Clinica Terapeutica最新文献

{"title":"Loss of chance in medical professional liability: the measure of our ignorance.","authors":"M Pallocci, P Passalacqua, G M Coppola, M Treglia, L T Marsella","doi":"10.7417/CT.2025.5187","DOIUrl":"https://doi.org/10.7417/CT.2025.5187","url":null,"abstract":"<p><strong>Abstract: </strong>In 1921, philosopher and economist J.M. Keynes, in his \"A Treatise on Probability\", described chance as a \"measure of our ignorance.\" The Italian Supreme Court also took up this fascinating definition in ruling No. 28993, 11.11.2019, to underline its intrinsically uncertain, sometimes subjective, however elusive, nature. The Supreme Court, with this judgment, set a point: to be compensable, the chance must be palpable, severe and consistent. Despite the various jurisprudential interventions that have attempted to give form and substance to the loss of chance damage, several questions still remain open, such as the actual estimation of the chance, based on reliable scientific criteria and its economic adaptation. These considerations are the starting point for our research. The analysis included all judgments issued by the Judges of the 13th Section of the Civil Court of Rome and published between January 2016 and December 2020. At the end of the collection, selection and anonymisation phase, 1117 documents were submitted for analysis. Loss of chance damages were claimed in only 51 cases (4.56 % of the total number of judgments), with recognition of this type of damage in only 13 out of 51 decisions (25.5 %). The amount paid was €2,265,682.06, representing approximately 1.7 % of the total compensation paid for all medical malpractice cases during the period under analysis. The average compensation was € 174,283.235. In most cases, there was misdiagnosis or delayed diagnosis or management of oncological diseases, conditions with reduced life expectancy in which medical intervention aims to increase the chances of survival or recovery.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"48-52"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological Insights into Pulmonary Hemorrhages: Enhancing Forensic Diagnoses.","authors":"F Orsini, S De Simone, A Cioffi, M Treglia, G Volonnino, A Ghamlouch, M Ottaviani, M Arcangeli","doi":"10.7417/CT.2025.5188","DOIUrl":"https://doi.org/10.7417/CT.2025.5188","url":null,"abstract":"<p><strong>Abstract: </strong>Pulmonary hemorrhage is a pathological condition characterized by bleeding within the lung parenchyma, ranging from localized microbleeds to extensive hemorrhagic events that significantly compromise respiratory function. The etiology of pulmonary hemorrhage encompasses multiple clinical and forensic contexts. For forensic pathologists, the most significant pulmonary hemorrhages occur in cases involving traumatic incidents, asphyxiation, narcotic substance use and resuscitation procedures. This study aims to analyze the histopathological features of pulmonary hemorrhages in a forensic context, highlighting the specific histopathological characteristics. The authors analyzed cases of pulmonary hemorrhages taken from sectoral case studies from the Forensic Department of Legal Medicine at the University of Foggia, spanning from 2019 to 2024. In all these cases the histological investigation was important for identifying the cause of death and for characterizing the lung damage, even in the absence of macroscopic contusions. In cases of asphyxia, ingestion of narcotic substances, and post-resuscitation, the edematous component prevails over the hemorrhagic component. The hemorrhagic component is evident in cases of trauma to the lung and airways, such as in chest compression or lung injury. These histopathological distinctions are pivotal for forensic pathologists as they provide concrete evidence that supports differential diagnoses, helping to clarify the cause of death in complex cases where circumstantial and autopsy data alone may not be conclusive.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"53-58"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring The Role of Serum Netrin 1 Levels in Diabetic Foot Syndrome And Uncomplicated Type 2 Diabetes Mellitus: A Comparative Analysis.","authors":"D Chaitra, N Pai Divya, H Raghavendra, D Kamath","doi":"10.7417/CT.2025.5206","DOIUrl":"10.7417/CT.2025.5206","url":null,"abstract":"<p><strong>Purpose: </strong>Serum netrin levels have been implicated in diabetes and its complications, including diabetic foot syndrome. Netrin 1, a protein encoded by the Netrin gene, has been recognized for its role in various physiological processes ranging from nervous system development to angiogenesis, inflammation, and wound healing. In the context of diabetes, there is growing interest in understanding the relationship between serum netrin levels and the disease. Studies have suggested that netrin-1 may have a role in angiogenesis and inflammatory responses, both of which are relevant to diabetes and its complications. Research has indicated that may be involved in the pathophysiology of diabetic foot syndrome, a serious complication of diabetes characterized by issues such as foot ulcers and impaired wound healing. Therefore, comparing serum netrin levels in individuals with diabetes, especially those with complications like diabetic foot syndrome, to those with uncomplicated diabetes, may provide insights into the potential association between netrin and the disease.