solutions to the global health crisis, research institutes and manufacturing facilities coordinated by BioCubaFarma-the country's biopharmaceutical conglomerate-have also developed COVID-19 treatments and essential medical equipment. To gain a better understanding of the regulatory process involved, MEDICC Review turned to Olga Lidia Jacobo-Casanueva, Director of the Center for State Control of Medicines and Medical Devices (CECMED), Cuba's national regulatory authority (NRA). A clinical microbiologist, Jacobo-Casanueva served as interim director throughout 2020 before becoming director in January 2021. She has spent nearly her entire career at CECMED, working her way up the ranks in a unique trajectory: from her first position in 1992 in the Center's microbiology laboratories, she has since worked in all but one of the six areas required by WHO to qualify as a National Regulatory Authority of Reference (NRAr; CECMED was certified as a Level 4 NRAr in 2011, a qualification it maintains). In short, Jacobo-Casanueva is a regulatory polymath, with hands-on experience in nearly every facet of regulation. She is also an adjunct researcher in the Faculty of Biology at the University of Havana. Cuba's decision to confront the pandemic autonomously by developing preventive vaccines to control COVID-19 is deliberate and fraught with challenges. With dozens of ongoing clinical trials, coupled with the declining epidemiological and economic situation in Cuba-exacerbated by tightened US sanctions affecting all facets of COVID-19 prevention and response-we appreciate the time Jacobo-Casanueva took from her schedule to parse the complex regulatory mechanisms required to introduce Cuban and imported products into the national hea","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":" ","pages":"9-14"},"PeriodicalIF":2.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39431233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subtype-Dependent Co-receptor Tropism in Cuban HIV-1-Infected Patients: Implications for Maraviroc Treatment.","authors":"Yenisleidys Martínez-Montesinos,&nbsp;Vivian Kourí-Cordellá,&nbsp;Lissette Pérez-Santos,&nbsp;Rui Han,&nbsp;Yanet Pintos-Saavedra,&nbsp;Yoan Alemán-Campos,&nbsp;Yudira Soto-Brito,&nbsp;Yoanna Baños-Morales,&nbsp;Yaniris Caturla-Fernández","doi":"10.37757/MR2021.V23.N3.6","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N3.6","url":null,"abstract":"<p><strong>Introduction: </strong>Unlike most high-income countries where subtype B viruses predominate, the Cuban HIV-1 epidemic is characterized by a great diversity of subtypes and circulating recombinant forms. Some studies have shown that HIV variants exhibiting a preference for the CXCR4 co-receptor (X4-tropic) could have impacts on disease pathogenesis, with clinical implications for antiviral treatment plans. Determination of HIV co-receptor tropism is crucial for clinicians in deciding whether maraviroc is an appropriate antiviral.</p><p><strong>Objective: </strong>Characterize V3 sequence variability and its relation to viral tropism across different subtypes circulating in Cuba and explore how this may affect treatment success with maraviroc.</p><p><strong>Methods: </strong>We designed a cross-sectional study that included 72 plasma samples obtained at the Pedro Kourí Tropical Medicine Institute in Havana, Cuba. We sequenced the C2V3 env region and assessed subtype based both on env and pol sequences; tropism was predicted by Geno2pheno analysis. Additionally, 35 V3-loop Cuban sequences, obtained from a previous study, were incorporated into the analysis. Statistical associations among virological, clinical and epidemiological variables were assessed by a chi-square test.</p><p><strong>Results: </strong>Tropism prediction for 72 variants revealed that CRF19_cpx was associated with dual-tropic R5X4 viruses (p = 0.034). Moreover, when 35 sequences from a former study were added, the association was significant not only for R5X4 (p = 0.019) but also for X4-tropic variants (p = 0.044). Alignment of 107 V3-loop sequences showed wide diversity among the different HIV-1 subtypes circulating in Cuba.</p><p><strong>Conclusions: </strong>In accordance with G2P, CRF19_cpx is a genetic variant with a high proportion of X4 and R5X4-tropic viruses. The results from the present study suggest that the Cuban recombinant could be a more pathogenic variant and that maraviroc may not be suitable for patients infected with CRF19_cpx.</p>","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":" ","pages":"29-36"},"PeriodicalIF":2.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39431236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US Sanctions on Cuba Further Imperil Global Vaccine Equity.","authors":"","doi":"10.37757/MR2021.V23.N3.1","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N3.1","url":null,"abstract":"","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":" ","pages":"4-6"},"PeriodicalIF":2.