Nepal Medical College Journal最新文献

{"title":"Study of Incidence, Risk Factors, and Outcome of Acute Kidney Injury in Neonatal Intensive Care Unit at Tertiary Care Center","authors":"Mandira Shrestha, Sabina Shrestha, Kailash Sah, Lopsang Lama, Poonam Bodh Tamang, Tara Devi Rijal","doi":"10.3126/nmcj.v26i2.67214","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67214","url":null,"abstract":"Acute Kidney Injury (AKI) remains a notable cause of morbidity and mortality in neonates and the costs of care for patients with AKI are also very expensive, particularly in developing countries like Nepal. The global burden of AKI is quite high specially in lo w-middle-income countries and has very limited data on the incidence of AKI worldwide and the data vary generally in different studies This is a hospital based retrospective cross-sectional study of neonates admitted at Nepal Medical College and Teaching Hospital (NMCTH) from January 2022 till January 2023. Among 318 admitted newborns, incidence of AKI was found to be 18 (5.7%) with male to female ratio of 3:1 in AKI group. The mean length of hospital stay was 13 days, which was longer in AKI group in comparison to non AKI group which was 6.3 days. The rate of neonatal AKI varied within the gestational age cohorts: lower the gestational age more chance of AKI as 28 -32 weeks (n=3/17, 17.6 %) had more incidence of AKI in compare to older gestational age as 32–36 weeks (n=3/50, 6%), and ≥37 weeks (n=12/250, 4.8 %). Meconium stained liquor and pregnancy induced hypertension were the maternal risk factors found to be associated with the development of AKI. Respiratory distress syndrome (RDS) was the commonest cause of neonatal AKI (44.40%), followed by neonatal sepsis (38.90%) and fluid overload (38.90%). In term of outcomes all the cases were discharged from non AKI group while among AKI group mortality was 4/15 (22.2%). Stage 3 AKI had poor prognosis with 100% mortality. Use of nephrotoxic drugs was the main cause of morbidity and mortality of AKI in both discharged and expired group. This showed that this vulnerable population need to be taken care early with effective management and awareness should be developed for the better understanding of the epidemiology of AKI in neonates as there is high risk of developing chronic kidney disease (CKD).","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"76 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702040","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":"Use of Video Laryngoscope during Intubation in Patients with Non Difficult Airway","authors":"S. Acharya, Anupa Khanal, R. Yadav, Sushil Baral","doi":"10.3126/nmcj.v26i2.67208","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67208","url":null,"abstract":"Endotracheal intubation using laryngoscope which is an important skill required for all anesthesiologist in day to day practice is considered as gold standard for airway management. Various methods can be used for endotracheal intubation of which direct laryngoscopy is most commonly used and video laryngoscopy is an alternative. The success rate of tracheal intubation in cases of difficult airways has increased dramatically with the use of video laryngoscopes and improvements in the degree of glottic exposure. Hence this study aims to evaluate the laryngoscopic view, ease of intubation and haemodynamic changes during intubation using video laryngoscope in patients with non difficult airway. This interventional study was conducted in fifty nine patients of ASA I or II, ≥18 yrs of age with Mallampati grade I or II, mouth opening >3 cms, thyromental distance >6.5 cms of either sex planned for elective surgery under general anesthesia. General anesthesia was induced with similar doses for all the patients and intubated using video laryngoscope. Cormack-Lehane grade, intubation time, number of attempts for intubation and haemodynamic parameters were recorded. In this study, all patients had grade I type of laryngeal view during laryngoscopy and the mean time required for intubation was 18.93±7.08 sec. Out of 59 patients, 58 (98.3%) were intubated in single attempt and there was no significant haemodynamic changes during laryngoscopy with video laryngoscope. Hence, the result of this study concluded that endotracheal intubation using video laryngoscope provides good laryngoscopic view, better intubating condition for the ease of intubation without significant haemodynamic changes, thus considering worth for intubation of non difficult airway.