Journal of Vestibular Research-Equilibrium & Orientation最新文献

{"title":"Clinical features of secondary BPPV: A nation-wide multicenter study.","authors":"Seunghee Na, Eun-Ju Jeon, Min-Beom Kim, Jung-Yup Lee, Chang-Hee Kim, Sung Il Nam, Hyun Ah Kim, Hyung Lee, Ji-Soo Kim, Jeong-Yoon Choi, Min-Ku Kim, Ji-Yun Park, Jeon Mi Lee, Eunjin Kwon, Seong-Hae Jeong, Sung-Kwang Hong, Hyo-Jeong Lee, Jae-Yong Byun, Myung Hoon Yoo, Seok Min Hong, Tae-Kyeong Lee, Sangwoo Lee, Yun Ji Lee, Kyu-Sung Kim, Jae-Hyun Seo, Sun-Uk Lee, Eek-Sung Lee, Hong Ju Park","doi":"10.1177/09574271251319775","DOIUrl":"10.1177/09574271251319775","url":null,"abstract":"<p><p>BackgroundBenign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and its prevalence is substantial. While primary BPPV has been well studied, the understanding of secondary BPPV is still limited.ObjectiveTo investigate the prevalence and clinical characteristics of secondary BPPV in a national multicenter retrospective analysis.MethodsThe study involved a retrospective analysis of medical records from 17 institutions across South Korea, between January and June 2022. We evaluated clinical features, presumed etiologies, involvement of semicircular canals, response to canalith repositioning procedures (CRPs), presence of residual dizziness, recurrence, and results of auditory and vestibular function tests for both primary and secondary BPPV cases.ResultsOf the total 1363 BPPV cases, 14.5% (198 patients) were categorized as secondary BPPV. The most prevalent etiology for secondary BPPV was head trauma. Secondary BPPV was associated with a higher prevalence of comorbidities including diabetes and inner ear diseases. Patients with secondary BPPV demonstrated more frequent involvement of multiple semicircular canals, necessitated a greater number of CRPs for resolution, and experienced a higher incidence of residual dizziness compared to primary BPPV cases. Furthermore, secondary BPPV patients exhibited more frequent abnormalities in auditory and vestibular function tests.ConclusionsSecondary BPPV accounts for a significant proportion of BPPV cases, with distinct clinical characteristics compared to primary BPPV.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"193-204"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of viewing distance on dynamic visual acuity.","authors":"Lien Van Laer, Allison Nogi, Jorge Serrador, Michael C Schubert","doi":"10.1177/09574271251327957","DOIUrl":"10.1177/09574271251327957","url":null,"abstract":"<p><p>BackgroundPatients with dizziness and unsteadiness are commonly prescribed gaze stability exercises at varying target distances to manage vestibular impairments but lack objective tools to monitor progress. Maintaining gaze stability during head motion at near distances demands greater eye velocity relative to head velocity due to vergence and increased translational eye rotation demands.ObjectivesThis study compared dynamic visual acuity (DVA) during yaw and pitch at both near and far distances in patients and healthy controls.MethodsThis study includes individuals with unilateral vestibular deafferentation (UVD), veterans with dizziness yet healthy vestibular function, and healthy controls. The computerized DVA at near (50 cm) and far (200 cm) distances were collected. Data analysis included comparisons of near and far DVA in yaw and pitch planes.ResultsA total of 94 participants (34 UVD, 24 veterans with dizziness, 36 controls) were included. Near-distance DVA was significantly worse than far-distance DVA for the entire sample and within each group (<i>p</i> < 0.001).ConclusionsNear-distance DVA is more challenging than far-distance DVA across populations and planes of head rotation. Near-distance DVA may serve as a robust measure of vestibulo-ocular reflex function and offers a practical means for patients to self-monitor the effects of gaze stability training.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"185-192"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High prevalence of sleep disorders in Ménière's disease: Interplay between vestibular function and sleep.","authors":"Arnaud Petry, Manuela Leuzzi, Claire Thibault, Henri Comtet, Ulker Kilic-Huck, Patrice Bourgin, Anne Charpiot, Elisabeth Ruppert","doi":"10.1177/09574271251328339","DOIUrl":"10.1177/09574271251328339","url":null,"abstract":"<p><p>BackgroundIn Ménière's disease (MD), impaired sleep worsens the quality of life and triggers episodes, perpetuating a vicious cycle. The intricate connection between vestibular function and sleep regulation is poorly understood.ObjectiveWe aimed to investigate this link by studying sleep in confirmed MD patients.MethodsIn a single-center observational study, 26 consecutive patients with MD were enrolled. Sleep characterization included thorough symptom inquiry, questionnaires (PSQI, ESS, PFS, STOP-Bang, and AAO-HNS), and respiratory polygraphy (RP) or polysomnography (PSG).ResultsDespite 42% of patients reporting overall sleep satisfaction, further inquiry revealed 