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39431230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"At Least One Zoonosis Silently Spreads During COVID-19: Brucellosis.","authors":"Guillermo Antonio Barreto-Argilagos,&nbsp;Herlinda de la Caridad Rodríguez-Torrens","doi":"10.37757/MR2021.V23.N3.2","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N3.2","url":null,"abstract":"To the Editors: Brucellosis dates back to when humans began herding goats and several reasons account for its re-emergence today. First is underestimation stemming from the erroneous notion that brucellosis was brought under control in the last century. Second is underestimation of the role that goats and goat products play in the chain of transmission to humans. And fi nally is the failure to consider biofi lm phenotypes in research assessing Brucella spp.–ecosystem interactions. Thus, false results are derived, the illness’s chronicity increases along with the corresponding failures in antibiotic therapies, and measures more apt to control the disease are simply not adopted.[1]","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":" ","pages":"8"},"PeriodicalIF":2.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39431231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoxemia and Cytokine Storm in COVID-19: Clinical Implications.","authors":"Calixto Machado,&nbsp;Alina González-Quevedo","doi":"10.37757/MR2021.V23.N3.10","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N3.10","url":null,"abstract":"<p><p>One of the most dreadful complications that can occur during the course of COVID-19 is the cytokine storm-also known as cytokine release syndrome-a form of systemic inflammatory response syndrome triggered by SARS-CoV-2 infection. The cytokine storm is an activation cascade of auto-amplifying cytokines, which leads to excessive activation of immune cells and generation of pro-inflammatory cytokines. It occurs when large numbers of white blood cells are activated and release inflammatory cytokines, in turn activating even more white blood cells, finally resulting in an exaggerated pro-inflammatory-mediated response and ineffective anti-inflammatory control, leading to tissue damage, multiorgan failure, acute respiratory distress syndrome and death. Although cytokine storm pathogenesis is multifactorial, we hypothesize there is a close association between hypoxemia and cytokine storms in COVID-19, although it is difficult to establish the direction of this relationship. Most probably they coexist and, given enough time, one triggers the other in a chain reaction. Careful analysis of the day-to-day clinical evolution of COVID-19 indicates that there are short and slight periods of hypoxemia (confirmed by pulse oximetry and arterial gasometry), even on the day of the onset of persistent cough and/or shortness of breath. We propose the use of continuous positive airway pressure in early stages of COVID-19, at the onset of respiratory symptoms. This non-invasive ventilation method may be useful in individualized treatments to prevent early hypoxemia in COVID-19 patients and thus avoid triggering a cytokine storm. We believe such an approach is relevant everywhere, and in Cuba in particular, since the country has initiated national production of mechanical ventilation systems, including non-invasive ventilators. Moreover, as Cuba's COVID-19 protocols ensure early patient admission to isolation centers or hospitals, clinicians can prescribe the early use of continuous positive airway pressure as soon as respiratory symptoms begin, averting early hypoxemia and its triggering effect on cytokine storm development, and consequently, avoiding acute respiratory distress syndrome, multi-organ failure, and death.</p>","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":" ","pages":"54-59"},"PeriodicalIF":2.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39413264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Inflammation on Assessing Iron-Deficiency Anemia in Cuban Preschool Children.","authors":"Gisela M Pita-Rodríguez,&nbsp;Cristina Chávez-Chong,&nbsp;Brenda Lambert-Lamazares,&nbsp;Minerva Montero-Díaz,&nbsp;Rolando Selgas-Lizano,&nbsp;Beatriz Basabe-Tuero,&nbsp;Karen Alfonso-Sagué,&nbsp;María E Díaz-Sánchez","doi":"10.37757/MR2021.V23.N3.7","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N3.7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Anemia is a public health problem worldwide and is most prevalent in preschool children, for whom it is the most frequent cause of nutritional deficits. In turn, iron deficiency is the main cause of anemia, affecting 43% of children globally. Previous studies in Cuba show rates of iron deficiency in preschool children between 38.6% and 57.6%, higher in infants (71.2% to 81.1%). WHO recommends using serum ferritin as an indicator of iron deficiency accompanied by acute (C-reactive protein) and chronic (a1-acid glycoprotein) inflammation biomarkers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Assess how inflammation affects measuring and reporting of iron-deficiency anemia rates in Cuban preschool children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were obtained from serum samples contained in the National Anemia and Iron Deficiency Survey, and included presumably healthy preschool Cuban children (aged 6-59 months). Serum samples were collected from 1375 children from randomly selected provinces in 4 regions of the country from 2014 through 2018. We