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"10 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705038","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":"Antibiotic Resistance Pattern of Bacteria Isolated from Clinical Specimens: A Hospital-Based Cross-sectional Study in Kathmandu, Nepal","authors":"R. P. Parajuli, Niten Bharati, Shristi Bhandari, Dharmaraj Kumar Patel, Arti Neupane, Zainuddin Ansari, Siddha Raj Ojha, Anju Karmacharya, Anisha Kc, Rachana Bhusal, Yamini Chettri, Merina Lama, Tsunami Thapa Magar, Minu Shilpakar, Sandhya Gautam, Madan Nepal, N. Yadav, Muna Bhattarai, Bimala Bhattarai, Shaniya Bhusal, Ganesh Chaudhary, Jitendra Gautam, S. P. Dumre","doi":"10.3126/nmcj.v26i2.67202","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67202","url":null,"abstract":"Antibiotics are vital in combating infectious diseases, yet their increasing use fosters resistance. Antimicrobial resistance (AMR) is rising in Nepal due to factors such as indiscriminate, inappropriate, and inadequate antibiotic usage. This study aims to explore the association between demographic factors and the prevalence of specific bacterial strains within the surveyed population. Additionally, it seeks to determine the antibiotic resistance patterns of these bacteria. Antibiotic susceptibility or resistance data were retrieved from the Medical Records Department (MRD) of the Manmohan Memorial Medical College and Teaching Hospital (MMMCTH) in Kathmandu. Samples from patients with certain types of bacterial infections were included, with 56 from sputum reports, 46 from urine, and 8 from blood samples out of 110 retrieved. Analysis revealed that sputum samples were mostly from older males, while urine samples were mostly from females. Yet, gender did not significantly influence bacterial presence across sample types. Overall, Escherichia coli was the most prevalent bacterium (74%), followed by Salmonella typhi (25%), Staphylococcus aureus (25%), and Klebsiella pneumoniae (23%) isolated from different type of clinical samples. Altogether, 6-15 antibiotics were assessed for sensitivity, with 2–6 antibiotics showing sensitivity to blood bacteria, 1-6 antibiotics demonstrating sensitivity to sputum bacteria, and 3–8 antibiotics exhibiting sensitivity to urine bacteria. Many investigated antibiotics were resistant, only gentamicin exhibited sensitivity for all types of bacteria found in blood, sputum and urine. These findings underscore the importance of discerning bacterial resistance patterns for effective antimicrobial treatment selection.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141717073","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":"Prevalence of Thyroid Disorders among Pregnant and Non-Pregnant Women Attending a Tertiary Care Center in Kathmandu","authors":"A. Pokhrel, B. R. Pokhrel, Richa Bhattarai, M. Khanal, Nayan Neupane, Anu Thakali, Astha Shrestha","doi":"10.3126/nmcj.v26i1.63892","DOIUrl":"https://doi.org/10.3126/nmcj.v26i1.63892","url":null,"abstract":"Thyroid hormones are crucial for the overall development of the fetus, and their impact on the pregnancy outcomes needs to be considered seriously. Hence, universal screening for thyroid disorders is recommended in the first trimester of pregnancy. One hundred pregnant women in their first trimester and 100 non-pregnant women of the reproductive age group were screened for thyroid function test. The prevalence of thyroid disorders among the total participants was 32.0% of which 23.5% were hypothyroid and 8.5% were hyperthyroid. Pregnant females had a significantly higher prevalence of thyroid disorders (46.0%) than non-pregnant counterparts (18.0%; P <0.001). Pregnant females had significantly higher odds of hypothyroid disorders than non-pregnant females (OR 3.95; P <0.001). The prevalence of subclinical hypothyroidism among pregnant and non-pregnant was 34.0% and 12.0% respectively which makes it the most common thyroid disorder in both study groups. The median values of FT3, FT4, and TSH levels were, however, not significantly different between the study groups. After adjusting for the confounding effect of age, the odds of thyroid disorders were still significantly higher in pregnant women than in non-pregnant (p =0.001). The prevalence of thyroid disorders, specifically hypothyroidism, is higher in pregnant women compared to non-pregnant counterparts. And this emphasizes on the need of antenatal thyroid screening to be made mandatory in the health policy.