76% experiencing sleep disturbances per PSQI. STOP-Bang indicated 56% with a moderate-to-severe risk of OSAS. OSAS defined by apnea hypopnea index (AHI) ≥ 5/h was present in 75%. OSAS severity was categorized as mild (5/h ≤ AHI < 15/h, 33%), moderate (15/h ≤ AHI < 30/h, 21%), and severe (AHI ≥ 30/h, 21%). In patients with AAO-HNS score >3, migraines and insomnia were more prevalent. Patients with moderate-to-severe OSAS had poorer hearing. All recently diagnosed patients with moderate-to-severe OSAS had undergone more than one medical treatment compared to others (32%).ConclusionsThe high prevalence of sleep disorders in MD patients underscores the need for thorough screening, even without spontaneous complaints. Instrumental sleep exploration via RP or PSG is essential, as OSAS treatment could aid vestibular function.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"205-212"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods and clinical outcomes in vestibular implantation - A systematic literature review.","authors":"Jonathan Olsgård Hansen, Hjalte Christian Reeberg Sass, Niels Cramer West, Per Cayé-Thomasen","doi":"10.1177/09574271251332157","DOIUrl":"10.1177/09574271251332157","url":null,"abstract":"<p><p>BackgroundThe vestibular implant is an experimental device that may provide treatment to patients suffering from bilateral vestibulopathy who do not benefit from standard vestibular rehabilitation.ObjectiveThe objective is to identify the various methodology regarding device designs and surgical approaches in addition to assessing subjective and objective vestibular and clinical outcomes in order to evaluate the future and possible limitations of the vestibular implant.MethodsA systematic search of Medline and Embase was conducted according to the PRISMA guidelines using pre-defined inclusion and exclusion criteria. 350 hits were found, which after 2 rounds of screening by 2 independent reviewers resulted in 21 studies eligible for full-text review.ResultsA total of 36 recipients of a vestibular implant across four centres world-wide were identified. Both surgical approach and devices as well as vestibular and functional outcomes varied greatly across centres and from patient to patient, evaluated using a variety of objective and subjective tests.ConclusionSeveral promising results in vestibular implantation were found using both subjective and objective measurements. However, some questions with regards to hearing preservation and long-term, continuous use of the vestibular implant remain to be answered, and more studies are needed to assess the efficacy and cost-utility of the implant.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"172-184"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of using virtual reality on balance in people with persistent postural-perceptual dizziness: A randomized controlled trial.","authors":"Madlien M Al-Omari, Sawsan M Abuzaid, Hamzeh J Khair, Haidzir Manaf, Alia A Alghwiri","doi":"10.1177/09574271251326587","DOIUrl":"10.1177/09574271251326587","url":null,"abstract":"<p><p>BackgroundPersistent postural-perceptual dizziness (PPPD) represents a relatively new vestibular diagnosis that has garnered attention within the medical community. Consequently, there is a pressing demand for efficacious management strategies.ObjectiveTo assess the comparative effectiveness of virtual reality (VR) versus vestibular rehabilitation therapy (VRT) in improving PPPD symptoms.MethodsWe randomly assigned a cohort of 42 individuals conclusively diagnosed with PPPD to two distinct groups. The experimental group included 21 participants who received a combination of VR and optokinetic stimulation in addition to VRT, while the control group, also made up of 21 individuals, only received optokinetic stimulation in conjunction with VRT. We administered the intervention sessions twice weekly over a span of 6 weeks, resulting in a total of 10-intervention sessions. Additionally, baseline, post-intervention, and follow-up assessments were conducted.ResultsOur analysis revealed that participants in both groups significantly improved with no significant differences between the groups. Individuals undergoing VR interventions demonstrated marked improvements across all of the assessed parameters including the primary outcome measure that were reduced from 41.55 (11.87) to 23.40 (14.17) (<i>p</i><0.001). Moreover, participants in the control group also displayed notable enhancements in select outcome measures post-intervention including the primary outcome measure that were reduced from 43.60 (12.75) to 26.10 (16.25) (<i>p</i> = 0.001). All participants in both groups maintained significant improvement in the severity of PPPD after 1 year of the. However, the study cannot determine if this change was definitely from the treatment because there was no non-treatment control group.ConclusionsThe study found that the addition of VR to a well-structured VRT did not significantly improve clinical outcomes, indicating a need for further investigation into more effective approaches to yield meaningful clinical benefits. Moreover, adding a control group with no intervention would help revealing a real effect of the intervention.