examined the association between ferritin and two inflammatory biomarkers: C-reactive protein and a1-acid glycoprotein. Individual inflammation-adjusted ferritin concentrations were calculated using four approaches: 1) a higher ferritin cut-off point (⟨30 g/L); 2) exclusion of subjects showing inflammation (C-reactive protein ⟩5 mg/L or a1-acid glycoprotein ⟩1 g/L); 3) mathematical correction factor based on C-reactive protein or a1-acid glycoprotein; and 4) correction by regression with the method proposed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia Group. We estimated confidence intervals of differences between unadjusted prevalence and prevalence adjusted for inflammation by each method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The proportion of children with inflammation according to C-reactive protein concentrations &gt;5 mg/L was lower (11.1%, 153/1375) than the proportion measured according to the concentrations of a1-acid glycoprotein, at &gt;1 g/L (30.8%, 424/1375). The percentage of children with high concentrations of at least one of the aforementioned biomarkers was 32.7% (450/1375). Thus, each correction method increased the observed prevalence of iron deficiency compared to unadjusted estimates (23%, 316/1375). This increase was more pronounced when using the internal regression correction method (based only on C-reactive protein) or the method based on a higher cut-off point. Adjustment using all four methods changed estimated iron deficiency prevalence, increasing it from 0.1% to 8.8%, compared to unadjusted values.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;One-third of preschool children had biomarkers indicating elevated inflammation levels. Without adjusting for inflammation, iron deficiency prevalence was underestimated. The significant disparity between unadjusted and inflammation-adjusted ferritin when using some approaches highlights the importan","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":" ","pages":"37-45"},"PeriodicalIF":2.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39431237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Multiple Cause-of-Death Analysis to Estimate Systemic Autoimmune Disease Mortality Burden in Low- and Middle-Income Countries.","authors":"Halbert Hernández-Negrín,&nbsp;Yeniver Roque-Dapresa,&nbsp;Onan Martínez-Morales,&nbsp;Anabel Mederos-Portal","doi":"10.37757/MR2021.V23.N2.12","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N2.12","url":null,"abstract":"<p><p>Autoimmune diseases are not always recognized as urgent health issues, despite a worldwide prevalence of 4%-5%. Most estimates come from high-income countries, as low- and middle-income countries face more issues of under-reporting. Despite this and the lack of recognition under current reporting practices, the role these diseases play in mortality must be acknowledged. In particular, considering multiple causes of death as opposed to a single cause of death results in a 1.5-4.2-fold increase in deaths classified as relating to autoimmune diseases, evidence of their share in overall mortality burden, a factor important for patient care and healthcare policy decision making. However, formulating such policies and programs for timely, appropriate diagnoses and care is stymied in low- and middle-income countries by the shortage of methodologically sound studies on mortality from systemic autoimmune diseases. This limitation exacerbates inequalities and health gaps among patients in different countries and localities. Multiple cause-of-death methodology has been validated for research on other diseases and demonstrates the mortality burden of these illnesses in countries where traditional methodological approaches, primarily based on prospective cohort studies, are not feasible. Studying mortality from systemic autoimmune diseases by analyzing multiple causes of death with data from national mortality registries is a low-cost alternative to traditional mortality analysis. The objective of this paper is to demonstrate and defend the usefulness of this approach to estimate mortality burden.</p>","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"23 2","pages":"69"},"PeriodicalIF":2.1,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38900845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Heart Problems in Convalescent COVID-19 Children: Alert from a Cuban Study.","authors":"Lisset Ley-Vega","doi":"10.37757/MR2021.V23.N2.13","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N2.13","url":null,"abstract":"Although children with COVID-19 are often asymptomatic or exhibit only mild symptoms, they can transmit the disease and suffer from serious manifestations. In Cuba, 2932 patients ≤18 years old tested positive for COVID-19 between March 2020 and February 1, 2021. Most of these children presented few to no symptoms upon diagnosis. At the time of this writing, 82.8% of those children had recovered,[1] and there had not been a single pediatric death due to the novel coronavirus.","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"23 2","pages":"76"},"PeriodicalIF":2.1,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38969322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}