</p><p><strong>Methodology: </strong>Eligible patients were recruited, and two ml of venous blood samples were collected from each patient Netrin-1 levels were estimated using an ELISA method from the blood sample collected in a plain vial.</p><p><strong>Objective: </strong>To assess and compare the levels of serum netrin in individuals diagnosed with diabetic foot syndrome and those with uncomplicated Type 2 diabetes mellitus.</p><p><strong>Results: </strong>Logistic regression identified gender, BMI, smoking, LDL, and Netrin 1 (NTN1) levels as predictors of diabetic foot, with males and smokers at higher risk, BMI showing a protective effect, and NTN1 indicating a potential protective role. Clinical presentations included cellulitis, ulcers, and gangrene. A weak positive correlation was observed between fasting blood sugar (FBS) and NTN1 levels (r = 0.1106), with no significant differences in NTN1 across diabetic foot grades (p = 0.435). ROC analysis of NTN1 levels (cutoff 140.0 pg/ml) showed moderate diagnostic utility (65.4% sensitivity, 60% specificity, AUC 0.577), suggesting its potential as a biomarker.</p><p><strong>Conclusion: </strong>The study findings unveiled that individual with diabetic foot syndrome (DFS) exhibited elevated serum Netrin-1 levels when compared to those with uncomplicated Type 2 diabetes (T2DM). These results emphasized the significance of Netrin-1 within the diabetic foot syndrome context and offered valuable guidance for forthcoming investigations into its role in angiogenesis, inflammation, and wound healing processes.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"201-206"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legal and Forensic Implications in Robotic Surgery.","authors":"L De Paola, M Treglia, G Napoletano, B Treves, A Ghamlouch, R Rinaldi","doi":"10.7417/CT.2025.5211","DOIUrl":"10.7417/CT.2025.5211","url":null,"abstract":"<p><strong>Abstract: </strong>The article examines the applications of robotic surgery, and the legal, ethical, and financial challenges associated with its use, with a particular focus on advanced systems like Da Vinci and Watson. While these technologies have revolutionized the medical field by enhancing surgical precision and diagnostic efficiency, their use raises critical issues regarding safety, liability, and sustainability. The Da Vinci system, primarily utilized for complex uro-oncological and gynecological procedures, enables surgeons to operate with unprecedented accuracy. However, high costs and the complexity of training limit the widespread adoption of such technologies. The Watson system, based on artificial intelligence, supports physicians in diagnosis and treatment planning, reducing the time required to integrate new scientific evidence but posing challenges in decision-making transparency. A key aspect of the discussion is medical liability in cases of patient harm during robot-assisted procedures. Complications may arise from human error, technical malfunctions, or software defects. Currently, the attribution of liability involves multiple stakeholders: surgeons, robot manufacturers, maintenance technicians, and healthcare institutions. Existing regulatory frameworks, such as the European Directive on defective products, are inadequate to address the specific challenges posed by advanced robotic systems, particularly regarding the collec-tion of evidence in litigation cases. The \"opacity\" of decision-making based on artificial intelligence and the lack of transparency in robot-generated data further complicates the legal process. In conclusion, while robotic surgery represents a promising frontier, more specific regulations are needed to balance innovation with patient protection. This includes policies for mandatory insurance, increased operational transparency, and strengthening informed consent as a cornerstone for safeguarding patients' rights. The aim of the research is to examine the current applications of robotic surgery and analyze the legal, and ethical challenges associated with their use. The research intends to explore the benefits of these systems in surgery, but also the issues related to safety, legal liability, and sustainability, with the goal of identifying the need for more specific regulations to balance innovation with patient protection.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"233-240"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Languages of Medicalisation.","authors":"M Massaro, K Karaboue","doi":"10.7417/CT.2025.5214","DOIUrl":"10.7417/CT.2025.5214","url":null,"abstract":"<p><strong>Abstract: </strong>The complexity of the scenarios that mark our modern world's variegated articulation and structure of individual identity, traversed by multiple tensions and characterised by a form of plasticity, express in a paradigmatic manner a dialectical intersection between dimensions of humanity which are embodied in an existential praxis: the interaction between the technical dimension in all its meanings and the social level generates a uniquely existential viewpoint with an intimate processuality. In the perspective of a social dialectic of technical facts, what proves to be essential in the immediate term is a consideration of the impact on our everyday life: individual existence and its socially structured form acquire and metabolise technical facts in a complex manner, rewriting and reinterpreting their points of meaning and the dynamics of everyday life, based on the capacity that technology itself has to re-shape the reality, potential and