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"30 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140752689","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":"Pattern of ABO and Rh Blood Groups among Voluntary Blood Donors at Nepal Red Cross Society Central Blood Transfusion Service Centre, Kalimati, Kathmandu","authors":"Smriti Singh, Barsika Katwal, Tara Devi Rijal","doi":"10.3126/nmcj.v26i1.63884","DOIUrl":"https://doi.org/10.3126/nmcj.v26i1.63884","url":null,"abstract":"Blood is a circulatory fluid, responsible for the transport of hormones, nutrients, and enzymes all over the body. It consists of a protein-rich fluid known as plasma, in which are suspended cellular elements: white blood cells (WBC), red blood cells (RBC), and platelets. ABO blood grouping and cross-matching are commonly tested for transfusion of blood and its components, organ transplantation, genetic studies, forensic determinations, as well as for medico-legal issues such as paternity disputes. A descriptive cross-sectional study was conducted in Nepal Red Cross Society Central Blood Transfusion Service Centre, Kalimati, Kathmandu from January 1st 2023 to June 2023 done in 187 donors. Among 187 donors, the age of the donors ranged from 18 years to 55 years, with an average age of 35±0.58 years. The above figure showed that the majority (65.0%) fell into the age group of 26-40 years, followed by those aged 41-55 years, and finally, those aged 18-25 years, respectively. Among all voluntary donors, the majority (71.0%) were male, while 29% were female donors. Data analysis was done by using SPSS and MS-Excel. The result showed maximum number of voluntary donors to be of blood group O, followed by B, A and AB.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"295 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754203","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":"Clinicopathological Study of Helicobactor Pylori Infection and Gastric Carcinoma at a Tertiary Care Hospital in Kathmandu","authors":"Rakesh Pathak, Sujata Pudasaini, Manjila Basnet","doi":"10.3126/nmcj.v26i1.63890","DOIUrl":"https://doi.org/10.3126/nmcj.v26i1.63890","url":null,"abstract":"Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size <10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size < and ≥ 10 mm, stone density < and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"15 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753863","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":"Evaluation of Effectiveness of Sinus Surgery in Chronic Rhinosinusitis Patients using Sinonasal Outcome Index-22, modified Lund Mackay Score and Rhinosinusitis Disability Index","authors":"A. Pokharel, J. Mayya, C. Bhandari, Bibek Sharma","doi":"10.3126/nmcj.v26i1.63882","DOIUrl":"https://doi.org/10.3126/nmcj.v26i1.63882","url":null,"abstract":"Functional endoscopic sinus surgery (FESS) is done in patients with chronic rhinosinusitis (CRS) not responding to medical therapy. This study aims to evaluate the subjective, objective and overall quality of life improvement in CRS patients following FESS surgery. Sinonasal outcome index-22, modified Lund-Mackay score and Rhinosinusitis Disability Index were used to evaluate subjective, objective and overall quality of life in patients with CRS. The questionnaires were asked before the surgery and three months after surgery. A total of 110 patients were enrolled in the study. All three types of evaluation showed improvement following FESS surgery. FESS in CRS patients refractory to medical management caused significant improvement in symptom intensity, endoscopic score and overall quality of life.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"214 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754716","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":"Comparison of Efficacy and Safety of Intrauterine Balloon Tamponade Versus Uterovaginal Packing in Females Presenting with Postpartum Hemorrhage after Normal Vaginal Delivery","authors":"Subhadra Agrawal, Shamila Ijaj Munir","doi":"10.3126/nmcj.v26i1.63879","DOIUrl":"https://doi.org/10.3126/nmcj.v26i1.63879","url":null,"abstract":"To compare the efficacy and safety of intrauterine balloon tamponade with uterovaginal roll gauze packing in patients presenting with primary postpartum hemorrhage after normal vaginal delivery. This randomized controlled trial, conducted at Department of Obstetrics and Gynecology, Lady Willingdon Hospital, Lahore, from December 2015 to November 2016. Two hundred and twelve patients presenting with primary postpartum hemorrhage who did not respond to medical treatment following normal vaginal delivery were included. They were randomly divided in two groups. The first group underwent balloon tamponade using condom and second group underwent intrauterine packing using roll gauze. Both interventions were removed after 24 hours. All females were kept under observation with antibiotic coverage in ward to prevent infection. If bleeding was stopped within 15 minutes and the patient remained hemodynamically stable, then efficacy was labeled and if no complications occur while applying or removing, safety was labeled. Mean age group of women using balloon tamponade and intrauterine packing was used was 28.25±4.672 and 28.30±4.613 years. The mean gestational age of patients using balloon tamponade and intrauterine packing was 38.57±1.36 and 38.63±0.62 years. Mean blood loss in patients using balloon tamponade and intrauterine packing was 600.28±25.338 and 699.21±70.176 ml. Efficacy of intrauterine packing was 94 (88.7%) and balloon tamponade was 104 (98.1%). Safety of intrauterine packing was 83 (78.3%) and that of balloon tamponade was 97 (91.5%). Thus, treatment of balloon tamponade was more effective and safer than intrauterine packing in female presenting with postpartum hemorrhage after normal vaginal delivery.