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"213-224"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial magnetic stimulation use with chronic vestibular disorders: A scoping review.","authors":"Elizabeth Cornforth, Devashish Tiwari, Teresa Jacobson Kimberley","doi":"10.1177/09574271251334012","DOIUrl":"10.1177/09574271251334012","url":null,"abstract":"<p><p>BackgroundTranscranial magnetic stimulation (TMS) is extensively studied as a neuromodulation tool in neurological disorders. However, its use with the central vestibular disorders is limited.ObjectiveTo evaluate the utility of TMS as an assessment and treatment of chronic vestibular disorders and propose recommendations for future work.MethodsA comprehensive search of four electronic databases (PubMed, CINAHL, PsycINFO, and Rehabilitation and Sports Medicine Source) identified 206 records of which 16 studies were included.ResultsOne study used TMS as a neurophysiological assessment tool and 15 used repetitive TMS (rTMS) as a neuromodulatory intervention. Mal de Debarquement syndrome was the most frequently explored diagnosis. Dorsolateral prefrontal cortex and the cerebellum were the most frequent sites for rTMS application. Statistically significant improvements were noted on the Dizziness Handicap Inventory (3/7 studies) but clinically significant improvements were not observed. Postural control (7/7 studies) showed improvements along with VOR gain (1/1 studies).ConclusionsTMS shows promise as both a neurophysiological assessment tool and a neuromodulatory intervention for chronic vestibular disorders. Methodological limitations of the studies warrant caution while interpreting the results. Larger sample sizes, control groups, optimal neuroanatomical targeting, and dosing along with active rehabilitation are required to determine effectiveness in chronic vestibular disorders.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"155-171"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which factors influence the deterioration in vestibular function? A nationwide, population-based study with video-head impulse test.","authors":"Jeon Mi Lee, Sung Goo Yoo, Hyun Jin Lee","doi":"10.1177/09574271251351681","DOIUrl":"https://doi.org/10.1177/09574271251351681","url":null,"abstract":"<p><p>ObjectivesWe aimed to investigate the prevalence and age-related changes in vestibular function within the general population using survey data from the Korean National Health and Nutrition Examination Survey (KNHANES) and examine the potential factors influencing it.MethodsWe analyzed retrospective data from 1270 participants from the 2021 KNHANES who completed both the video head impulse test and audiometric evaluations. Participants with vestibulo-ocular reflex (VOR) gains <0.8 and >1.2 were excluded to minimize the impact of possible testing errors and prior impaired vestibular function. We assessed the prevalence and age-related changes in vestibular function and analyzed potential influencing factors using logistic regression analysis.ResultsThe VOR gain decreased with age; however, statistical significance was not achieved (coefficient -0.0003, <i>p</i> = 0.281). The presence of corrective saccades significantly increased with age (<i>p</i> < 0.001), with those in their 70s being 3.98 times more likely to exhibit corrective saccades than those in their 40s. The overall prevalence was 17.08%. Subjects with corrective saccades exhibit lower VOR gain than those without it (<i>p</i> < 0.001). Age, sex, hypertriglyceridemia, and hearing levels at 4000 Hz were significantly associated with the presence of corrective saccades.ConclusionVestibular function declined with age, influenced significantly by sex, hypertriglyceridemia, and hearing level at 4000 Hz. The increased prevalence of corrective saccades among older adults underscores the importance of early detection and intervention. Understanding age-related changes in vestibular function can facilitate appropriate management strategies and countermeasures at the personal and societal healthcare level.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251351681"},"PeriodicalIF":2.