prospects of individual lives. At the centre of these evaluations remains the person in his or her capacity as an inhabitant of the social universe and a constructor and user of technology. A consideration of the impact on different planes of existence is a question that concerns people firstly from a generalised perspective relating to the interpretation of existence as a whole and secondly from a local perspective that concerns situational perception and therefore an individual encounter with a technical fact and the specific impact it can have on a person. The potential impacts and substantial weight of medicalisation as a reconfiguration of the social universe are constructed within these spaces. The relocation of the functional spheres of the healthcare profession in people's social lives identifies an essential task for each practitioner: transferring the evaluative, descriptive and explanatory languages of medicalisation to a concrete level of individual existence in its social dimension implies reshaping that dimension by giving it new and complex meanings. It also means interpreting medicalisation's interests as forms of social existence.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"249-252"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of serum vitamin E levels with oxidative stress in a pediatric intensive care unit in coastal South India: A cross sectional study.","authors":"O A Mushtaq, S S Rao, P Mithra, P Manjrekar, N Kamath","doi":"10.7417/CT.2025.5202","DOIUrl":"10.7417/CT.2025.5202","url":null,"abstract":"<p><strong>Background: </strong>Increased oxidative stress leads to organ dysfunction in critically ill children. Vitamin E is a lipid-soluble vitamin that is protective against oxidative injury. We aimed to study the status of vitamin E and its association with malondialdehyde (MDA), an oxidative stress biomarker in the pediatric intensive care unit (PICU).</p><p><strong>Methods: </strong>This hospital-based cross-sectional study enrolled 60 children admitted to the PICU. Serum levels of vitamin E and MDA were determined at 24 ± 1 hour after admission. Patient details were obtained from medical records. Patients were divided into vitamin E deficiency group and normal vitamin E level group for analysis .The chi-square test, Mann‒Whitney U test, and Spearman correlation test were applied.</p><p><strong>Results: </strong>Vitamin E deficiency was detected in 46 (76.7%) children. The median value of vitamin E was 2.3 mg/L (interquartile range (IQR) 2.1-2.9). The median value of MDA was 4.5 nmol/ml (IQR 2.95-7.1). Decreased hemoglobin and increased C-reactive protein were noticed in the vitamin E-deficient group in comparison to normal vitamin E level group. There was a significant difference in the need for respiratory support (p=0.004) and any degree of organ dysfunction (p=0.01) between the two groups. There was no difference in mortality among the groups. Vitamin E levels were negatively correlated with MDA levels (rho= -0.270, p=0.037).</p><p><strong>Conclusion: </strong>Our study showed association of Vitamin E deficiency with lower hemoglobin, increased CRP and heightened disease severity as evidenced by need of respiratory support and organ dysfunction. Vitamin E levels showed an inverse correlation with MDA.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"174-179"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI metastatic lymph nodes detection in rectal cancer staging: retrospective analysis of intra- and inter-observer variability in an academic health centre.","authors":"R Vinci, L P Stoppino, S Piscone, S Saccone, G Schiraldi, P Milillo, L Macarini","doi":"10.7417/CT.2025.5209","DOIUrl":"10.7417/CT.2025.5209","url":null,"abstract":"<p><strong>Abstract: </strong>This study aimed to evaluate the agreement among observers with different abdominal MRI expertise and intra-observer reliability in metastatic lymph nodes detection and features definition. In this retrospective study, MRI examinations were performed in 88 patients with rectal adenocarcinoma treated with primary surgery. Four obser-vers, two senior and two junior physicians, analyzed MRI scans in two sessions 30 days apart and determined size and morphological pattern of regional lymph nodes. Statistical analysis included the determination of the Fleiss kappa (k) coefficient, Cohen's Kappa coefficient, and confidence intervals (CI). The inter-observer reproducibility for MRI N-staging was good among the four physicians (kappa = 0.65; CI 0.45-0.77). Reproducibility between the two senior physicians had a kappa of 0.68 (CI 0.62-1.00), while between the two junior physicians had a kappa of 0.61 (CI 0.33-0.89). The intra-observer reproducibility progressively decreased between observers with different experience. There was a significant difference in lymph nodes measurements between the first and second sessions in observer A (p ≥ 0.05). Excellent intraobserver reproducibility was found for mesorectal lymph nodes while the lowest ones were found for presacral and lateral sacral lymph nodes. This study demonstrates good interobserver reliability among physicians with different abdominal MRI experiences.