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"11 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754029","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":"Post COVID-19 Infection in Subclinical Hyperthyroidism among Patients Attending a Tertiary Hospital in Kathmandu","authors":"Prabin Adhikari, Rasu Singh","doi":"10.3126/nmcj.v26i1.63871","DOIUrl":"https://doi.org/10.3126/nmcj.v26i1.63871","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) infection may induce thyroid dysfunction as Coronavirus 2 (SARS-CoV-2) can invade the human tissue cells through the cell receptor of angiotensin-converting enzyme 2 (ACE2), expression of which is high in thyroid tissue. The aim of the present study was to assess the subclinical hyperthyroidism post-COVID-19 effects on thyroid function in patients without history of thyroid disease after complete recovery from mild-to-severe COVID19 and find the prevalence of subclinical hyperthyroidism. A descriptive cross-sectional study was conducted in the Department of Internal Medicine, of tertiary care center from September 2022 to February 2023 after obtaining ethical approval from the Institutional Review Committee of Nepal Medical College (Ref. No.: 15-079/080). Convenience sampling method was used among patients who met the eligibility criteria. Point estimate at 95.0% confidence interval were calculated along with frequency and proportion for binary data. Out of 38 patients, 34 (89.5%) had thyroid dysfunction. Among them, 7 (20.6%) had subclinical hyperthyroidism, 2 (5.9%) had thyroiditis and 1 (2.9%) had Graves’ disease. Those who had thyroid dysfunction, 10 (29.4%) people were diagnosed with hyperthyroidism. The hyperthyroidism among COVID-19 patients is a common finding and subclinical hyperthyroidism was seen in 20.6% of patients post COVID-19. Therefore, while managing COVID-19, patients’ thyroid profile should be considered.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"28 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753566","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":"Influence of Fixed Orthodontic Treatment Duration on the Prevalence and Severity of Gingival Enlargement","authors":"Junima Rajkanikar, Samriddhi Vaidya, Anshu Piya","doi":"10.3126/nmcj.v26i1.63872","DOIUrl":"https://doi.org/10.3126/nmcj.v26i1.63872","url":null,"abstract":"In patients undergoing fixed orthodontic therapy, favorable conditions for plaque stagnation as well as difficulty in performing usual oral hygiene measures have been associated with poorer periodontal health among orthodontic patients. So this study aims to assess the effect of the duration of fixed orthodontic treatment on presence of gingival enlargement in adolescents and young adults. This cross sectional descriptive study was conducted in the dental hospital of Nepal Medical College Teaching Hospital. Patients under fixed orthodontic therapy for at least 3 months were examined for the presence of gingival enlargement (GE). Demographic variables and the details of duration of the fixed orthodontic therapy was recorded along with presence of gingival enlargement and its grading. The oral hygiene habits like frequency of brushing, use of interdental cleaning aids were recorded along with plaque index. Gingival enlargement was present in 204 (63.7%) out of total 320 patients taken, among which 124 patients (38.8%) had gingival enlargement of score 1 and 80 (25.0%) patients had gingival enlargement of score 2. Gingival enlargement was observed in 101 (73.2%) in 20-30 years old patients which was more prevalent in this age group. Oral hygiene habits like frequency of brushing and use of interdental aids also seem to affect the occurrence of gingival enlargement in patients. Among those who were undergoing orthodontic therapy for more than 2 years, 48 (82.8%) had presence of gingival enlargement. Mean of plaque index was seen to be statistically associated with presence of gingival enlargement. Thus, this study showed that the duration of orthodontic treatment duration significantly influenced the occurrence of GE. Therefore, oral hygiene instructions and motivations should be reinforced for patients undergoing orthodontic treatment.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"31 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753083","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}