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive modeling of maneuver numbers in BPPV therapy using machine learning.","authors":"Mine Baydan-Aran, Kübra Binay-Bolat, Emre Söylemez, Orkun Tahir Aran","doi":"10.1177/09574271251351905","DOIUrl":"https://doi.org/10.1177/09574271251351905","url":null,"abstract":"<p><p>ObjectiveSome patients with benign paroxysmal positional vertigo (BPPV) do not improve with a single maneuver and may require multiple maneuvers. This study aims to utilize machine learning (ML) to identify parameters predisposing multiple CRMs, thus enhancing the predictability of treatment requirements in BPPV patients.Study designRetrospective study.SettingHospital.PatientsThis study included 520 participants diagnosed with BPPV between 2018 and 2023, with a mean age of 56.2 ± 14.0 years.InterventionsAge, BPPV type, comorbid diseases, gender, and number of maneuvers that the patients recovered with were determined. The target outcome-\"number of maneuvers\"-was dichotomized as either one (0) or more than one (1). The models' success was evaluated using metrics such as precision, F1-score, accuracy, balanced accuracy, recall, area under the Receiver Operating Characteristic (ROC), and area under the curve (AUC).ResultsThe applied maneuver number to treat BPPV was 188 (36%) in one maneuver and 332 (67%) in more than one maneuvers. Gradient Boosting Machine (GBM) had the best AUC in maneuver number estimation. Also, logistic regression resulted the best precision score; XGBoost showed the best F1 and recall score while support vector classifier showed the best accuracy and balanced accuracy scores.ConclusionsMachine learning models with high predictive capabilities can help identify patients likely to need multiple maneuvers, allowing for more efficient treatment planning and enhanced patient outcomes.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251351905"},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of computerized rotational impulse test (crHIT) and video head impulse test (vHIT) in all semicircular canals among normal subjects.","authors":"Erin Williams, Fumihiro Mochizuki, Alexander Kiderman, Joseph Furman, Michael Hoffer","doi":"10.1177/09574271251326054","DOIUrl":"https://doi.org/10.1177/09574271251326054","url":null,"abstract":"<p><p>BackgroundThe computerized rotational head impulse test (crHIT) employs whole-body impulsive rotations like the angular motion used in the video head impulse test (vHIT) to assess the function of all semicircular canals (SCCs).ObjectiveThis study utilized vertical crHIT and vHIT among healthy subjects to evaluate the effectiveness of these tools in assessing SCC function.MethodsThirty-five individuals with no history of vestibular disorders or traumatic brain injury were enrolled in this study. Participants underwent vHIT (ICS Impulse Otometrics) and crHIT (Neuro-Otologic Testing Center, Spryson America, Inc.).ResultsMean VOR gain was significantly higher during crHIT compared to vHIT, except for the right horizontal SCC (<i>p</i> < 0.01). Coefficient of variation (CV) for crHIT was smaller than that observed in vHIT across all 6 SCCs, with significant differences in all but the LA and RP SCCs. We also computed lower limits of normal (LLN) for each condition; up to 2.9% of crHIT values fell outside the acceptable LLN compared to up to 37% of vHIT gain values. Average reduced vestibular response (RVR) for crHIT was lower than that observed in vHIT among all semicircular canal pairs and demonstrated less variability for crHIT as compared to vHIT.ConclusionsOverall, these findings support the clinical utility of crHIT for comprehensive SCC function evaluation.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251326054"},"PeriodicalIF":2.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation, validity, and reliability study of shortened version of the Vestibular Activities and Participation Measure into Turkish.","authors":"Bilgehan Tekin Dal, Gurbet İpek Şahin Kamışlı","doi":"10.1177/09574271251347262","DOIUrl":"https://doi.org/10.1177/09574271251347262","url":null,"abstract":"<p><p>BackgroundVestibular disorders significantly impact daily activities and participation, leading to reduced quality of life. The Shortened Vestibular Activities and Participation Measure (VAP) is a 12-item tool designed to assess activity limitations and participation restrictions in individuals with vestibular disorders.ObjectiveIn this study, the Turkish Shortened VAP was translated and culturally adapted. Its validity and reliability were also assessed.MethodsA total of 123 participants with vestibular disorders were included. The translation and cultural adaptation followed standard guidelines. Structural validity was assessed through exploratory and confirmatory factor analyses, and convergent validity was evaluated using correlations with the Dizziness Handicap Inventory (DHI). Reliability was examined using internal consistency (Cronbach's alpha and McDonald's omega) and item analysis.ResultsFactor analyses confirmed the two-factor structure with good fit indices (GFI = 0.938). Significant correlations with the DHI supported convergent validity (r = 0.65). Internal consistency was strong for the total scale (Cronbach's α = 0.85; McDonald's ω = 0.91) and acceptable for subscales. All items demonstrated acceptable corrected item-total correlations.ConclusionsThe Turkish Shortened VAP is a valid and reliable tool for assessing activity limitations and participation restrictions in vestibular disorders, suitable for clinical and research use in Turkey.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251347262"},"PeriodicalIF":2.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}