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"219-224"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INFORMED CONSENT Beyond The Person and The Body.","authors":"G V Lacasella, K Karaboue","doi":"10.7417/CT.2025.5213","DOIUrl":"10.7417/CT.2025.5213","url":null,"abstract":"<p><strong>Abstract: </strong>Individual power of choice has overcome the old boundaries which governed only a patient's existence or body and now takes into account surrogate consent, i.e. that expressed by a third party, as well as the management of cells, tissues and organs that are no longer part of the person, parts that were previously considered surgical waste and that today have become priceless objects of research. Just over a decade ago doctors made the decisions and patients did what they were told. Doctors were not used to asking patients what their wishes and priorities were; they often withheld vital information from them and patients were treated like children: \"too fragile and clueless to face the truth, let alone make decisions.\" Patients were sometimes attached to machines, forced to take drugs, and subjected to operations without their opinion being sought. The principle of consent constitutes a natural corollary of the broader principle of personal freedom and is substantiated by the exclusivity of one's body and mind in that the person cannot be subjected to coercion or violation of his or her bodily sphere nor moral freedom; any power or duty of the doctor over the patient finds its sole and exclusive source in the consent of the patient themselves, representing the focal point of all legal authorisation of medical activity.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"246-248"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting venous drainage of dorsum of foot for anatomical rationale behind venous ulcers, a cadaveric study.","authors":"M P Shenoy, R Vadgaonkar, B V Murlimanju, M M Pai, S Sabapathi, A Dixit","doi":"10.7417/CT.2025.5201","DOIUrl":"10.7417/CT.2025.5201","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to study the venous drainage pattern of dorsum of foot and its anatomical variations with reference to the venous ulcer of foot. The objectives were to study its connection with the deeper structures and extensor retinaculum and to study the variations of its continuity with great saphenous vein (GSV) and short saphenous vein (SSV) at medial and lateral malleolus respectively.</p><p><strong>Methods: </strong>The present study included 50 dorsum of feet specimens from embalmed adult cadavers. The skin thickness viz dermis and epidermis were measured using the digital Vernier callipers at three places, over the medial malleolus, lateral malleolus and over the dorsum mid foot.</p><p><strong>Results: </strong>The midtarsal retinaculum is found in 4 specimens (8%) and one of the tributaries of DVA is found embedded in it. The sural and saphenous nerves were giving more than three (>3) cutaneous branches each at the lateral and medial malleoli in only 5 specimens (10%). The cutaneous branches from the deep peroneal nerve were observed and piercing the extensor retinaculum in only 2 specimens (4%). The double great and short saphenous veins were observed in 2 specimens each (4%), with a variable course of termination. The absence of great and short saphenous veins was observed in one specimen each (2%). The tributaries of GSV, SSV and DVA were piercing the extensor retinaculum in 5 specimens each (10%). The GSV and DVA were communication with the anterior tibial vein in only 5 specimens (10%).</p><p><strong>Conclusions: </strong>Since venous drainage is least studied area, our study will bring the anatomical aspects to be studied to understand the probable aetiology and this will give way for future studies. The findings of this study may help in understanding the rationale behind the ulcer formation and its effective treatment.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"167-173"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Associated infections: European comparative analysis and forensic expertise in compensation systems.","authors":"L De Paola, G Napoletano, N Di Fazio, S Marinelli, R Rinaldi","doi":"10.7417/CT.2025.5189","DOIUrl":"https://doi.org/10.7417/CT.2025.5189","url":null,"abstract":"<p><strong>Background/objectives: </strong>Healthcare-associated infections (HAIs) represent one of the most common and serious complications of healthcare, significantly impacting both clinical outcomes and medicolegal processes. The rising incidence of HAIs has led to increased attention toward compensation mechanisms. In Europe, there are various compensation systems for personal injury, and HAIs can also be considered in the calculation of redressable biological damage.</p><p><strong>Methods: </strong>This study provides a comparative analysis of compensation systems in selected European countries, focusing specifically on the treatment of HAIs. All studies published between 2013 and 2023 on HAIs and compensation systems have been accounted for, yielding 296 relevant articles, of which 21 met the inclusion criteria. Further literature, data, and additional records were identified through hand searching.</p><p><strong>Results: </strong>The aim of this review is to explore the most effective compensation systems for HAIs and to emphasize the critical role of forensic expertise in these processes. Notably, no-fault compensation systems emerged as more efficient and cost-effective, offering faster resolution times compared to fault-based models.</p><p><strong>Conclusions: </strong>In all systems, forensic medical experts play an essential role in assessing cases and determining appropriate compensation.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"59-65"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}